Old Greenwich optometrist focuses on unique specialty

February 22, 2019 GMT

GREENWICH — Optometrist Inna Lazar remembers when a professor mentioned a type of contact lens that a patient wears only at night, freeing them to see perfectly during the day without correction.

Her mouth dropped. “Why is no one doing this?” Lazar thought. She decided to try them herself and was pleased by the results. She now offers the technology to her patients at Greenwich Eye Care in Old Greenwich.

The specialty lenses are called orthokeratology, a technology approved by the federal Food and Drug Administration two decades ago.

“People think it’s magic,” she said. “They’re skeptical when they come in, and the next morning, they leave with smiles. It works. It always works.”


The lenses, which do not permanently change the eye, appeal to patients who do not want irreversible eye surgery, Lazar said. They are also ideal for younger patients, who often dislike wearing glasses or contacts during the day, she said.

Orthokeratology has not caught on in the U.S. the same way it has in parts of Asia. In Japan, China and Korea, the technology is widely used, partially because those countries have much higher populations of near-sighted individuals than America does.

But experts say the problem is growing here, too.

In fact, there is evidence of a worldwide myopia epidemic, said Thomas Steinemann, an ophthalmologist, professor and clinical spokesman for the Academy of American Ophthalmologists.

Israel, Australia and some countries in the Mideast and Europe are also seeing higher rates of near-sightedness. “It’s way more common than it used to be in the U.S., and way more common and aggressive in Asian countries,” Steinemann said.

For people who are low- to moderately near-sighted, orthokeratology works well, he said. Over time, the eyes adapt to the nightly flattening, so patients who use overnight orthokeratology can sometimes wear their retainer lenses only once or twice a week.

Many eye doctors offer orthokeratology, but few specialize in it because it requires extra training, extra office visits and extra technology. Lazar is one of three optometrists in Connecticut who focuses on orthokeratology.

Because the treatment is more common in Asian countries, Asian-Americans and Asian immigrants seek out optometrists who specialize in orthokeratology, including Lazar, but the lenses are less known outside of these populations.

“The way people know about this is one patient at a time,” Lazar said. “It’s going to take me 50 years to educate the town of Greenwich.”


The FDA has approved nighttime wear of these contact lenses for daytime freedom, and allows eye care practitioners to decide when children can use them. Data is still being collected to approve a second use for the lenses — to slow the progression of myopia.

There are studies that could change that. A report by the American Academy of Ophthalmology in March 2018 reviewed evidence from 13 clinical trials, 10 of which reported patients’ myopia progression slowed while wearing the lenses. The results were more pronounced in children ages 6 to 8 years old.

Steinemann finds the results promising, but said further studies need to follow larger populations for longer than one to three years to determine whether the lenses truly slow myopia progression, he said.

The study also reminded wearers to be vigilant about hygiene because these contacts could lead to infections.

“It’s a medical device that has to be used properly,” Steinemann said. “Even though contact lenses are relatively safe, they’re not absolutely safe. There’s a risk of vision loss.”

Nature or nurture?

Like Steinemann, Lazar is also seeing evidence of the myopia epidemic within the walls of her practice.

“The near-sighted population is definitely growing in the U.S,” she said. “We have young adults who are more near-sighted.”

Nearsightedness is a combination of nature and nurture, Steinemann said. Myopia is an inherited trait, but the rate at which these vision problems are increasing suggests environmental factors are to blame, too.

Increased near work — such as reading and screentime — as well as less time spent outdoors are two environmental influences that have been associated with nearsightedness in children.

“It could be a lot of this epidemic has something to do with children, at a young age, with very sustained, long, daily use of electronic devices. It could be. I don’t think we know for sure,” Steinemann said.

Lazar sees the effect of technology on her youngest patients: Their tear glands are not exercised because they stare at computer screens, which decrease the blink rate by about 50 percent.

Patients who stare at screens and do not give their eyes a break by going outside or just focusing on something far away can develop digital eyestrain.

Steinemann tells computer users to look at something 20 feet away for 20 seconds every 20 minutes to rest the eyes.

Lazar also has non-medicinal advice — reading real books and spending two hours outside during daylight hours, even just strolling, playing sports or walking a dog.

“The scary part is that we don’t fully understand” the impact of screentime on vision, she said.