By the time she was 14 years old, Devon Wiley of Hingham had been wearing glasses for four years. She hated the way they looked on her, and they also got in the way when she did gymnastics.
Now, at 17, she competes in field hockey, lacrosse, and track, without having to worry about glasses or contact lenses.
Similarly, Jonathan Vautrin, 15, of Brookline got tired of having to remember to bring his glasses to school or to a movie. His mother, Muriel Vautrin, was concerned that every year, her son’s eyes got weaker and his prescription stronger.
Wiley and Vautrin, who are nearsighted, are the new target market for orthokeratology, also known as ortho-k, a once-maligned treatment option for weak
vision that uses specially designed contact lenses to temporarily reshape the cornea. Lenses are worn overnight and removed in the morning. Vision remains clear the next day.
“I don’t have to worry about them falling out when I’m playing sports or swimming,” said Wiley.
Vautrin said he prefers the ortho-k lenses over traditional contact lenses. “For some reason, I found it a lot more annoying to wear them [contact lenses] all day than to just put them in at night,” he said.
There are advantages to ortho-k beyond convenience, proponents say. Several studies show that regular wearing of ortho-k lenses may slow the progression of nearsightedness — though ophthalmologists debate the claim.
Nearsightedness, or myopia, affects between 33 and 42 percent of Americans, depending on how it is defined and what age ranges are included, according to statistics from the National Eye Institute, one of the National Institutes of Health.
Optometrists and ophthalmologists, who differ in methods for treating nearsightedness, compete for what is a lucrative market to correct myopia.
Typically appearing in childhood, myopia worsens until about age 20 when the eye stops changing. It is caused by an eyeball that is too long or a cornea that is too steeply curved. The curvature causes the light entering the eye to miss the correct target on the retina, according to the American Optometric Association. While close vision is unaffected, distant objects look blurry.
Orthokeratology is now also being used to treat farsightedness, astigmatism, and age-related loss of close vision, but it was first developed to correct myopia.
To treat myopia, orthokeratology uses specially designed contact lenses to flatten the soft tissue of the cornea so the light hits the retina correctly. As a concept, it has been around since the 1960s, but did not gain traction as a treatment option until the 1990s when the introduction of corneal mapping equipment and gas permeable materials for lenses made it more practical, according to Dr. Cary Herzberg, president of the American Academy of
Orthokeratology and International Academy of Orthokeratology in Illinois, an advocacy group.
After a brief surge of interest in the 1990s, ortho-k fizzled as a treatment.
At that time, optometrists would fit patients with a series of hard, gas permeable lenses that were similar to conventional contact lenses. They were worn during the day on a schedule that included some days off. Ortho-k “couldn’t do much, it took a long time to do it, and the results were unpredictable,” said Dr. Curtis Frank, a practicing optometrist in Boston who offers ortho-k at his Federal Street office.
Technological changes that matched the lenses more precisely to a patient’s cornea improved the safety of the lens and consistency of results.
More permeable materials led to US Food and Drug Administration approval for overnight wear in 2002. Patients were able to put the lenses in at night, take them off in the morning, and after a short period of adjustment, have corrected vision all day.
But ortho-k is still limited. The FDA approves use of ortho-k lenses only for mild to moderate myopia, although Herzberg says many practitioners successfully treat patients with more severe myopia.
Wearing lenses overnight means a higher risk of infection, and the treatment is expensive. The initial fitting and lenses cost between $1,500 and $2,000, according to Frank. Annual replacement lenses cost $500 per pair. The cost for regular contact lenses varies widely, but the average cost of two-week disposable contacts for myopia cost between $220 and $260 per year.
By comparison, Lasik, which permanently reshapes the cornea with laser surgery, costs from $1,000 to $3,000 per eye, but generally dispenses with the need to buy glasses or contact lenses afterward.
Ortho-k appeals to adults with mild to moderate myopia who do not want to wear glasses or daily contact lenses and either are not candidates for Lasik or are averse to its potential risks, Frank said. But he sees the biggest growth in ortho-k in children.
Children have softer, more malleable corneas. This makes their eyes especially receptive to treatment with the lenses, Frank said.
“The biggest problem with kids is that they get more nearsighted every year,” Frank said.
While Lasik surgery is not recommended for teenagers under 18 years old, children can begin ortho-k as young as 8, if they can handle putting a contact lens into their eyes and follow directions for cleaning them, Herzberg said.
The lenses are uncomfortable at first. Said Wiley, “It’s weird to get used to what is basically a piece of plastic in your eye.” But because they are worn only at night, when the eyelid is shut and not chafing against the lens with every blink, adaptation is fairly swift. “After about a week you get used to it; I never even think about them anymore,” she added.
The lenses reshape the cornea on a temporary basis only. Miss a night or two of overnight lens wear and vision reverts to its original form.
“I’ve forgotten to bring them with me to sleepovers, and my vision is definitely blurry the next day,” Wiley said. “It’s a pain.”
Muriel Vautrin said that while the ortho-k lenses work well for her son Jonathan, they are not for every child. “Even if you are extremely tired at night, you have to put them in and wear them. You have to be a disciplined person.”
Speaking on behalf of the American Academy of Ophthalmology, Dr. David Hunter, ophthalmologist in chief at Boston Children’s Hospital, said he is not convinced by the research that shows that ortho-k slows the progression of myopia. He said the research “used small sample groups and showed a high variability in results.”
“If I have a patient who really wants it, I don’t tell them not to do it,” Hunter said, adding that he remains concerned about a possible “Cinderella effect” — because the reshaping from the ortho-k lenses is only temporary, an adult driving late at night might experience a reduction in vision clarity as the cornea begins to resume its natural state.
Frank argued that this “Cinderella
effect” would only occur in rare instances and would not apply at all to children, whose corneas are more malleable and stay corrected longer.
Herzberg said that because of the improvements in technology, he predicts that ortho-k will grow in popularity. “I promise you the dialogue will change in the very near future.”
A look at the costs
The initial fitting and lenses cost between $1,500 and $2,000.
Annual replacement lenses cost $500 per pair.
By comparison, Lasik, which permanently reshapes the cornea with laser surgery, costs from $1,000 to $3,000 per eye, but generally dispenses with the need to buy glasses or contact lenses afterward.Jan Brogan can be reached at firstname.lastname@example.org.