A question that I am often asked is, “What do I need to get started with orthokeratology (ortho-k) in my practice?” The answer has changed over the years as technology has evolved and our profession as a whole has become more dedicated to using ortho-k to combat myopia. The majority of the necessary items are typically found in a standard eyecare practice, such as a slit lamp and a phoropter, but a few may not be so standard.
Tools of the Trade
Topographer Because ortho-k lens manufacturers have become increasingly more sophisticated with their lens designs and fitting tools, it is fairly easy to create a lens for a patient with a few data points gathered from a basic eye examination. Unfortunately, it is nearly impossible to effectively troubleshoot any vision or fit issues without the aid of a post-wear topographical map. These maps reveal common issues such as lens decentration, central islands, and poor treatment zones that could not otherwise be detected (Figure 1). Corneal topography also provides information about the pre-treated cornea that reveals whether a patient is an appropriate ortho-k candidate.
Optical Biometer If ortho-k is utilized in your practice as a form of myopia management, regularly measuring axial length should be strongly considered. Optical biometry is not a mainstay of eyecare practice at this time and may not be a cost-effective investment in the growth stage of your ortho-k endeavors. However, units that combine both topography and optical biometry could make the purchase more attractive.
If purchasing is not an option, establish a relationship with a nearby office or optometry school that has an optical biometer and refer patients for that measurement alone.
Anterior Segment Photography Although this is more of a luxury item, having the ability to photograph a lens fit can be quite beneficial. For example, during the troubleshooting process, a photo speaks volumes to a consultant and can remarkably minimize lens remakes with more challenging cases. Many topographers have anterior segment photo and video capabilities, thus making one unit multifunctional. In addition, several slit lamp adapters are available that can transform a mobile phone into an impressive anterior segment camera!
Contact Lens Magnifier/Loupe This simple tool can make your life so much easier! A contact lens loupe can be utilized to quickly assess ortho-k lenses for scratches and chips. It is also invaluable when determining lens parameters, as many manufacturers etch the parameters onto the lens itself. Unfortunately, patients tend to switch their lenses and/or lose track of which lenses they are wearing. A loupe will help easily identify the lens being worn so that you can get patients back on track. Lastly, most loupes come with a ruler on the flat surface. This tool can be used to verify lens diameter when identifying a lens or duplicating a lens from another practitioner.
The Bottom Line
There is no perfect recipe of equipment to create a successful ortho-k practice. These are recommendations for items that could improve your success rate, efficiency, and standard of care. CLS