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High Myopia Orthokeratology Treatment for Children
Paul T. Woo, O.D.
California,U.S.A

Prevalence of Myopia
"In Taiwan,the myopia rate increased from 20% at 7 years, to 61% at 12years,and 81%at 15years. A myopic rate of 84% was found for schoolchildren aged 16 years through 18 years"(Lin et al,2001)

Prevalence of Myopia
"In Singapore,78% of all teenagers have myopia"(Quek et al,2004)

In the US
In 1996,the Framingham offspring eye study group reported myopia in 60% of the population between ages 23 to 34.

Etiology of Myopia
Genetics
"…In countries where the prevalence of myopia has rapidly increased to 80 to 90 percent in young adults, it is clearly not simple genetic determination that leads to myopia.The prevalence is changing so fast that many young Asians are now myopic without any family history of myopia"(Morgan,2003)

Etiology of Myopia
Environmental factors
"There is no doubt that an environmental component is involved and extended near work appears to be the major risk factor…"
(Feldkamper M,Schaeffel F,2003)

High Myopia
Risks and complications
-Retinal detachment
-Macular degeneration
-Glaucoma
-Earlier onset posterior Subcapsular cataract

High Myopia Orthokeratology
-Myopia reduction up to -10.00 diopters
-Inventory system for simple and effective treatment
-Longer maintenance time up to 16 hours

Case Report
Methods
-30 high myopia children ages 8 to 17 years old
-Myopia range from -5.00to -9.00 diopters
-Treatment and follow-up over3 month period

Case Report
Data monitored
-subjective refraction
-Keratometry readings
-Topography
-Slit lamp findings

Topography Results
12 year old male
Original Rx
-6.50-.75×165
-6.75-1.25×010

Final Rx
Pl-.25×060
-.25-.50×120

Topography Results
13 year old male
Original Rx
-7.25-.75×010
-7.00DS

Final Rx
+.25DS
+.75-.50×090

Topography Results
16 year old female
Original Rx
-6.00-.75×055
-6.25-.25×130

Final Rx
+.25-.25×095
+.75-.50×090

Results
All 30 children enjoyed 20/40vision or better
Effective for higher astigmatism of up to 2.25 diopters
Minor complications developed in 1/3 of the cases

List of Complications
-3 cases of epithelial stippling due to poor lens removal techniques
-1 case of central corneal erosion due to protein build up on the lenses
-3 cases of halos and shadows due to residual astigmatism
-2 cases of allergic conjunctivitis
-1 case of bacterial conjunctivitis after swimming

Conclusion and Discussion
Wish longer and stable vision during the day the children are more outgoing and active in school
Able to participant more in sports and compete at an elevated level
Definitely possible to treat high myopia beyond -5.00 diopters with ease and confidence

Conclusion and Discussion
Orthokeratology children are more responsible than soft contact lens wearers
More chance of academic improvement when the children are more confident and enjoy going to school
The possibility of myopia control in these children is an added benefit
Special group of patients that require better technique from the clinician

Conclusion and Discussion
Clinicians who treat high myopia with orthokeratology will be looked upon as leaders in the field
The treatment range of Orthokeratology should be accepted as from -1.00to -9.00 diopters
As clinicians improve their techniques in treating high myopia treating -8.00 will be as easy as treating -2.00 diopter myopes