My nine year old daughter has type 1 diabetes. A few days ago, we found she is also slightly nearsighted. Her mom and I are also both nearsighted. We have heard of orthokeratology, a non-surgical contact lens program to control the progression of or temporarily reduce or eliminate myopia. Do you think people with diabetes can try this?

This is an excellent question. Orthokeratology has been around for about 35 years, but improvements in rigid contact lens design and manufacture have made the process much better. In the U.S., several different lenses are Food and Drug Administration (FDA) approved for overnight corneal reshaping (e.g. Paragon Vision Science’s CRT lenses). Patients sleep in the lenses and are able to see clearly throughout the day before lenses are re-inserted the next night and, after a while, several nights later. Nearsightedness (myopia) is due, in part, to the cornea (the clear windshield of tissue at the front of the eye) being too convex (too curved) and these lenses are designed and fit to reduce that curvature. Long-term studies have shown the process to be safe and reversible. The biggest risks are corneal abrasion and, rarely, corneal infection which, if not treated aggressively, can lead to scar tissue and vision loss.

My concern for a patient with diabetes undergoing this process is the fact that high blood glucose can weaken the adhesions of cells on the front surface of the cornea (the corneal epithelium), making corneal abrasion more likely. A hyperglycemic environment may also promote the growth of certain bacteria and fungi, increasing the risk of infection.

Depending on the amount of your daughter’s prescription, orthokeratology does work and, in truth, the risk of her having a corneal complication due to diabetes is lower now than it ever will be because she hasn’t had diabetes that long (the rule in diabetes is always “the longer you’ve had diabetes, the higher the risk of complications.”) If your daughter has good blood glucose control (glycosylated hemoglobin less than 7%), good hygiene and is responsible, she would most likely do very well. I would strongly recommend that you see someone who specializes in orthokeratology/CRT and be especially vigilant.

However, if my child were nearsighted and had type 1 diabetes, I would not pursue orthokeratology; I would recommend conventional rigid contact lenses because they are far less likely to abrade the cornea and will slow down (though not reverse) the progression of her nearsightedness over time.

PC