Computer Assisted Corneal Molding Therapy 

at Eye Center South

(CAST)

        The nickname "CAST" stands for Computer Assisted Corneal Molding Therapy. It is a highly advanced procedure, also known as Corneal Refractive Therapy (or, Paragon CRT®) to reshape the patient’s corneas (the eye's front surface) so that the nearsighted patient will neither require glasses nor contact lenses to obtain good functional vision (20/40 or better). CAST does not require invasive surgery with knives nor does it require the use of a surgical laser.  For additional information, go to the Paragon CRT website: www.paragoncrt.com.  Dr. Gindoff has completed the education and certification program for prescribing Paragon CRT for Corneal Refractive Therapy.

The CAST procedure is best understood when you understand the basic anatomy and physiology of the human eye. A person needs an eyeglass (or contact lens) prescription when his/her cornea is misshapen: it can be curved too flat, too steep, or it can be "out of round" (astigmatism) in relation to the other elements or parts of the eye. This relatively soft corneal tissue produces about two-thirds of the eye's total power to focus light onto the retina (that tissue in the eye that collects the light and sends it to the brain "to see"). By our slightly modifying the shape of the patient's cornea, clear functional vision is restored to the individual.


The fitting procedure usually requires two weeks to a month from start to finish, however, almost all patients will achieve 20/40 visual acuity (driving vision) or better after just one night of treatment.

 

Here's the procedure that is followed:

The patient has a complete and comprehensive, dilated ophthalmic examination. Should this examination show that the patient is likely to benefit from a CAST/Paragon CRT procedure, then we...

Perform a very specialized corneal examination, known as a corneal topography study. In our office, we use the Alcon EyeMap computer topographer which maps in incredible detail the surface features of each cornea. This computer identifies approximately 8,000 different points on the cornea and through some very complex mathematics (calculus), it derives a "road map" of the cornea for analysis by our physicians.

 

Once we have determined that CAST is an appropriate method of treatment for the patient's refractive error, some paperwork will be completed (such as a Consent Form) and the appropriate fees will be reviewed and collected by our office personnel.

Specific corneal molds will be applied to each eye and the doctor will evaluate their centration and molding characteristics.

The molds will be dispensed with an FDA approved care kit. The patient will leave the molds on until he arrives back at this office the next morning.  At that appointment, the patient will learn how to apply and remove the molds.

The doctor will evaluate the fit of the molds on the corneas at the follow-up visit and review any last minute questions.

The patient will wear the molds home from the office and keep them in his or her eyes until the being seen the very next morning. That's right, the patient will sleep with the molds the very first night! Prior to sleeping and upon awaking, instill a drop of contact lens wetting solution or eye lubricant. The patient will wear his/her molds into the office the day following dispensing so that the doctor can see them in place.

During the office visit this next day, the molds will be removed and visual acuity measured. This visual acuity could be AT LEAST 20/40 and in many cases is 20/20! Other specialized tests might be performed at this initial follow-up visit.

Assuming that the patient is seeing as noted above, the patient will not wear his/her molds until either later in the day or merely at bedtime. We allow the patient to notice whether or not his/her vision is regressing as the day goes on...if it is, then the molds will be re-applied; if not, they're merely applied prior to bed. In either case, they should be removed each morning (unless instructed differently by your doctor).

After two or three days there rarely will be any regression and the patient should just wear them prior to bed and removal upon awakening.

The patient will be seen, as mentioned above, on the day following the initial dispensing of the molds.  Then he/she is seen in one week, and after that week, generally he is seen about three weeks.  The doctor will indicate when he needs to see the patient next, however, the patient is usually then released from care and will merely be seen for his/her yearly eye exams.

Since this is a reversible procedure (as opposed to surgical LASIK), the patient will have to wear this CAST molds every night otherwise the eyesight will return to the previously uncorrected values.

We will release the patient from CAST therapy once the eyesight and corneas have stabilized which is usually about a month from the inception of care.   Certain paperwork will be completed once the patient is released from our CAST are. Periodic, annual eye examinations will still be necessary.

Should there be any questions at all, it is VITAL that our office be called at once. We have a 24 hour per day, 7 day per week answering service (941) 378-EYES (378-3937), and if you are out of town, our toll-free number is 800-318-EYES (3937).


Fees Associated with CAST Procedure

    CAST is a process that requires a considerable amount of time, labor and materials, computers, and doctor expertise and training-especially when compared to the "relatively" simple procedure of fitting a contact lens to most peoples' eyes. Therefore, the fees involved reflect this particularly unique process. Besides the benefit of good eyesight without depending upon spectacles, you are free from the considerable annual expense of replacing them. Even though the initial expense may be greater than that of traditional contacts, the long-term expense becomes only a fraction of what might be spent to maintain spectacles and/or contacts especially if the patient is a child or young adult.

Remember that the CAST process takes time and involves a true commitment on the patient's part. Although there is a "quick fix," it takes a fair amount of time for the eyes to "hold" the new shape. This is somewhat like braces in orthodontia. The patient's eyes' health is always of utmost concern to us and the follow-up visits are mandatory for their proper molding and maintenance. We're ABSOLUTELY POSITIVE, if we take you on as a patient, that the end result will be beyond your expectations.

1. CAST evaluation (includes topography, consultation, and any additional tests that the doctor deems necessary to make an appropriate decision to proceed with this form of therapy): $100.  This fee is applicable to the “Professional Fees” as noted below, that is, if the patient elects to become a CAST patient, this fee would be included in the “Professional Fee” for this service.


2. Professional Fees:  $899 ($799 + $100)

3. Solutions may be purchased, when needed, at a 15% discount. CAST molds cost $118 each unless purchased within 30 days of the inception of CAST care, and the laboratory offers a 25% "discount" which we pass on to you, making the second, spare set of molds cost $88.50 each.

Insurance does not, typically, cover CAST and required materials. We will gladly provide you with receipts with the appropriate diagnostic codes so that you may attempt to file a claim with your carrier. In general, however, your costs associated with CAST are tax deductible as a medical expense.