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      Effectiveness of Toric Orthokeratology in the Treatment of Patients with Combined Myopia and Astigmatism

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          Abstract

          Purpose

          The purpose of this multi-institute, single-group clinical trial was to evaluate the effectiveness and safety of toric orthokeratology lenses for the treatment of patients with combined myopia and astigmatism.

          Methods

          A total of 44 patients were included in this clinical trial. The patients ranged in age from 7 to 49 years, with myopia of -0.75 to -6.0 diopters (D) and astigmatism of 1.25 to 4.0 D. After excluding 21 subjects, 23 subjects (39 eyes) were analyzed after toric orthokeratology lens use. The subjects underwent ophthalmologic examination after 1 day and 1, 2, 3, and 4 weeks of wearing overnight toric orthokeratology lenses.

          Results

          A total of 19 subjects (31 eyes) completed the trial after five subjects (eight eyes) dropped out. In the patients who completed the study by wearing lenses for 4 weeks, the myopic refractive error decreased significantly by 2.60 ± 2.21 D ( p < 0.001), from -3.65 ± 1.62 to -1.05 ± 1.64 D. The astigmatic refractive error were also significantly decreased by 0.63 ± 0.98 D ( p = 0.001), from 2.07 ± 0.83 to 1.44 ± 0.99 D. The mean uncorrected and corrected visual acuities before wearing the lenses were 2.14 ± 0.80 logarithm of the logMAR (logMAR) and 0.05 ± 0.13 logMAR, respectively, which changed to 0.12 ± 0.30 logarithm of the logMAR ( p < 0.001) and 0.01 ± 0.04 logMAR ( p = 0.156) after 4 weeks. No serious adverse reactions were reported during the clinical trial.

          Conclusions

          Our results suggest that toric orthokeratology is an effective and safe treatment for correcting visual acuity in patients with combined myopia and astigmatism.

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          Most cited references27

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          Retardation of myopia in Orthokeratology (ROMIO) study: a 2-year randomized clinical trial.

          This single-masked randomized clinical trial aimed to evaluate the effectiveness of orthokeratology (ortho-k) for myopic control. A total of 102 eligible subjects, ranging in age from 6 to 10 years, with myopia between 0.50 and 4.00 diopters (D) and astigmatism not more than 1.25D, were randomly assigned to wear ortho-k lenses or single-vision glasses for a period of 2 years. Axial length was measured by intraocular lens calculation by a masked examiner and was performed at the baseline and every 6 months. This study was registered at ClinicalTrials.gov, number NCT00962208. In all, 78 subjects (37 in ortho-k group and 41 in control group) completed the study. The average axial elongation, at the end of 2 years, were 0.36 ± 0.24 and 0.63 ± 0.26 mm in the ortho-k and control groups, respectively, and were significantly slower in the ortho-k group (P 0.54) but was correlated with the initial age of the subjects (P 1.00D per year) were 65% and 13% in younger (age range: 7-8 years) and older (age range: 9-10 years) children, respectively, in the control group and were 20% and 9%, respectively, in the ortho-k group. Five subjects discontinued ortho-k treatment due to adverse events. On average, subjects wearing ortho-k lenses had a slower increase in axial elongation by 43% compared with that of subjects wearing single-vision glasses. Younger children tended to have faster axial elongation and may benefit from early ortho-k treatment. (ClinicalTrials.gov number, NCT00962208.).
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            Long-term effect of overnight orthokeratology on axial length elongation in childhood myopia: a 5-year follow-up study.

            Our prospective study was conducted to compare axial length elongation in myopic children receiving long-term overnight orthokeratology (OK) treatment to those wearing spectacles as controls. There were 59 subjects enrolled in this study. The OK group comprised 29 subjects who matched the inclusion criteria for OK. The control group comprised 30 subjects who also matched the inclusion criteria for OK, but preferred spectacles for myopia correction. Axial length was measured periodically for 5 years using an IOLMaster device, and the time course of changes was evaluated and compared between the groups. A total of 43 subjects (22 and 21 in the OK and control groups, respectively) completed the 5-year follow-up examinations. At baseline, the mean age ± SD was 10.04 ± 1.43 and 9.95 ± 1.59 years, the spherical equivalent refractive error was -1.89 ± 0.82 and -1.83 ± 1.06 diopters (D), and the axial length was 24.09 ± 0.77 and 24.22 ± 0.71 mm in the OK and control groups, respectively, with no significant differences between the groups. The increase in axial length during the 5-year study period was 0.99 ± 0.47 and 1.41 ± 0.68 mm for the OK and control groups, respectively, and the difference was statistically significant (P = 0.0236, unpaired t-test). The annual increases in axial length were significantly different between the groups for the first (P = 0.0002), second (P = 0.0476), and third years (P = 0.0385), but not for the fourth (P = 0.0938) and fifth (P = 0.8633) years. There were no severe complications throughout the study period. The current 5-year follow-up study indicated that OK can suppress axial length elongation in childhood myopia.
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              Influence of overnight orthokeratology on axial elongation in childhood myopia.

              This prospective study was conducted to assess the influence of overnight orthokeratology (OK) on axial elongation in children, with those wearing spectacles as controls. One hundred five subjects (210 eyes) were enrolled in the study. The OK group comprised 45 patients (90 eyes, age 12.1 ± 2.5 years, mean ± SD; OK group) who matched the inclusion criteria for OK. The control group comprised 60 patients (120 eyes, 11.9 ± 2.0 years) who also matched the inclusion criteria for OK but preferred spectacles for myopia correction. Axial length was measured at baseline and after 2 years using ocular biometry, and the changes were evaluated and compared between the groups. Ninety-two subjects (42 and 50 in the OK and control groups, respectively) completed the 2-year follow-up examinations. At baseline, the spherical equivalent refractive error was -2.55 ± 1.82 and -2.59 ± 1.66 D, and the axial length was 24.66 ± 1.11 and 24.79 ± 0.80 mm in the OK and control groups, respectively, with no significant differences between the groups. The increase in axial length during the 2-year study period was 0.39 ± 0.27 and 0.61 ± 0.24 mm, respectively, and the difference was significant (P < 0.0001, unpaired t-test). OK suppressed axial elongation in myopic children, suggesting that this treatment can slow the progression of myopia to a certain extent.
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                Author and article information

                Journal
                Korean J Ophthalmol
                Korean J Ophthalmol
                KJO
                Korean Journal of Ophthalmology : KJO
                The Korean Ophthalmological Society
                1011-8942
                December 2016
                06 December 2016
                : 30
                : 6
                : 434-442
                Affiliations
                [1 ]Department of Ophthalmology, The Catholic University of Korea College of Medicine, Seoul, Korea.
                [2 ]Department of Ophthalmology, Myunggok Medical Research Institute, Konyang University College of Medicine, Daejeon, Korea.
                Author notes
                Corresponding Author: Kyung Sun Na, MD, PhD. Department of Ophthalmology, Yeouido St. Mary's Hospital, The Catholic University of Korea College of Medicine, #10, 63-ro, Yeongdeungpo-gu, Seoul 07345, Korea. Tel: 82-2-3779-1245, Fax: 82-2-761-6869, githen@ 123456hanmail.net
                Article
                10.3341/kjo.2016.30.6.434
                5156617
                14bdad0f-f7ea-4c91-94ed-9c175d5b24d0
                © 2016 The Korean Ophthalmological Society

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Funding
                Funded by: Korea Health Industry Development Institute, CrossRef http://dx.doi.org/10.13039/501100003710;
                Award ID: HI13C0307
                Categories
                Original Article

                Ophthalmology & Optometry
                astigmatism,contact lenses,myopia,orthokeratologic procedures,refraction
                Ophthalmology & Optometry
                astigmatism, contact lenses, myopia, orthokeratologic procedures, refraction

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