Download files
Abstract
Although there is considerable published research on the efficacy and corneal response to orthokeratology (OK) lenses that flatten corneal curvature to correct myopia, the effects of OK lenses that attempt to steepen corneal curvature to correct hyperopia are poorly understood. This project investigated the effects of hyperopic OK lens wear on corneal shape, refraction and vision.
Open-eye and closed-eye overnight studies were conducted with proprietary hyperopic OK lenses, and these led to the development of an experimental hyperopic OK lens design which allowed manipulation of individual lens design parameters. Changes to refraction and best corrected visual acuity (BCVA), corneal topography (Medmont E300), and the profile of total and stromal corneal thickness (Holden-Payor optical pachometer) were measured over periods up to one week of overnight lens wear.
Most refractive change occurred after the first night of wear, with increasing effect towards one week. Retention of effect at the end of the day increased with more nights of lens wear. BCVA decreased with longer periods of lens wear. Greater inter-subject variability in effect was found with higher refractive targets.
The central cornea steepened and para-central cornea flattened producing a central steepening zone (CSZ) surrounded by a para-central annular flattened zone. CSZ diameter reduced with longer periods of lens wear, and this was significantly associated with decreases in high and low contrast BCVA.
There was no change in central corneal thickness beyond the normal overnight lens induced hypoxic edema response. Once edema had resolved thinning of the para-central corneal epithelium was found which resulted in an overall thinning of the para-central cornea.
Although central lens fenestrations did not affect the hyperopic OK response, a stronger relationship between changes to apical corneal curvature and refraction resulted. This supports the conclusion that the hyperopic OK effect is due to molding of the corneal surface towards alignment with the lens back surface. Similarities to the pattern of clinical change in myopic OK suggest that a similar corneal molding mechanism occurs in myopic OK. BCVA loss prevented longer term studies and needs to be resolved if hyperopic OK is to become established as a viable clinical technique.