Refractive Changes From Hyperopic Orthokeratology Monovision in Presbyopes

Purpose. To investigate the time course of refractive and corneal topographic changes in overnight hyperopic orthokeratology (OK) for emmetropic presbyopes. Methods. Sixteen adult emmetropic presbyopic subjects were fitted with rigid hyperopic OK lenses (BE Enterprises, Brisbane, Australia/Capricornia, Slacks Creek, Australia) targeted to correct + 2.00 D, in one eye only. The fellow eye acted as a non-lens-wearing control. Thirteen subjects completed the study. Lenses were worn overnight for a 7-day period, and changes in subjective refraction and corneal topography were measured in the morning on lens removal (A.M.) and 8 hr after lens removal (P.M.). Results. There were statistically significant changes from baseline in all variables at all visits in lens-wearing eyes. Hyperopic OK caused a -1.00 (0.33) D shift in best vision sphere refraction at Day1 A.M., and -1.11 (0.61) D, at Day7 A.M., with -0.91 D of best vision sphere change from baseline still apparent by Day7 P.M. (mean [SD]). This led to an improvement in monocular near visual acuity (VA) from Jaeger 10.8 (2.4) at baseline to Jaeger 4.6 (2.5) at Day1 A.M., Jaeger 3.2 (2.3) at Day7 A.M., and Jaeger 3.9 (3.0) at Day7 P.M. Binocular distance VA did not change from baseline. The central cornea steepened, and the mid-peripheral nasal cornea flattened at lens removal after one night of wear. There was no significant difference in central corneal steepening between A.M. visits, but there was longer retention of effect by Day7 P.M. Nasal paracentral corneal flattening also showed a greater effect and longer retention of effect by Day7. Conclusions. Hyperopic OK induced central corneal steepening and paracentral corneal flattening, which led to a monovision myopic shift in refraction that was sufficient to provide functional correction of near vision. Lack of change in binocular distance VA indicates that hyperopic OK offers a viable option for providing monovision correction in emmetropic presbyopia. (Optom Vis Sci 2013;90:306-313)