Corneal Refractive Therapy (CRT): Frequently Asked Questions

Dr. Stuart Spind in Glen Burnie, MD is certified to prescribe Paragon CRT.  His careful selection process permits more than 90% of his patients undergoing CRT to leave with their initial therapeutic lenses on their first day rather than needing to to order them. CRT Brand Contact Lenses are FDA approved therapeutic contact lenses used to gently reshape the cornea while you sleep to correct nearsightedness (myopia). Most commonly referred to as “Corneal Reshaping or Orthokeratology”, CRT offers a safe, non-invasive, non-surgical procedure that temporarily corrects nearsightedness and mild amounts of astigmatism.

  Corneal Refractive Therapy (CRT): Frequently Asked Questions

 Why should I choose Dr. Stuart Spind for CRT?

Dr. Stuart Spind uses state-of-the-art technology to measure the change in corneal curvature, along with the change in nearsightedness. Finally, Dr. Spind carefully selects his patients undergoing this procedure, maximizing the likelihood of success. An honest assessment is the first step for obtaining desired treatment outcomes, and that's what Dr. Stuart Spind is known for.

Is there an minimum age requirement for CRT?

There is no lower age limit on the FDA approval for CRT, which makes this treatment available for carefully selected children.  The scientific literature supports contact lens treatment for some children as young as eight years of age.  Any child undergoing CRT must have the aptitude and responsibility to adhere to proper lens care and hygiene, and this requires a careful and honest assessment by both the parents and Dr. Spind.

How much does CRT cost?

CRT is very affordable and the cost includes all progress visits 3 months from the initial prescribing visit, training on contact lens handling and care, and the initial pair of CRT lenses.

Is CRT risky?

No. The FDA has validated the safety and efficacy of CRT. But like all forms of contact lens treatment, eye irritation is possible.  Most cases are minor and resolve on their own if CRT wear is stopped and there is appropriate professional care. Still, there are rare and isolated reports of serious eye infection with overnight corneal reshaping where improper lens care and hygiene were suspected. Dr. Spind's patients receive a complete review of the benefits, risks, and alternatives during their consultation so that it is possible for you to make an educated decision to undergo CRT.

Can I set up a flexible spending account (FSA) for CRT?

Yes, provided that you have access to an FSA through your employer.  An FSA allows you to allocate pre-tax dollars toward qualified healthcare expenses including CRT.

Does CRT prevent myopia for getting worse?

Currently there is no definite proof that CRT prevents or slows myopia progression.  In fact the FDA approval for CRT does not permit the manufacturer from making such a claim.  However there is mounting evidence suggesting that CRT indeed can reduce the natural rate of childhood myopic progression.  Dr. Stuart Spind has provided information about this in an article on myopia control.

How do I find out if I'm a candidate for CRT?

Call Dr. Stuart Spind at (410) 766-1683 and schedule an eye examination.  During your exam, Dr. Spind will provide a complimentary CRT consultation!

What Is Orthokeratology?

What Is Orthokeratology?

In the most basic of terms Accelerated Overnight Orthokeratology or Ortho-k is the science of changing the curvature or shape of the cornea to change how light is focused on the retina at the back of one's eye.

Think of the cornea as the eye's equivalent of a watch crystal. It is a clear, dome shaped structure that overlies the colored iris. Its tissue is most similar to clear, wet skin; and like skin it is very pliable. Because the cornea separates the eye from air and the rest of the outside world and because it has a curvature that bends light towards the back of the eye, it is responsible for most of the eye's corrective power and contributes to various conditions such as nearsightedness (myopia), farsightedness (hyperopia), and the blur of astigmatism.

When you choose Ortho-k a few key tests must be performed. Chief among these tests is the determination that your eyes are healthy. The Orthokeratologist will examine the retina and also the health of the outside of the eye. The other key procedure is the mapping of your cornea. To do this an instrument called a Topographer is used. Just like a topographical map of a camping area show hills, plains, and valleys; the topography of the eye shows your doctor exactly how your cornea is shaped. The information from your corneal mapping plus the size of your cornea and the prescription needed to correct your vision are all used to design the retainer lenses (corneal molds) needed to create the Ortho-k effect.
 

On the day you pick up your Ortho-k retainer lenses you will be instructed in how to insert, remove, and take care your vision retainers. The fit of your retainers will be evaluated and you will be scheduled to be seen after your first night of wear. On day 1, your doctor will re-evaluate your fit and newly corrected vision and another mapping of your cornea will be performed.

Throughout your initial fitting period, your Orthokeratologist will monitor your corneal health and the effectiveness of treatment. At certain times your retainer lens fit may be modified to achieve your goals.

Orthokeratology can produce results in a surprisingly short period of time. The length of treatment to achieve your goals can vary from patient to patient. Factors which can affect the speed of treatment include:

1. your initial prescription
2. corneal rigidity
3. tear quality and quantity
4. your expectations.

We advise patients that they may need to use their retainers every night to maintain their newly corrected vision although some patients are able to vary their wearing time to once every two to four nights. The reason for this is due to the flexibility of your cornea.

Vitamin B-Based Treatment for Corneal Disease May Offer Some Patients a Permanent Solution

ScienceDaily (Oct. 24, 2011) - Patients in the United States who have the Cornea-damaging disease keratoconus may soon be able to benefit from a new treatment that is already proving effective in Europe and other parts of the world. The treatment, called collagen crosslinking, improved vision in almost 70 percent of patients treated for keratoconus in a recent three-year clinical trial in Milan, Italy. The treatment is in clinical trials in the United States and is likely to receive FDA approval in 2012.

The results of the Milan study are being presented Oct. 24, 2011 at the 115th Annual Meeting of the American Academy of Ophthalmology in Orlando, Florida.

In a session titled Long-term Results of Corneal Crosslinking for Keratoconus, Paolo Vinciguerra, MD will describe the treatment and three-year follow up of more than 250 keratoconus patients who received collagen crosslinking at his clinic. Sixty-eight percent of the 500 eyes treated gained significant visual acuity, with their results remaining stable at the end of the follow-up period. Patients over age 18 were most likely to improve.

In the collagen crosslinking procedure, riboflavin (vitamin B) is applied to the Cornea, which is then exposed to a specific form of ultraviolet light. Collagen fibers regenerate with new bonds forming between them, increasing Corneal stiffness and strength. The treatment also combats the causes of keratoconus, reducing the chance that it will recur. The rest of the eye receives only minimal UV exposure during treatment. Dr. Vinciguerra's new study confirms that adverse effects are rare. Previous research by his team indicated no loss of Corneal endothelial cell, a measurement used to assess the safety of corneal treatments, in patients who received collagen crosslinking.

"For many people with keratoconus, collagen crosslinking can provide a better and more permanent solution to their vision problems," said Dr. Vinciguerra. "Given that no current treatment in use in the U.S. offers permanent correction, this effective option represents a significant advance for corneal medicine."

One in 2,000 people in the United States and worldwide are diagnosed with keratoconus, a disease that damages the collagen fibers that form the structure of the cornea, which is the outer surface of the eye. The cornea's crucial task is to focus, or "refract," incoming light toward the eye's lens. To perform properly, the cornea needs to be rounded, like the surface of a ball. As keratoconus worsens and the cornea becomes thinner, it may bulge outward in a cone shape, causing nearsightedness and/or astigmatism, making clear vision impossible. As the number of fibers and links between them decline, the cornea loses up to 50 percent of its normal stiffness.

Standard treatments in the U.S., such as specialized eyeglasses, contact lenses, or implanted lenses, cannot permanently correct keratoconus, and none of these treatments address the underlying causes. Severe keratoconus often requires corneal transplant.

The 115th Annual Meeting of the American Academy of Ophthalmology is in session October 23 through 25 at the Orange County Convention Center in Orlando, Fla. It is the world's largest, most comprehensive ophthalmic education conference. Approximately 25,000 attendees and more than 500 companies gather each year to showcase the latest in ophthalmic technology, products and services. To learn more about the place Where All of Ophthalmology Meets visit www.aao.org/annual_meeting.

 

http://www.sciencedaily.com/releases/2011/10/111024084641.htm

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The above story is reprinted from materials provided by American Academy of Ophthalmology.

Note: Materials may be edited for content and length. For further information, please contact the source cited above.

Cornea Gene Discovery Reveals Why Humans See Clearly

ScienceDaily (Dec. 12, 2011) — A transparent Cornea is essential for vision, which is why the eye has evolved to nourish the Cornea without blood vessels. But for millions of people around the world, diseases of the eye or trauma spur the growth of blood vessels and can cause blindness.

A new Northwestern Medicine study has identified a gene that plays a major role in maintaining clarity of the Cornea in humans and mice -- and could possibly be used as gene therapy to treat diseases that cause blindness. The paper is published in the Proceedings of the National Academy of Sciences.

"We believe we've discovered the master regulator gene that prevents the formation of blood vessels in the eye and protects the clarity of the Cornea," said lead author Tsutomu Kume, associate professor of medicine at Northwestern University Feinberg School of Medicine and a researcher at Feinberg Cardiovascular Research Institute.

The existence of the gene, FoxC1, was previously known, but its role in maintaining a clear Cornea is a new finding. Working with a special breed of mice that are missing this gene, Kume and colleagues found abnormal vascular formations, or blood vessels, streaking their Corneas and blocking light.

When Kume discovered the Corneal blood vessels in the mutant mice, he called a collaborator at the University of Alberta in Canada, Ordan Lehmann, MD, professor of ophthalmology and medical genetics.

Lehmann found that his patients who have a single copy of this mutated FoxC1 gene -- and who have congenital glaucoma -- also have abnormal blood vessel growth in their eyes.

"The exciting thing is by showing the loss of FoxC1 causes vascularization of the Cornea, it means increasing levels of the gene might help prevent the abnormal growth of blood vessels, potentially in multiple eye disorders that cause blindness," said Lehmann, a coauthor on the paper. "That's the hope." One possible use might be in corneal transplants, he said, where the growth of new blood vessels onto the transplanted cornea is a major problem.

Kume next plans to test the gene therapy in mice to see if injecting FoxC1 inhibits the formation of blood vessels in the cornea.

The research is funded by National Institutes of Health and Canadian Institutes of Health Research.

http://www.sciencedaily.com/releases/2011/12/111212153121.htm

Story Source:

The above story is reprinted from materials provided by Northwestern University. The original article was written by Marla Paul.

Note: Materials may be edited for content and length. For further information, please contact the source cited above.