August 23, 2003.
New therapy correction for nearsighted vision offers alternative to LASIK eye surgery.
It's 10 p.m., bedtime for Elsye Gieseman of Ames. She brushes her teeth and puts in her contacts. Then she climbs into bed for a restful night's sleep.
The next morning she takes out her contacts. She is ready for her day to begin - a day of great vision without the use of glasses or contacts.
Gieseman, along with numerous others, is taking advantage of a treatment called corneal refractive therapy, using a product called Paragon CRT. It's a hard contact lens especially designed to temporarily reshape the cornea while the wearer sleeps. The contacts, worn at night, are a non-invasive, non-surgical way to correct myopia, or nearsightedness - with or without astigmatism.
"I was a little nervous about this at first, and it took a couple of weeks to get used to the contacts," said Gieseman, who has needed the aid of eye correction since elementary school. "Now I am seeing all day (without contacts) and not having to worry about things popping in or out of my eyes. I do a lot of biking and outdoor activities and there is a lot of dust. I just wanted to eliminate the whole glasses thing."
Kristian Dugger, an optometrist at McFarland Clinic in Nevada, has been working with a number of patients such as Gieseman who are candidates for the night-time lenses.
"These lenses reshape the cornea in the same manner that LASIK surgery does," Dugger said. "The surgery zaps the (corneal) tissue, while the contacts change the shape. It is just one more option for people to correct their vision."
Dugger said the new product is now available because of clinical research that has combined corneal surface mapping technology, computerized manufacturing and space-age oxygen-breathing materials. But in everyday terms, it means using hard contact lenses that allow the eyes to breathe and be reshaped - much like a night-time retainer for the teeth changes their alignment.
The lenses are placed in the eyes at bedtime and taken out in the morning. This allows the wearer to have clear vision during the day without any other correction.
Reshaping the cornea is not a new concept; it is just the technology that has advanced. Currently seven optometric physicians at McFarland Clinic are certified to use the product. They serve patients in two Ames offices, Boone, Story City, Nevada, Marshalltown and Iowa Falls.
Not everyone qualifies for therapy correction. Dugger said the night-time lenses are designed for individuals with low to moderate nearsightedness in the corrective range of -0 to -6. Most success has been in lower ranges, but some patients at the higher end have also had success. The therapeutic lenses are not for those who need bifocal prescriptions or have farsightedness.
"It is definitely cosmetic," Dugger said in talking about why people would want to use the therapy. "But the contacts are also functional. You get youngsters who want to be active in sports or adults who cannot wear contacts because they work in dirt or dust."
He said the therapy works well for people who play sports, work in a dusty or windy environment or simply apply make-up. He said the therapy is safe and effective for patients of all ages, and the results are no more torn or lost lenses, no more broken frames and no more discomfort from dry eyes.
Dugger said the therapy's results are ongoing and temporary. There is no permanent change to the eye and the patient has control and flexibility in their vision correction. If the patient stops wearing the lenses regularly, the cornea will return to its original state in as little as 72 hours.
Most people have rapid improvement of vision in the first few days, achieving nearly optimum vision in 10 to 14 days. Dugger said there are some risks, but these are no greater than what could be expected from any other contact usage.
How does the cost compare with other eye treatments?
Dugger said a pair of glasses can cost $300 to $500. The corneal refractive therapy is about $1,500. And lasic surgery is about $4,000.
Gieseman said she made the choice to go with the Paragon CRT because it was a lot cheaper. She had been debating whether to have LASIK surgery when she read about the CRT therapy in a brochure at her office. Since she began using the CRTs, she has experienced very little discomfort.
"You can feel the contacts," she said. "But I have worn contacts during the day, so it was like second nature. It is nice not to be chained to everyday contacts. And you don't have to worry about losing them in the middle of the day."
Not everyone agrees that the Paragon CRTs are the end-all product.
Louis Scallon, an ophthalmologist at the Wolfe Clinic in Ames, emphasized that the product is only temporary. He and other Wolfe colleagues are not using the product at this time.
"(The lenses) haven't always been comfortable for the patients, and they are pretty limited to the number of people you can help," he said. "And I'm still not convinced the lenses are healthy."
Scallon said the new products are much improved, but his concern is still that the lenses do not allow enough oxygen to get to the eye.
"There can be some swelling and infection, and I just feel they are not that healthy," he said.
He recommends LASIK surgery to his patients because it is a permanent fix. He said daytime contacts are much safer and it makes more sense to wear them because people are awake and can blink, which allows a greater flow of oxygen to the eyes.
"There are risks and limitations, but I don't want to totally negate them," he said. "People just need to look at all the options."
Dan Koenig, who's an optometrist at McFarland Clinic in West Ames and certified to fit Paragon CRT, said the corneal refractive therapy program is a good alternative for people who are in the right parameters and who may be nervous about LASIK surgery. Ideally, he said those with lower prescriptions will have faster results in terms of their rate of correction and the amount of time needed to wear the contacts during sleeping hours.
Koenig said the therapy was FDA approved last February. For the right candidate, it can be a good alternative to daytime contacts and spectacles. He said it is definitely not for everyone.
"And it is temporary - with LASIK, once it's done, it's done," he said. "What if it doesn't work? The CRT is 100 percent reversible. If a person is legally blind and can see with this correction, that's truly amazing. It is just another weapon in the battle against refractive error needing correction."
©Ames Tribune 2003.
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