• Therapeutic Cataract & Refractive
  • Lens Technology
  • Glasses
  • Ptosis
  • Comprehensive Eye Exams
  • AMD
  • COVID-19
  • DME
  • Ocular Surface Disease
  • Optic Relief
  • Geographic Atrophy
  • Cornea
  • Conjunctivitis
  • Myopia
  • Presbyopia
  • Allergy
  • Nutrition
  • Pediatrics
  • Retina
  • Cataract
  • Contact Lenses
  • Lid and Lash
  • Dry Eye
  • Glaucoma
  • Refractive Surgery
  • Comanagement
  • Blepharitis
  • OCT
  • Patient Care
  • Diabetic Eye Disease
  • Technology

Newton's third law may solve orthokeratology conundrum


Night-therapy orthokeratology is a noninvasive procedure for improving vision by reshaping the cornea.

For several years, the disparity between the pachymetry and topography findings perplexed Jerome M. Garber, OD, FIOS, FAAO, a private practitioner in Old Westbury, Long Island, NY. However, through an epiphany-like revelation, Dr. Garber believes he has identified the explanation, and that it lies in Newton's third law of motion: For every action, there is an equal and opposite reaction.

"A conundrum that tortured me for almost 2 years was resolved by merely understanding simple corneal anatomy and physiology combined with the basic forces of nature," Dr. Garber said. "Ortho-K initiates anterior epithelial flattening, but this induces a steepening response of the posterior epithelial surface and a chain-reaction that continues successively onward through each of the cornea's four other contiguous layers."

Although it seemed intuitive that flattening any material should result in a thinning response, in aiming to collect the measurements to prove this relationship for a paper he planned to present at the 2005 Congress of the International Society of Contact Lens Specialists, he was surprised to find that corneal thickness was not affected by Ortho-K.

Using an ultrasound pachymeter (Corneo-Gage Plus, Sonogage) that determines both epithelial and total corneal thickness, measurements were taken at 30 points across the entire cornea in all patients at baseline and all scheduled follow-up visits (1 week and 1, 3, and 6 months). However, the results were consistent in showing an absence of any change in epithelial or total corneal pachymetry.

Presuming the findings might be due to measurement error, Dr. Garber recalibrated the pachymeter and repeated his research. He also considered poor examiner technique as the explanation, but in speaking to others, he learned his results were being duplicated.

Dr. Garber told Optometry Times, "I was bothered by these findings, which seemed to make no sense, and discussed them extensively with colleagues, engineers, Alex Dybbs, PhD, who designed the ultrasound pachymeter, and anyone who would listen. My epithelial epiphany did not arrive until after my health had begun to suffer because of my frustration."

Related Videos
Adam Alexander, OD, chats with Optometry Times about his AOA e-poster presentation on Miebo
Lorraine Provencher, MD, presenting slides
Megan Cavet, PhD
Nazlee Zebardast, MD, MSc, overviews her ARVO 2024 presentations on glaucoma and polygenic risk scores
© 2024 MJH Life Sciences

All rights reserved.