Recently, a colleague referred a seven-year-old patient to me. The child’s prescription had progressed from a -1.50D to a -2.25D in the last year. Her family expressed concern over the progression of myopia and the difficulty she had wearing glasses or sports goggles while participating in swimming and Taekwondo. The patient’s mother had happily worn GP lenses for several years and had laser vision correction a few years prior to this consultation with her daughter.
If this sounds like a dream scenario for fitting ortho-k lenses, you would be correct. A parent with a history of success with GP lens wear can appreciate being free of corrective lenses and offer strong parental support. An active child with incentive to get rid of awkward corrective lenses is inclined to make orthokeratology work. Finally, the concern over the progression of myopia presents the opportunity to discuss current research indicating how ortho-k may be able to slow the disease advancement.1-3
Arguments Against Ortho-K
Why don’t more practitioners offer orthokeratology to their patients? I can only think of a few valid reasons. Perhaps the practitioner believes that it is difficult to fit ortho-k lenses. In reality, fitting ortho-k lenses is as easy as fitting a standard GP lens. All you need to do is take the time to go through a tutorial. The fitting protocol is a straightforward, step-by-step process that utilizes a decision tree to help get to the optimal fit.
Another common deterrent may be the hesitation over discussing the cost with patients. I suggest presenting the orthokeratology option to your patient and guardian while being up front about the fees (including the material costs), the amount of testing and the follow-up protocols. Bring in a technician if you need help with the consultation. If the patient or parent declines the procedure, look at other options. However, you will likely find that, more often than not, people want to weigh the costs against the benefits of the procedure.
Finally, I know some practitioners are concerned about overnight lens wear and its impact on ocular health. I can partially understand the validity behind this argument, but it is no different than avoiding any other means of correcting vision. The incidence of complications from overnight ortho-k have not been well-established, but every indication suggests that it is comparable to daily soft lens wear and laser vision correction. The argument is more of a personal decision than a scientific question.
Arguments For Ortho-K
For a moment, let’s assume orthokeratology may slow the progression of myopia in growing children. It is a recognized fact that corrected vision during waking hours without wearing lenses is desirable. Consider the advantages of sending your kids off to school without worrying about what will happen should they rub their eyes and have a contact lens come out, or break their glasses. Let’s look at the cost of ortho-k vs. the real benefits. If we say that the risks of ortho-k are comparable to any other forms of vision correction as evidence suggests, then why are we not fitting a substantially higher percentage of our patients in ortho-k?
By not offering ortho-k as an option to our potential candidates, we are depriving them of the chance to keep their prescriptions lower and in turn, saving money. Ortho-k may help make them a candidate for refractive procedures—which might otherwise not be an option due to their higher prescriptions. Some of our patients, like the swimmers, need to be given an alternative so they don’t jeopardize their eye health by wearing soft lenses in the water. For those who can afford the cost, we should not deny them the choice of this method of correction.
Orthokeratology is an innovative method of correcting vision (see “Recession-proof Your Practice,” Review of Optometry, February 2011). The benefits are even greater than just the convenience of not needing daytime correction. I myself am about to offer ortho-k to a happy, soft lens-wearing 10-year-old patient who has progressed a half diopter in the last 12 months. By the end of a 10-minute discussion, his mother was convinced. And so was I. What is holding you back?
1. Chan B, Cho P, Cheung SW. Orthokeratology practice in children in a university clinic in Hong Kong. Clin Exp Optom. 2008 Sep;91(5):453-60.
2. Kang P, Swarbrick H. Peripheral refraction in myopic children wearing orthokeratology and gas-permeable lenses. Optom Vis Sci. 2011 Apr;88(4):476-82.
3. Walline JJ, Jones LA, Sinnott LT. Corneal reshaping and myopia progression. Br J Ophthalmol. 2009 Sep;93(9):1181-5.