A Message From Dr. Maller
In this installment of the No Blur! Eyemail I would like to mention the GOS.
GOS stands for the Global Orthokeratology Symposium. Although the art of
Orthokeratology has now extended past the four decade mark, this incredible
procedure is still generally unknown to the public. In the summer of 2002,
the very first GOS took place in Toronto, Canada. It was an international
meeting of minds all practiced and dedicated to the art of
Orthokeratology. Over four hundred physicians from
seventeen represented countries around the world for the first time in
history were all together in one place discussing Orthokeratology. Everything
from the scientific research to the clinical management of patients. Although
I have been performing Orthokeratology for almost fifteen years now, I don't believe
that I can relate the feeling that I experienced in discussing face-to-face,
my ideas with my colleagues from Australia, China, and the United Kingdom.
The free exchange of ideas and concepts crossing over international borders
brings a wealth of benefits to patients around the world who are interested in
this incredible procedure that we refer to as
Orthokeratology. I sincerely believe that more was accomplished to advance the art
of Orthokeratolgy in that short week than has been done in the past decade. In 2003
the GOS was unfortunately cancelled due to the SARS epidemic but once again in the
summer of 2004, the second GOS was held. At this meeting over six hundred physicians from
thirty-seven countries were present. Again, an enormous amount of information was
exchanged amongst all of those in attendance. I believe that the increase in
attendance is a signal that Orthokeratology has finally come of age. Orthokeratology
should in the near future be finding its way more into mainstream treatment modalities,
and I would expect public consumption of this procedure
to rise dramatically. After forty years, I would have to say, it is about time! I
am already looking forward to the GOS 2005. The future of Orthokeratology is looking
very bright.
Dr. Maller
Infections Following Lasik
Although the rate of infection after a Lasik procedure is very low, a recent study looked at
this problem. It is believed to be, based on the reporting, as high as 1.2%. The study also
looked at its effects on vision and showed that when infection occured the quality of vision
was affected moderately to severely in just about 50% of the cases. Possible improvement
on visual outcome was shown by performing a flap lift and repositioning within three days. Depending
on the organism involved, the infections would show up as early as the first few days or even well
into the second week or later. The latest generation antibiotics that are now being routinely
used should help decrease this infection rate.
Retinal Complications after Lasik
Although Lasik complications do not often involve retinal problems, when the retina does
get involved the complications can be very serious. Dilated fundus examinations are important
prior to Lasik as well as after Lasik, especially if the level of acuity is not as it as
expected. A study recently done looked at the involvement of retinal complications associated
with Lasik based on several retrospective studies as well as case reports. Among the complications
noted are retinal breaks, retinal detachments with a tear, and choroidal neovascularization. One of the
studies cited, showed that after the retinal complications and subsequent retinal surgical treatment for
repair, 45.8% lost two or more lines of acuity. Studies such as this continue to emphasize the
importance of continued comprehensive eye care following Lasik surgery.
COMET - Correction of Myopia Evaluation Trial
In discussing myopia progression in children with their parents I will discuss gas permeable lenses, Orthokeratology,
and Progressive Addition Lenses (PAL) in spectacles. The parents are often surprised at my recommendations for
contact lenses since their children are so young and I absolutely draw stares when I mention that if contacts
are not chosen (gas permeable lenses or Orthokeratology) I am going to prescribe a Progressive multifocal pair of
glasses. The response that I usually receive is "Bifocals for my child?" The results of the COMET, which included
469 ethically diverse children ages six to eleven, showed that Progressive Addition Lenses in addition
to correcting their vision may have the additional benefit of slowing the myopic progression. I will still
continue to recommend gas permeable contact lenses and Orthokeratology as my preferred method of treatment in
children with progressive myopia but studies like COMET show that PALs may also be a viable option.
Message from Dr. Maller
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