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Hudson Day

Prof. Dunham

English 1101.509

24 April 2020

Corneal Refractive Therapy is Worth the Risks

It is 90 degrees and humid. The goalkeeper’s glasses are steamed up and almost

impossible to see through. The ball flies at his face. Looking through the fog, he just barely sees

it in time to make the save. He wishes that he had good eyesight and could see without glasses,

but he’s legally blind without them. He knows that contacts are an option, but when dust is

flying, and his body is slammed to the ground many times during a game, they could be an even

bigger problem. He is not a candidate for corrective Lasik until his eyes stop growing at about

age 20. If only he could see without wearing glasses or contacts…The good news is that there is

a way – corneal refractive therapy (CRT), sometimes termed orthokeratology. CRT is

wonderfully convenient, cost-effective, and beneficial for the long-term eyesight of children.

Despite some concerns, CRT is the best choice for kids with rapidly progressing myopia (near-

sightedness), especially if they play sports.

CRT is the process of using specially-designed rigid gas permeable (RGP) contact lenses

to reshape your cornea. The process can be used to treat and slow the progression of myopia,

astigmatism, and hyperopia (Heiting). The difference between CRT and regular contacts is that

CRT lenses are worn during sleeping hours and they require very precise fitting to achieve 20/20

vision for the entire day after their removal. “In the FDA clinical study for approval of Paragon

CRT lenses, 93 percent of patients achieved 20/32 vision or better, and 67 percent achieved

20/20 or better” (Heiting 4). The United States Food and Drug Administration first approved the
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use of these lenses back in 2002 (Ostrov). CRT has been used longer and is a much more popular

treatment in East Asian countries where the incidence of myopia in children is much higher.

According to a 2016 study, rates of myopia in children have doubled in the last ten years with

90% of university students in China now suffering from myopia (Liu and Xie). The great

increase in myopia around the world has been attributed to “the overburden of studies” at a

young age and “the frequent use of tablet computers, smartphones and other electronic products”

(Li et al. 35). High myopia increases the risks of “vision-threatening eye abnormalities, such as

glaucoma, macular degeneration, retinal detachment, and chorioretinal degeneration” and “are

more likely to develop severe visual impairment and blindness later in life” (Hiraoka et al. 281).

The use of CRT to control myopia progression can aid the well-being of children, ease the socio-

economic burden, and increase the long-term health of early-onset myopic individuals.

Convenience is the biggest reason children like CRT. For children who have struggled

with wearing glasses while playing contact sports or being almost completely blind without

them, the convenience of being glasses and contact-free while still being able to see seems

almost too good to be true. Children using CRT can go to the pool and see everything clearly

without worrying about losing their contacts or dealing with glasses. There are no more instances

of taking off their glasses and breaking them accidentally, dealing with dirt under their contacts,

or losing them while away from home. CRT is an amazing option for “children and young adults

who want to be glasses-free but are too young for LASIK or are not good candidates for

refractive surgery for other reasons (dry eyes, for example)” (Heiting 2-3).

Cost-effectiveness is a huge bonus for parents and society when choosing CRT as a

treatment for children with rapidly progressing myopia. The cost of the lenses and all the

necessary fitting sessions (you most likely will need multiple pairs of lenses during the fitting
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process) in the United States runs “between $800 and $2,000, which is much less than laser

surgery” (Radcliffe 3). From personal experience, the cost in the Dayton, Ohio area at Nova

Vision Care is just under $1,500 (not sponsored by the way). This one-time cost is very

reasonable, especially considering how many pairs of glasses most active sports players go

through over the years. If the child takes good care of the lenses, they may last for the duration of

their treatment. If the lenses were lost or needed to be replaced, they cost approximately $300 for

a new set. There is an ongoing cost of cleaning and rewetting solutions, but that is minimal.

Since the lenses stop the progression of myopia, the prescription should not need to be changed.

Once a child reaches maturity and their eyes stabilize around the age of 20, they may opt to

return to glasses, contacts, or the more permanent LASIK solutions. The cost-benefit to society

for children undergoing CRT “could have important implications in terms of reducing ocular-

related morbidity and substantial health-care costs” (Hiraoka et al. 281). The economic burden of

dealing with myopia is huge with “expenditures on myopia-related optical correction estimated

more than $2 billion annually in the United States alone” (Liu and Xie 35).

Safety concerns about CRT must be considered when deciding to try CRT. One case that

has been highly publicized is of a nine-year-old boy named Logan Levenson who got a fungal

infection while wearing Ortho-K brand lenses that led to a corneal transplant (Ostrov). Logan

“will need to use eye drops daily to avoid rejection of the new cornea. And because the cornea is

not completely attached, he will no longer be able to play team sports” (Radcliffe 3). The doctor

that performed Logan’s cornea transplant, Dr. Chris Rapuano, chief of the Wills Eye Hospital

Cornea Service, has some reservations about the safety of wearing the Ortho-K lenses after

seeing two other patients with similar issues. Ostrov quotes Dr. Rapuano as saying “I’m not

saying these lenses are evil, that no one should use them, but they do have risks, and each of
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these patients was not told of the risks” (3). Some of the biggest safety issues identified are poor

cleaning practices and the lack of parent involvement to ensure a child does not become

complacent in the cleaning routine (Cho and Boost). When considering if a child is a good

candidate for CRT, the practitioner must look at the “commitment and ability of the parents to

fulfill their role in aiding their child to correctly wear and, importantly, to reduce the risk of

possible serious infection, clean and disinfect the lenses and accessories” (Cho and Boost 83). In

a study conducted by The Ohio State University at the request of the FDA to “address concerns

about the safety of overnight wearing of corneal reshaping lenses in children,” a sample of 1,317

over two years resulted in an estimated incidence of only “7.7 events per 10,000 years of wear”

(Herzberg and Legerton 23). The wearing of CRT lenses overnight is only a slightly higher risk

than daily disposable soft lenses that do not require the cleaning regimen (Cho and Boost).

Paragon Vision Sciences (the maker of the CRT lenses prescribed locally at Nova Vision Care)

has had “only nine FDA medical device reports of problems with the lenses since 2002, and none

caused vision loss” out of an “estimated half-million of its Paragon CRT lenses prescribed to

children worldwide” (Ostrov 3). With proper cleaning routines, users of CRT lenses have an

incredible safety record.

The most important reason for choosing CRT is to slow the progression of near-

sightedness and prevent future blindness. “Myopia causes vision loss and related complications,

which seriously affect the physical and mental health of teenagers” (Li et al. 35). Myopia is one

of the leading causes of vision loss and its complications occur much earlier than other causes of

blindness, leading to a greater and earlier impact on the quality of life than other visual

complications (Liu and Xie). Studies show that age is the most crucial factor in preventing

myopia progression and that for best results therapy should be started early and continued “until
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late in the second decade of life, when eye growth and myopia progression becomes stable”

(Hiraoka et al. 286).

With all the evidence showing the benefits of CRT in slowing the progression of myopia

in children, “failure to provide or at least recommend Ortho-K could even be considered to be

professionally unethical” (Cho and Boost 84). The convenience, cost-effectiveness, and benefits

of CRT make it the best choice for kids with myopia, as long as they are at a level of maturity to

stick to the cleaning routine. In case you have not guessed, I am the goalkeeper in the

introduction and after over a year of using CRT lenses, I can attest to how they have changed my

life. If you know someone who has myopia especially if it is progressing rapidly, please do the

right thing and suggest that they talk to their optometrist about CRT.
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Works Cited

Cho, Pauline, and Maureen Boost. “Orthokeratology - Back to the Future.” Optometry Today,

vol. 56, no. 5, May 2016, pp. 80–84. Academic Search Complete,

doi:10.4324/9781315610719. Accessed 18 Mar. 2020.

Heiting, Gary. “Ortho-K And Corneal Refractive Therapy: Overnight Contacts to Correct

Myopia.” All About Vision, 2020, pp. 1–6,

https://www.allaboutvision.com/contacts/orthok.htm. Accessed 18 Mar. 2020.

Herzberg, Cary, and Jerome A. Legerton. “The Advancing Specialty of CRT.” Review of

Optometry, 17 Apr. 2011, pp. 20–24. Academic Search Complete, Accessed 18 Mar.

2020.

Hiraoka, Takahiro, et al. “Safety and Efficacy Following 10-Years of Overnight Orthokeratology

for Myopia Control.” Ophthalmic and Physiological Optics, vol. 38, no. 3, 2018, pp.

281–89. MEDLINE, doi:10.1111/opo.12460. Accessed 18 Mar. 2020.

Li, B., et al. “Fourier Analysis and Research on the Influence on Juvenile Myopia and Corneal

Surface Morphology with Orthokeratology.” Indian Journal of Pharmaceutical Sciences,

vol. Special Is, no. 1, 2019, pp. 35–41. Academic Search Complete, Accessed 18 Mar.

2020.

Liu, Yue M., and Peiying Xie. “The Safety of Orthokeratology - A Systematic Review.” Eye and

Contact Lens, vol. 42, no. 1, 2016, pp. 35–42, doi:10.1097/ICL.0000000000000219.

Accessed 18 Mar. 2020.

Ostrov, Barbara F. “Overnight Contacts Can Help Kids’ Sight During Day, But Also Carry

Risks.” NPR.ORG, 21 May 2015, pp. 3–5, https://www.npr.org/sections/health-

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shots/2015/05/21/406502395/overnight-contacts-can-help-kids-sight-during-day-but-

also-carry-risks. Accessed 18 Mar. 2020.

Radcliffe, Shawn. “Overnight Contacts Carry Unforeseen Eye Risks.” The Health Journals, 1

July 2015, pp. 1–6, https://www.thehealthjournals.com/overnight-contacts-carry-

unforeseen-eye-risks/. Accessed 18 Mar. 2020.