I am about to spend a large sum of money on a procedure known as CRT
or ortho-k.  I'd like to know what I'm getting myself into.  As such,
I have several questions.  I prefer these be answered by a person with
firsthand experience.

1. What discomforts are there, to what degree, and are they strong
enough to slow or stop the procedure?
2. How long does it take (did it take you) to achieve optimal results?
3. How good are optimal results (for you)?
4. Is the procedure detrimental to one's health over time?
5. How fragile are the implements?  Should I expect to pay for a
replacement set within a year?
6. How much did you pay, or what is the range of prices, and what do
the prices include?
7. What is your impression of the procedure and results?  Are you
satisfied?  Do they merit the cost and pain?
8. Anything else I should know?

Do not research the background or purpose of the procedure, as I have
already done extensive research in that area.
Keep a running list of names and references used to answer the question.

I need the answer to this question by Tuesday, 11/23/2004.

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Clarification of Question by ryatziv-ga on 19 Nov 2004 15:20 PST

My major concern is long term issues, so please focus the majority of
your research on this.

Hello ryatziv-ga,

I am glad to be able to help you with the answers to your questions. I
will go through your questions 1 by 1 and list the answer below each
question. The answer will be indicated with ?*****?. Let us begin. I
would also like to mention I wish you the best of luck with the
procedure.

1. What discomforts are there, to what degree, and are they strong
enough to slow or stop the procedure?

*****Some of the discomforts involved may be blurred vision for a few
days because your cornea stays swollen. Some patients may notice glare
during the day. Bacterial infections may occur. Slight discomfort is
sometimes reported due to dry eyes. Most patients do not have any
major discomfort and can continue to wear the lenses.
A discomfort may also be that it may be hard to switch back to
prescription glasses as the corrective effect wears off.

http://www.floridaeyecenter.com/SeniorEyeCare/CornealandExternalDiseases/#What%20are%20the%20possible%20complications

http://www.innovations-report.de/html/berichte/medizin_gesundheit/bericht-26346.html

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=6344645

--------------------------------------------------

2. How long does it take to achieve optimal results? **AND** 3. How
good are optimal results?


*****In many patients, It is recommended to wear the lenses while you
sleep or every other night. Without regular wear, after 48 hours to a
week your eye will return to it?s previous vision state.

In a study of 159 patients 59% obtained 20/20 or better without other
correction and 92% obtained 20/40 or better at 9 months. (20/40 vision
is the acuity required in most states to drive without glasses). 67%
Of the subjects obtained 20/20 vision in at least one eye (their
better seeing eye) and 94% achieved 20/40.
(http://www.coopereyecare.com/new_page_1.htm)

In another study??In the FDA clinical study for approval of CRT, 93%
of patients achieved 20/32 vision or better, and 67% achieved 20/20 or
better. The study included 205 patients that were followed over a
nine-month period.? (http://www.allaboutvision.com/contacts/orthok.htm)

Most say it takes about 10-14 days to initially work.


--------------------------------------------------

4. Is the procedure detrimental to one's health over time?

*****The two most common side effects that occur corneal edema  Also
called Cloudy Cornea which is a loss of transparency of the cornea, 
and corneal staining which is when fluorescein penetrates damaged cell
membranes and leaves a ?stain? on the eye. You can see a picture here:
http://www.siliconehydrogels.com/glossary_terms/index.asp#cccc (Scroll
down to Corneal staining and click enlarge below the picture).
 Other side effects that may occur are pain, redness, tearing, and
irritation, and discharge, abrasion of the eye or distortion of
vision. These are usually temporary conditions if the contact lenses
are removed promptly.
In very rare instances?
1. Infections of the eye
2. A corneal ulcer could occur, which is a wound in the surface of the
eye caused by injury, dryness due to lack of tear production, or
infection. The risk of corneal ulcers for people who keep
extended-wear lenses in overnight is 10 to 15 times greater than for
those who use daily-wear lenses only while awake
3. Iritis, which is an inflammation of the iris.
4. Neovascularization, which is when new, tiny blood vessels grow in a
new place, for example, out from the retina.
5. Corneal scarring.
6. Permanent decreased vision may occur. 
The occurrence of these side effects should be minimized or eliminated
if proper lens care is exercised.
--------------------------------------------------

5. How fragile are the implements?  Should I expect to pay for a
replacement set within a year?

*****Scratches and breakage are mostly what happen. Hard lenses are
fragile. With gentle care and maintenance, hard lenses can last up to
several years. Some places you get your lenses and a set of temporary
lenses to help in the beginning.

--------------------------------------------------

6. How much did you pay, or what is the range of prices, and what do
the prices include?

***** HERE ARE A FEW DIFFERENT EXAMPLES:

?For simple cases the cost can range from $1500 to $2500 depending on
length of treatment and the number of lenses needed. Fees are set by
each doctor and your doctor will be able to give you a better estimate
for your eyes.?

?Corneal reshaping costs an average of $1,000 to $1,500 for both eyes,
plus the cost of replacement lenses in subsequent years. The cost
varies from one practitioner to another and may also depend on how
many lens changes you require. Ortho-k and CRT are not normally
completely covered by vision care insurance plans.?

?The cost varies widely and can range from $800 to $3,500 for both
eyes, depending on your eye doctor and the number of different lenses
you will need to achieve your vision goal.?

7. What is your impression of the procedure and results?  Are you
satisfied?  Do they merit the cost and pain?

***** It seems like an effective procedure. If you treat your eyes and
the lenses well, and wear them as prescribed, you should have minimal
pain and be lens free during the day. Based on reviews in Google
Groups, it seems that most people feel it is worth the procedure.

--------------------------------------------------

8. Anything else I should know?

As always, get a 2nd opinion and ask your doctor for references or
licensure. You want someone who is comfortable with the procedure and
has a high success rate.

A Doctor search for Ortho-K is here: http://www.ortho-k.net/doctors.htm

?Overnight ortho-k is one such example. Some doctors will use extended
(overnight) wear RGP contact lenses for overnight ortho-k, even if the
lenses have not been specifically approved for that use.?

Make sure your lenses are approved for Ortho-K.

Here are websites used and google searches.

http://vision.about.com/od/contactlenses/a/orthok_2.htm

http://www.coopereyecare.com/new_page_1.htm

http://tjsamson.client.web-health.com/web-health/topics/GeneralHealth/generalhealthsub/generalhealth/eye/Contacts.html

http://www.allaboutvision.com/contacts/orthok.htm

http://www.ortho-k.net/orthokfaq.htm#detect

http://www.fda.gov/fdac/features/1998/298_lens.html

http://www.drallanpanzer.com/crt.htm

Corneal Refractive Therapy lenses how often
://www.google.com/search?num=100&hl=en&lr=&safe=off&c2coff=1&q=+Corneal+Refractive+Therapy+lenses+how+often&btnG=Search

OrthoKeratology how often to wear lenses
://www.google.com/search?num=100&hl=en&lr=&safe=off&c2coff=1&q=OrthoKeratology++how+often+to+wear+lenses&btnG=Search

Corneal Refractive Therapy discomfort
http://scholar.google.com/scholar?q=+Corneal+Refractive+Therapy+discomfort&ie=UTF-8&oe=UTF-8&hl=en&btnG=Search

Ortho-k lenses how many sets
://www.google.com/search?num=100&hl=en&lr=&safe=off&c2coff=1&q=Ortho-k+lenses+how+many+sets&btnG=Search

Corneal Refractive Therapy ortho k cost
://www.google.com/search?hl=en&ie=UTF-8&oe=UTF-8&q=%20Corneal%20Refractive%20Therapy%20ortho%20k%20cost&btnG=Google+Search

Ortho k
http://groups.google.com/groups?num=100&hl=en&lr=&safe=off&c2coff=1&q=ortho+k&btnG=Search


If this answer requires further explanation, please request
clarification before rating it, and I will be happy to look into this
further.
Nenna-GA
Google Answers Researcher

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Request for Answer Clarification by ryatziv-ga on 20 Nov 2004 11:38 PST

I would like to know the percentages (number of patients that end up
having the symptom) associated with each (or many) of the symptoms
described in #4.

---

Clarification of Answer by nenna-ga on 22 Nov 2004 14:02 PST

Hello again,

I found some more information relating to your clarification that may be useful.
I was having a hard time finding percentages on the internet, so I
turned to my trusty phone listings and called a few places that
specialize in Ortho-K for some answers.

From what I understand, 2-5% of patients experence some initial
discomfort of pain, redness, tearing, andirritation, and discharge,
abrasion of the eye or distortion of vision.

This can be corrected easily.

The rest of the side effects listed in #4 happen to less than .05% of
people undergoing Ortho-K. It is recomended that you go in for
frequent check-ups during the first few months of treatment and have
your Dr. monitor for any of these effects. Also, going to your Dr. at
the first sign of any changes or irritation minimizes the risk
greatly.

So, in VERY FEW cases it is detritimental over time, since it is a
easily reversed proceedure if there are complications. Your eyes
revert back and you can just stop wearing the lenses.

This should help. If you have further questions on the side-effects of
Ortho-K, and would like an indepth study done of the risks, feel free
to post another question on Google Answers.

Nenna-GA

I had done several months of research prior to posting this question,
and I got nowhere as good results as these.  Truly exceptional
research.

I just started my CRT about a week ago, so I'll answer what I can. 
Hope some of it helps.

1. I have never worn contacts before, so I did experience quite alot
of discomfort the first several times I had the lenses in place.  They
are a hard lense, and as such I would suspect they are considerably
more noticeable than soft lenses. I had a difficult time with my left
lense, but 3 lenses later it is comparable in comfort to the right
lense which has not given me any problems. After about a week of
wearing them every night, I am very happy with the comfort level. I'm
not sure I would be able to wear them all day; however, putting them
on and going to bed is wonderful.  My eyes are a little puffy in the
mornings, but I notice they are less so as each morning passes.

2.  After wearing the lenses for one night and going in for a check-up
the next morning, my right eye was seeing better than 20/20.  My left
eye has an astigmatism which is taking longer to correct.  At one
week, I can go most of the day without having to put my glasses
on...usually around 8:00 at night is when I start to notice a change
and usually start to get a headache. I have definately not achieved
optimal results as of yet.

3.  Optimal results will be going all day without the need for glasses
and without any noticable reversion to my previous eyesight.

4.  Again, I have only had them for 1 week, but my doctor has not
mentioned any long term risks or side effects.

5.  The lenses are hard and as such can be broken and scratched
without proper care.  My doctor said I could possibly need a
replacement yearly, which is similar to how often I was having glasses
replaced do to changes in my vision. The prices for glasses and CRT
lense replacement are about the same.

6.  I paid a little over $900.00 (US). That's total for both eyes. 
This includes an eye mapping, CRT lense fitting, 1 set of lenses, and
about 6 follow-up visits within the first year.

7.  So far I'm thrilled with the results, and expect more improvement
over the next few weeks.  At some point I should only have to wear
them to bed 2-3 nights a week.  I've only been wearing glasses about 3
years, and am very happy to be able to get rid of them.

8.  One thing my doctor mentioned that I had not read about anywhere
else was the use of eyedrops that "get the red out."  He said to avoid
them at all costs.  Several patients have told him that almost
immediately after using such an eyedrop, their vision reverted back to
pre-CRT vision.

Good luck!

Hello ryatziv-ga,

Thank you for the kind words, wonderful rating, and generous tip. I'm
very glad I could help you out. Maybe I can assist you in the future
again.

Nenna-GA