What if there was a method that combined with OrthoK virtually assured stability of refractive error?

What if there was a method that combined with OrthoK virtually assured stability of refractive error?What if the method required use of medications in the eye and the technique needed to be repeated at regular intervals to keep the effect stable? What if the technique wasn't FDA approved for myopia control, so its use would be off-label? What if your state board is against or silent concerning your ability to use the technique?

Am I talking about cross-linking for corneal stability of an OrthoK molding? Or am I talking about using very low dose atropine? Or am I talking about the next technique that we don't know about yet? Our profession continues to be defined by law and the laws do not always keep up with current technology. Wouldn't it be strange to find ourselves in a situation where we could treat the blinding medical condition of glaucoma but we couldn't treat the refractive condition of myopia with the best clinical tools?

We are generally very adamant about keeping insurance companies out of the equation when talking about orthokeratology. We've seen from prior experience that there is no benefit to traveling down that road. I think we need to realize that we could be blindsided from unexpected directions. You need to investigate your state laws with an eye towards determining your freedom to practice what has to be full-service optometry. If you don't like what you see, specifically with the ability to treat refractive errors with medications, then start working on it now. There are so many battles over health insurance - don't get locked out of what many of us may assume is our fall-back position if vision plans and health insurance fail to deliver what we and our patients need.

Richard L. Anderson, O.D.

Richard L. Anderson, O.D. is a fellow of the academy and has been assigned to head a committee tasked with creating a myopia prevention protocol. He has practiced in Camarillo California for more than a few years and his passion for myopia prevention led him to most recently create a website for patients and doctors at http://www.MyopiaPrevention.org.

Myopia Protocol Update

I'm working on a myopia protocol, which is an exciting, somewhat daunting project. Think about telling the majority of doctors that they are treating the most common diagnosis in their practice thewrong way. That should go over well, don't you think?!  It is fun though and I mean that sincerely.

Research is moving fast and what many of us thought was true just isn't so. RGPs don't slow myopia significantly. Just that one fact is not believed by many contact lens fitters. A protocol that goes against their cherished belief has a high bar to overcome. Not only must the protocol lay out the science behind what suggestions are made, it needs to make a solid case for why other alternative protocols don't make sense.

I think the protocol also needs to comment on techniques that have different levels of proof. This is commonly referred to as "levels of evidence." At the top level (from another's listing) would be evidence obtained from meta-analysis of randomized controlled trials while at the lowest rung would be evidence obtained from expert committee reports or opinions and/or clinical experiences of respected authorities. That's a large span but I think it is important to both guide individual doctors and guide future research.

Here's an example: A patient who is -4.50 and progressing and not willing to go for orthok or other treatments, asks you if it would in any retard their myopia progression if they went without their glasses for part of the day. I'm sure the majority of offices say something to the effect "Just wear them - your glasses don't make your eyes better or worse, they just compensate for the blur. If you get more nearsighted, we'll change your prescription next year." Certainly there is no research out there to support either view.

You, in your enlightened state of mind however, are willing to entertain a thought process that might go like this: "Hmm - myopia seems driven by peripheral hyperopia. It is better to have peripheral myopia and animal studies have shown that short intervals daily of peripheral myopia can compensate for long intervals of negative lens blurring. If this patient takes off their glasses that are most likely creating peripheral hyperopia and looks at anything beyond their fingertips, they most likely will have significant peripheral myopia. So yeah - I think they SHOULD take their glasses off an hour or so a day and go for a walk."  

Now that's a somewhat radical recommendation coming from a "traditional" optometrist. But if expert opinion agrees, maybe it needs to be mentioned in a protocol.

I don't know what the experts think yet. Imagine where you might stand.

Richard L. Anderson, O.D.

 

Richard L. Anderson, O.D. is a fellow of the academy and has been assigned to head a committee tasked with creating a myopia prevention protocol. He has practiced in Camarillo California for more than a few years and his passion for myopia prevention led him to most recently create a website for patients and doctors at http://www.MyopiaPrevention.org.

Another Ortho-K Pioneer Is Gone

We have lost another pioneer in the field of Orthokeratology. Nick Stoyan immigrant,inventor,founder of Contex and developer of the OK3 and Contex E lens designs has passed away at the age of 74. Nick who started his career with The Plastic Contact Lens Company owned by Wesley Jessen,as did many of the future leaders in the field,brought innovative concepts to contact lens design and fabrication. Nick was awarded the prestigious Excellence In Orthokeratology Award by the academy and though unable to travel much due to health reasons gave support to our efforts to educate practitioners and the lay public about corneal reshaping. Nick with Newton Wesley and Charles May,who both passed away last year,contributed mightily to the first twenty five years of corneal reshaping so much so that they all could be referred to as the pillars of the field.

My best memories of Nick came during my days leading The National Eye Research Foundation trying to deal with a man that was anything but predictable. Difficult but worthwhile negotiations were always the order of the day as we worked through issues large and small. I will never forget that twinkle in his eyes and the feeling that whatever we had just agreed to was somehow exactly what he had intended in the first place. Whether he was involved in negotiating lens sales at the yearly educational meetings of NERF in Las Vegas or lecturing all us on difficult fits or future innovative design challenges he was always involved and passionate.I will miss him greatly.

Cary M Herzberg O.D. FOAA

A Great Letter

I got an email today from a 20 yo male Filipino who was -6.50 and
wanted to know what he could do to "cure" his myopia or at least stop
it from getting worse.

"I'm really desperate to control myopic progression because I'll be
encountering lots of near-work and closed settings in the near future as I will be working as a hospital
nurse. Majority of the sites I have encountered, talk about Ortho-K and plus lenses
(including bifocal lenses). I've talked with my O. D. and she tells me that plus lenses are for older people and she advises against using them at a young age...I'm looking to inform my O.D. and persuade her into giving me one. But I think it may offend her or be against her conscience as a trained optometrist/opthalmologist (sic)."

Wow - what a great letter with so many significant points. For one, I was impressed that his web searching at least put OrthoK on par with plus lenses! Not too long ago it would have been See Clearly Method and pinhole glasses. All of your office web sites out there, the OAA site and the increasing social media buzz are making a slow but significant impact. It can only grow if we keep working at it.

Another important point he raises is that his OD seemed indifferent to his concerns. We've all seen that with our patients coming from elsewhere. The ability of optometry to bad-mouth the idea of myopia prevention is amazing to us but all too much the norm in most offices.

We have a big job ahead of us.

Invite another optometrist to Scottsdale!

Richard L. Anderson, O.D.

 Richard L. Anderson, O.D. is a fellow of the academy and has been assigned to head a committee tasked with creating a myopia prevention protocol. He has practiced in Camarillo California for more than a few years and his passion for myopia prevention led him to most recently create a website for patients and doctors at http://www.MyopiaPrevention.org.

That Was Easy ......Wasn't It?

In the last year several years the OAA has managed to enter into many strategic agreements with the corneal reshaping industry. This had led to many coordinated projects that all members will be able to benefit from.These efforts have allowed us to reach out to different groups who will play a more significant part in our present and future. it has been a strategic goal of the OAA board of directors and myself to engage the corneal reshaping industry as fully as possible to grow the field.

With the help of The Gas Permeable Lens Institute(GPLI) and Ed Bennett we are inviting contact lens residents of all the major Optometry schools to attend our meeting in Scottsdale . We have found in the past that while these residents are attending meetings like The GSLS they have not been able to or not aware of the opportunity to attend the greatest show on Earth for corneal reshaping. This year that will not be the case and relationship with Ed and GPLI has helped us accomplish this goal.

Bausch & Lomb has been one of our key supporters since the beginning of the academy. With the help of John Hibbs,Andrew White and David Bland we have been able to forge a new working relationship. This has been especially helpful in two key areas for us. Vision By Design will have a record number of exhibitors at this years meeting due in part to the efforts of Bausch & Lomb. With the help of both B&L and Paragon Vision Sciences we are offering core curriculum courses and live wet labs on corneal reshaping and specialty lens fitting for the first time this year.

Paragon Vision Sciences has been very instrumental in providing resources to us that allow us to advertise our meetings to the CRT community. Like B&L they have provided opportunities that we have found helpful to growing our membership. This year we will again have a booth, presentation and workshops in San Diego at the San Diego Specialty Contact Lens Symposium courtesy of Jerry Legerton, The San Diego Optometric Society and Paragon. At our meeting in Scottsdale Paragon will be providing a Slit Lamp for our wet labs and coordinating a golf tournament on the Wednesday before the meeting as well as several special outings during the event.

Never one to rest on their laurels the academy with he help of its members continues to grow new opportunities. Several years ago Eyequip/Wave was a newcomer as far as exhibiting at our events. Today they are supplying incentives to the "Wavers" to attend our meetings and workshops. This the direct result of our great relationship with Scott Lewis and the result of many hours of work from our Wave community. BE Enterprises/Precision Technology and Randy Kojima have made outstanding contributions to our meeting content. Euclid Systems and Joann Simonsen have supported us both locally in the US and overseas. Oculus and Michael Wolber a new vendor at last years event has increased their support at Scottsdale. Steve Ernst (Contex)has contributed workshops and lectures for many years now as has Tom Reim(Dreimlens). Patrick Caroline(Paragon) has been invaluable in presenting the latest corneal reshaping trends in a manner that has been both entertaining and educational.

At this years meeting we will have several new exhibitors including Optovue who will provide a OCT for our Scleral Wet Lab. Peter Wilcox was extremely important in getting this done for us. Blanchard,Valley Contax and Acculens will be participating their Scleral Lens designs in our Wet Lab as well as our exhibit hall all through the efforts of John Hibbs of B&L. The decision to include specialty fitting in VBD 2012 has been an objective of our board and Eddie Chow and was made part of our strategic objectives laid down at VBD 2009 in Phoenix.

At the recent Global Specialty Lens Symposium in Las Vegas I approached the Contact Lens Manufacturers Association(CLMA) in hopes of engaging them in a cooperative effort to work together to grow the GP industry and the IAO/OAA. Our group I believe can be the key to efforts to grow the GP industry to a level that can support healthy growth in the CLMA member labs. In much he same way that the American Academy of Optometry (AAO) is able to support their programs and annual education meeting the IAO/OAA can serve that same role in providing fertile ground to grow demand for GP products and attending educational meetings like GSLS, SDSCLS and VBD. With the help of CLMA to promote IAO/OAA through its labs and working with us we can and will develop the best GP education on the planet with record turnout to support it.

The board of directors passed a resolution to explore the creation of an international academy in Chicago at VBD 2010 by setting up a committee led by Marino Formenti and myself. At VBD 2011 the committee recommended going forward with the international academy and it came into being by an act of our membership during that meeting. We are proceeding at break neck speed as the IAO becomes fully involved in Europe and Asia. A delegation from the IAO will be traveling to Hangzhou in late March to participate in the AOSLC and the launching of the International Academy of Orthokeratology Asia Section(IAOAs). We are blessed by great leadership of Asia Section from Drs, Lufan and Xie with expert help from our own Helen Duan.There will be a membership meeting of IAOAs and their first full corneal reshaping training sessions for attendees that weekend of the meeting. Later this year in Madrid the IAO will be participating in our European Section(EurOk) first education meeting. Marino Formenti,Antonio Calossi,Mauro Frisani,Basil Bloom, Jose Meijome and many others have put in many hours of planning sessions and are to be applauded for this great accomplishment.

In the next month you will be receiving a proxy from the academy. This proxy will ask for your approval of our new IAO board of directors and also a change in our by-laws creating a fourth section of our academy called Oceania. Later this year I will be traveling with Bruce Williams,Marino Formenti and Matt Herzberg to attend the Orthokeratology Society of Oceanias (OSO) annual education event. There we will meet with the membership to answer questions they may have about becoming a section of IAO. After that there will be a vote to officially join the IAO.

What's in the cards for the future. The OAA initiative to develop an integrated myopia control protocol will soon be center stage not only at VBD 2012 but in publications around the world. This initiative will be a practice changer as the committee members making up a cross section of the leading authorities in the eye care field makes its recommendations. It seems hard to believe that just ten short years ago the OAA began. While it certainly has been a challenging decade I believe that we are now poised to reap the benefits of our accomplishments. As they say only time will tell!

Cary M Herzberg O.D. FOAA