Epithelial, Stromal, and Corneal Pachymetry Changes during Orthokeratology

Purpose. To describe epithelial, stromal, and corneal thickness profile changes induced by orthokeratology treatment. Methods. This is a case report of a mild myopic patient (OD -3.25/-0.50 x 172 and OS -3.25/-0.50 x 45) treated with orthokeratology lenses. The patient was assessed before treatment (following 2 weeks of no orthokeratology contact lens wear) and during treatment (after 30 consecutive nights of wearing orthokeratology lenses). Epithelial, stromal, and corneal thickness profile in vivo was measured by Artemis very high-frequency digital ultrasound scanning across the central 10 mm diameter of the cornea before and during orthokeratology treatment. Manifest refraction, contrast sensitivity, corneal topography, and corneal front surface aberrations were also measured before and during orthokeratology treatment. Thickness changes were correlated with corneal topography changes and corneal front surface aberrations changes. The effects of these changes on the patient's quality of vision were measured with manifest refraction and contrast sensitivity. Results. Orthokeratology lenses effectively corrected the patient's myopic refraction. Corneal topography demonstrated typical central flattening and an annulus of mid-peripheral steepening in both the eyes. The epithelial thickness profile was altered, with up to 18 mu m of central epithelial thinning and up to 16 mu m of annular mid-peripheral epithelial thickening. There also appeared to be a degree of stromal changes, with central stromal thickening and mid-peripheral stromal thinning, in particular in the left eye. There was a large increase in higher order aberrations, in particular in the left eye. This was associated with a decrease in contrast sensitivity in both the eyes. Conclusions. Refractive changes during orthokeratology treatment are mainly induced by changes in epithelial thickness profile, while stromal changes may also contribute to a small extent. (Optom Vis Sci 2009;86:1006-1014)