As I sat across from one long-term orthokeratology (ortho-k) patient, I could not believe how quickly time had passed. He was one of my first patients. At one time, his feet did not reach my exam chair’s footrest; now he towers over me. I have to adjust my eye chart upward to align with his line of sight.

In an effort to slow his myopia progression, I fit him with ortho-k contact lenses when he was in fourth grade. The evidence of its efficacy at the time was only anecdotal, but his father was adamant: he wanted to do something to help stop his son’s eyesight from deteriorating further. The patient began wearing eyeglasses in second grade, and by age 10, his prescription had progressed to –2.00D OD and OS.

He’s now one of thousands of patients whom I’ve fit over the past two decades. I co-authored a study (Ramdass et al, 2016) retroactively evaluating my ortho-k wearers to see whether they had progressed slower compared to the average eyeglasses wearer. This young man was patient #1 in the study. The results, after reviewing hundreds of records, showed that the rate of progression of children fit with ortho-k lenses was –0.13D per year on average, compared to the frequently referenced –0.50D per year for spectacle wearers. In this young man’s case, he started ortho-k at –2.00D and stabilized at –3.00D.

Amazingly, he still wears ortho-k lenses today at age 31. The only challenge that I’ve faced with him and with hundreds of other ortho-k wearers is that their careers take them far and wide, away from my office, making follow up more difficult. Gone are the days when I first fit him and his parents were so focused on his ocular status. I recall his mother frequently asking in the beginning when her son’s discomfort would subside, or when he’d stop breaking his lenses, or when the halos that he saw around lights would abate. At each visit, his parents would inquire as to whether his eyesight had deteriorated. Since then, his parents’ concerns have transitioned from myopia progression to high school graduation, college grades, housing, careers, and, most recently, to marriage! Everyone—except my recall manager and my inner voice—has forgotten the fact that throughout it all, he has continued to sleep wearing his lenses.

Don’t Allow Complacency

Ortho-k poses a challenge unlike any other optical correction that we prescribe: children mature into adults who are accustomed to wearing contact lenses that require very little maintenance. This very advantage often mistakenly leads patients to believe that they don’t need routine vision care. Here are lessons that I’ve learned to avoid losing our ortho-k wearers to follow up:

1. Have parents sign an acknowledgement, at the application/removal class, that the Centers for Disease Control and Prevention (CDC) states that sleeping with contact lenses puts them at greater risk of infection, with potential for vision loss.
2. Recall them yearly, reminding them again of the CDC’s warning.
3. If more than two years pass, implement a policy to refit them, adding financial pressure to return, or transfer their care appropriately.
4. Assign a staff member to track them down via the parents.

As myopia management becomes mainstream, most practitioners are focused on prescribing what’s best for arresting children’s myopia. However, decades of experience has taught me that that’s only the beginning. Ortho-k allows our patients to see clearly without eyeglasses during the day and requires them to reapply their “retainers” only nightly. These retainers can last years, possibly exposing patients to preventable vision loss. So, start with that end in mind: that myopia management requires diligent follow up, far more than what our traditional patient base requires.

By the way, my patient’s name is Nicholas, and he happens to be my son. I finally caught up with him during a family reunion and, despite his objection, dragged him into my office; it had been almost two years since I last examined him. He said, “Dad, I see just fine.” That’s where the danger lies. CLS

For references, please visit www.clspectrum.com/references and click on document #300.