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CASE REPORT: Rebellious teenager suffers one-eyed myopia progression


Mike Jackson

This case report involves a teenager whose myopia increased in one eye immediately after she ceased ortho-K lens wear. The other eye, which continued wear of an overnight lens, maintained the same prescription. The father of the girl (CT) was concerned about her worsening myopia and elected for ortho-K treatment.

Her initial prescription was RE -1.50 LE -0.75 -0.50×165. We fitted her with BE lenses RE 8.55/11.0 LE 8.60/11.0.

At the one week review we found her Rx to be RE +0.75 LE +1.25 with 6/6 unaided in each eye. Topography plot CT1 (Figure 1) shows 2.75 D of flattening.

CLF 16 Jackson CT1 - Web

Figure 1. Topography plot shows 2.75 D of flattening one week after starting ortho-K

CT was lost to follow up and returned two years later complaining of irritated eyes. She was not cleaning her lenses properly and was even rinsing them in tap water despite clear instructions to the contrary.

Her father explained that his teenage daughter had become rebellious and was not following any instructions. Because of the discomfort she had stopped wearing the lens in the right eye some months before but continued with the left.

Examination revealed dry, irritated eyes with papillae and mucous strands. We diagnosed contact lens-induced papillary conjunctivitis and decided to rest from the lenses for a few weeks. Within days of ceasing lens wear, her eyes were more comfortable and the redness was gone.

When we repeated the refraction we obtained RE -2.50 LE -0.75 -0.50×165.

We found the eye that had not worn the ortho-K lens had deteriorated by a dioptre in the sphere but the left eye in which she had been wearing the lens had stayed the same.

We refitted her into GOV XMJ lenses RE 44.00/10.4/-3.00 LE 44.0/10.4/-1.00. Within two nights she had 6/6 vision in each eye. The new topography is CT2 (Figure 2) and shows 3.50 D of flattening.

CLF 16 Jackson CT2 - Web

Figure 2. Topography plot more than two years later shows 3.50 D of flattening after lens refitting, following lapsed wear and conjunctivitis

This example is similar to the ground-breaking work done by Professor Helen Swarbrick from the Research in Orthokeratology (ROK) group at the University of New South Wales, where young children were fitted with an ortho-K lens on one eye and a normal rigid gas permeable lens on the other.

Within 12 months there had been a measurable difference in the progression of myopia between the eyes.

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