The relationship between the treatment zone diameter and visual, optical and subjective performance in Corneal Refractive Therapy™ lens wearers1

Abstract

To investigate the stability of the treatment zone (TZ) size during Corneal Refractive Therapy (CRT) over 4 weeks of lens wear, and to determine the relationship between TZ diameter and visual, optical and subjective performance. Twenty-three myopic subjects wore CRT lenses overnight and removed their lenses on awakening. Visual Acuity (VA), subjective vision, refractive error, aberrations and corneal topography were measured at baseline, immediately after lens removal on the first day and 14 h later, and these measurements were repeated on days 4, 10 and 28. The TZ including the central flattened zone (CFZ) and the annular steepened zone (ASZ) was demarcated by the change in corneal curvature from negative to positive and vice versa, using the tangential difference map from the Atlas corneal topographer. After overnight CRT lens wear, the central cornea flattened and the mid-periphery steepened (both p < 0.001). After 4 weeks of lens wear, the CFZ (+/-SE) increased from 3.41 +/- 0.09 mm on day 1 morning to 3.61 +/- 0.07 mm on day 28 morning and the diameter of the ASZ increased from 8.17 +/- 0.16 mm (day 1 morning) to 8.85 +/- 0.14 mm (day 28 morning) (both p < 0.001). From day 10 onwards, the CFZ and ASZ diameter were stable in the morning (p > or = 0.404). Throughout the day, the CFZ became smaller during the first 10 days (all p < or = 0.022), whereas the ASZ diameter remained constant (all p > or = 0.079). There were positive correlations between the CFZ or ASZ and residual refractive error, subjective vision and spherical aberration. The CFZ was also correlated with astigmatism and higher order aberrations, and the ASZ was positively correlated with coma (r = 0.726 to 0.961, all p < or = 0.042). In addition, there were negative correlations between the CFZ or ASZ and total aberration and defocus and between the ASZ and VA (r = -0.707 to -0.953, all p < or = 0.050). The TZ changed during the first 10 days. Its size was associated with VA, residual refractive error, aberrations and subjective vision. The concept of a TZ is a useful metric of visual, optical and subjective performance in CRT lens wearers.