John Mark Jackson

Overnight orthokeratology: preliminary results of the Lenses and Overnight Orthokeratology (LOOK) study.

Background. The Lenses and Overnight Orthokeratology (LOOK) study is a pilot study designed to learn the procedures of orthokeratology lens fitting in preparation for a planned larger clinical trial and to obtain data with which to calculate a sample size for that larger study. Data are presented for the first 3 months of the LOOK study. Methods. Sixty subjects were enrolled in this multicenter pilot study to evaluate the success and safety of treatment with overnight orthokeratology contact lenses. Refractive error, corneal topography, and biomicroscopic data were collected to determine the amount of refractive error change achieved, corneal changes, and a safety profile of overnight wear of reverse geometry rigid gas permeable lenses for orthokeratology. Results. Of the 60 subjects enrolled, 46 completed the 1-month visit, and 31 completed the 3-month visit. The mean change in spherical equivalent manifest refraction from baseline to the morning 3-month visit was 2.08 ± 1.11 D in the right eye and 2.16 ± 1.05 D in the left eye. At the 3-month morning visit, 74% of right eyes and 61% of left eyes had 20/20 unaided visual acuity. No corneal infiltrates or ulcers were noted in any subjects. Observations of fluorescein staining of the cornea, imprinting, and microcysts were noted in some patients at the 3-month visit. Conclusions. The preliminary results of the LOOK study indicate that improvement in unaided visual acuity can be attained for at least 6 h after lens removal. The short-term safety and efficacy of the procedure appear to be favorable; however, future studies are needed to determine the long-term outcomes of treatment.

Randomized Trial of the Effect of Contact Lens Wear on Self-Perception in Children

Purpose. To determine whether contact lens wear affects children’s self-perceptions. Methods. The Adolescent and Child Health Initiative to Encourage Vision Empowerment Study was a randomized, single-masked trial conducted at five clinical centers in the United States. Subjects were 8- to 11-year-old myopic children randomly assigned to wear spectacles (n = 237) or soft contact lenses (n = 247) for 3 years. The primary endpoint was the Self-Perception Profile for Children Global Self-Worth scale. Secondary outcomes included the Physical Appearance, Athletic Competence, Scholastic Competence, Behavioral Conduct, and Social Acceptance Self-Perception Profile for Children scales. Results. Global self-worth was not affected by contact lens wear [analysis of variance (ANOVA), difference = 0.06; 95% CI, −0.004 to 0.117]. Physical appearance (ANOVA, difference = 0.15; 95% CI, 0.07 to 0.22), athletic competence (ANOVA, difference = 0.08; 95% CI, 0.01 to 0.15), and social acceptance (ANOVA, difference = 0.10; 95% CI, 0.03 to 0.17) were all greater for contact lens wearers. Conclusions. Although contact lens wear does not affect global self-perceptions of 8- to 11-year-old myopic children their physical appearance, athletic competence, and social acceptance self-perceptions are likely to improve with contact lens wear. Eye care practitioners should consider the social and visual benefits of contact lens wear when choosing the most appropriate vision correction modality for children as young as 8 years of age.

The Adolescent and Child Health Initiative to Encourage Vision Empowerment (ACHIEVE) study design and baseline data.

Purpose. The purpose of this study was to describe the baseline characteristics of subjects and methods for a multicenter, randomized clinical trial to compare the effects of contact lens wear and spectacle wear on childrens self-perception. Methods. Eligible subjects are randomly assigned to wear glasses or contact lenses throughout the 3-year study. Self-perceptions are measured 1 month after randomization and every 6 months using the Self-Perception Profile for Children (SPPC). Childrens satisfaction with spectacles and refractive error-related visual quality of life are also measured using surveys developed for the study. Visual acuity, cycloplegic autorefraction, corneal curvature, and axial dimensions are measured annually. Results. Five clinical sites enrolled 484 subjects with a mean (± standard deviation [SD]) age of 10.4 ± 1.1 years. Approximately three-fifths of the subjects are girls, 47.1% of the subjects are white, 21.5% are black, and 21.5% are Hispanic. The mean (± SD) cycloplegic spherical equivalent autorefraction of the right eye is –2.38 ± 1.04 D, and the average (± SD) axial length of the right eye is 24.32 ± 0.77 mm. The average (± SD) Global Self-Worth score on the SPPC is 3.20 ± 0.62 on a scale from one (low perceived competence) to 4 (high perceived competence). The average (± SD) spectacle satisfaction is 59.1 ± 26.6 on a scale from zero (no satisfaction) to 100 (perfect satisfaction). The average refractive error-related quality of life score is 63.5 ± 12.8 on a scale from zero (poor quality of life) to 100 (excellent quality of life). Conclusions. Subjects enrolling in the ACHIEVE Study are an ethnically diverse group of young myopic children. Ocular characteristics of the sample are consistent with data presented in other randomized clinical trials evaluating treatments for myopic children. The data reported here represent the baseline data for a 3-year randomized clinical trial to investigate the effects of contact lens vs. spectacle wear on childrens self-perceptions.

Vision specific quality of life of pediatric contact lens wearers.

Purpose. Several studies have shown that children are capable of wearing and caring for contact lenses, but it is not known whether the benefits outweigh the risks associated with contact lens wear. The purpose of this article is to compare the vision-related quality of life benefits of children randomized to wear spectacles or contact lenses for 3 years using the Pediatric Refractive Error Profile. Methods. The Pediatric Refractive Error Profile was administered to 484 children who wore glasses at baseline. The children were then randomly assigned to wear contact lenses (n = 247) or spectacles (n = 237) for 3 years. The survey was administered at the baseline examination, at 1 month, and every 6 months for 3 years. Results. During 3 years, the overall quality of life improved 14.2 ± 18.1 units for contact lens wearers and 2.1 ± 14.6 units for spectacle wearers (p < 0.001). In all scales except the visual performance scales (Distance Vision, Near Vision, and Overall Vision), the quality of life improved more for older subjects than younger subjects. The three scales with the largest improvement in quality of life for contact lens wearers were Activities, Appearance, and Satisfaction with Correction. Conclusions. Myopic children younger than 12 years of age report better vision-related quality of life when they are fit with contact lenses than when they wear glasses. Older children, children who participate in recreational activities, children who are motivated to wear contact lenses, and children who do not like their appearance in glasses will benefit most.

Orthokeratology and corneal refractive therapy: a review and recent findings.

Purpose. To review the past and current literature and present recent findings on orthokeratology and corneal refractive therapy. Methods. Various articles on contact lens corneal reshaping were analyzed. Common clinical procedures and interference measurement of tear-film thickness were also used. Results. Although the numbers of patients tested to date do not allow conclusions of great certainty, based on a review of the current literature, our recent study of 60 patients, and the Food and Drug Administration approval of overnight contact lens corneal refractive therapy, there is a low incidence of complications, and unaided visual acuity of 20/20 in the morning is possible in most (74%) successful cases. Refractive error change of 2.25diopter (D) ± 1.00D is common. A presumed iron ring may appear in some patients in the midperipheral corneal epithelium. Conclusion. Overnight orthokeratology and corneal refractive therapy with modern design reverse-return zone lenses in high-Dk rigid gas-permeable contact lens materials is an option for transient vision correction for some myopic patients.

A comparison of spectacle and contact lens wearing times in the ACHIEVE study

Purpose:  The aim was to compare vision correction wearing time between myopic children and teenagers in a clinical trial of contact lenses and spectacles.