The International Myopia Institute (IMI) recently published a series of papers detailing the latest evidence on everything that we know about myopia (Wolffsohn et al, 2019). From the development of myopia and genetics to its risks, prevention, and treatment, each topic was covered by a committee of world experts.

There is much that we are still learning about the complexities of myopia, but there is no doubt that the incidence, prevalence, and degree of myopia is increasing. These increases are associated with a higher risk of potentially blinding ocular pathologies, such as myopic macular degeneration (MMD), glaucoma, cataract, and retinal detachment. Because of these serious risks, treatment and management of myopia is the future of eye care, and orthokeratology (ortho-k) will be a significant part of that future.

The IMI section on “Clinical Management Guidelines Report” states, “[Ortho-k] lenses are expected to slow myopia progression by approximately 30% to 60%. Additional benefits of ortho-k include not having to wear vision correction during the day. Some parents also like that they can oversee contact lens wear since lenses are only worn at night.” (Gifford et al, 2019; Hiraoka et al, 2012; Santodomingo-Rubido et al, 2012; Cho and Cheung, 2012; and others. Full list available at www.clspectrum.com/references ).

A recent review article details the use of ortho-k as a means of managing myopia (Lipson et al, 2018). Currently, prescribing ortho-k to manage progression is considered off-label. In this instance, practitioners may prescribe ortho-k for myopia management at their discretion with acknowledged informed consent.

Although there is concern about the safety of ortho-k, recent large-scale and long-term studies confirm that risks associated with ortho-k are small (7.7 events of microbial keratitis per 10,000 patient-years of wear) (Bullimore et al, 2013). Even with this low level of risk, general consensus shows that these risks can be minimized with careful fitting and that follow-up care can ensure patient compliance with wearing schedule, proper lens care process, and good application and removal techniques (Liu and Xie, 2016).

Quality of Life Improvements

Prior to studies on managing myopia, the ortho-k process gained popularity as an alternative to wearing glasses or contact lenses during the day. The main advantage that patients report is an improvement in vision-related quality of life (VR-QOL). Attributes that contribute to this improvement include independence from daytime correction, less activity restrictions, better self-image/confidence, less worry, and clarity of vision (Lipson et al, 2005; Santodomingo-Rubido et al, 2013).

Modern ortho-k has been practiced for the last 25 years and gained a U.S. Food and Drug Administration indication for correcting refractive error in 2002. With an increasing volume of peer-reviewed publications on all aspects of ortho-k, it is gaining recognition among eyecare professionals as well as awareness from the public. More manufacturers, designs, and fitting techniques are available to make ortho-k easier to incorporate into regular practice.

In Conclusion

Given the relationship between myopia-related ocular pathology and the level of myopia, the risk of not managing myopia progression may exceed the risk of any treatment intervention, including ortho-k. In fact, it has become an established part of modern eyecare practice and will continue to grow as a treatment modality. It’s time to embrace ortho-k, bringing it into your practice to benefit your patients’ VR-QOL now and their vision health in the future. CLS

For references, please visit www.clspectrum.com/references and click on document #290.