Myopia management has become an exciting topic over the last several years. In my practice, I have recently seen a significant surge in parent interest due to many children partaking in virtual learning. Parents are more concerned than ever about the potential impact of near work on their child’s prescription.
With so many options available to us (most off-label), it is imperative to take a moment and truly think about which myopia management strategy is best suited for each child in your exam chair and for each child’s family. In many cases, orthokeratology (ortho-k) will be the ideal option, but consider the following items before making your final decision.
Prescription and Topography
In the United States, ortho-k lenses are approved for treatment (not management) of up to –6.00D of myopia and for up to –1.75D of astigmatism; but, the prescription alone does not provide the entire picture! Not every patient within that range will be an ideal candidate for ortho-k.
Thoroughly evaluate the baseline topography to further assess candidacy. Specifically, the axial, tangential, and elevation maps will provide a wealth of information about the overall status of a patient’s cornea. The axial map shows a global representation of the corneal shape, which is helpful in grossly assessing corneal astigmatism. This map provides more accurate information about the central cornea, as software algorithms assume a spherical surface both centrally and peripherally. However, the tangential map provides the most accurate representation of the cornea, because details of the peripheral corneal curvature are included in the algorithm. Thus, subtle corneal defects that may exclude a patient from candidacy can be easily identified. Lastly, the elevation map depicts the sagittal height of the cornea and, more importantly, the difference in sagittal height between different areas of the cornea. This can help identify whether a patient needs a single- or a dual-axis ortho-k lens (Lipson, 2019).
Some argue that any age can be appropriate for ortho-k. For younger children (10 and under), parents are thrilled that their child can have clear vision without the burden and responsibility of glasses and/or contact lenses outside of the home. In addition, some parents feel more comfortable assuming full responsibility of lens application, removal, and care. For older children, especially those involved in sports, ortho-k is an ideal alternative to the fuss of daytime correction of any kind during activities; it is especially advantageous for water sports, contact sports, and sports in dusty or dirty environments.
Dry Eye Disease
Although still rare, dry eye disease (DED) is becoming more prevalent in the pediatric population, especially with the increasing use of electronic devices and the advent of virtual learning. Pediatric patients are less aware of DED signs and are less likely to comply with treatment strategies, making them more vulnerable for long-term sequelae. Because ortho-k lenses are worn only overnight, any discomfort that might result from daytime soft multifocal lens wear is prevented.
It has been reported that approximately 30% of children suffer from ocular allergies (Feng et al, 2017). In fact, allergy is the third most chronic disease for children under the age of 18 (Urgacz et al, 2015.) Although the recent addition of daily disposable contact lenses to our myopia management arsenal has been groundbreaking, those patients who suffer from environmental allergies may still report significant symptoms during daytime lens wear. This is likely due to allergens collecting on the front surface of the lens, exacerbating the allergic response. Because ortho-k lenses are worn overnight when the eyes are closed, exposure to external allergens is reduced, preventing the opportunity for heightened symptoms. CLS
For references, please visit www.clspectrum.com/references and click on document #302.