Orthokeratology (ortho-k) can be a life-changing treatment; but, unfortunately, many patients will not qualify. The three Ms—measurements, maturity, and motivation—can serve as a useful tool when determining whether a patient is an appropriate candidate.

The Three Ms

Measurements When assessing eligibility, the two most important measurements are refraction and keratometry values (Figure 1). In the United States, ortho-k is approved by the U.S. Food and Drug Administration for up to –6.00D of myopia and up to 1.75D of astigmatism (Lipson, 2019). For best success, it is recommended that practitioners abide by these guidelines. Although success outside of these parameters can absolutely be obtained, it would be considered off-label, and patients and parents must be fully informed and written consent documented. Keratometry values are typically obtained either from a keratometer or a topographer. Currently, there are no documented guidelines on appropriate keratometry values for ortho-k. Thus, practitioners must consider the amount of corneal flattening necessary to achieve the desired end result and determine whether the resultant keratometry values are appropriate for continued ocular health.

Maturity Ortho-k is most attractive to patients seeking freedom from daytime correction and for parents who desire a treatment regimen that is exclusive to the home environment. For this reason, ortho-k is a popular choice for young children. However, some patients will have a genuine fear of the idea of putting any kind of lens on their eye, and overcoming this fear boils down to their maturity level. For some children, a simple conversation along with in-depth application and removal training will result in success.

On the other hand, for the most fearful children, no amount of talking or training will change their mind. Although ortho-k has many benefits, the goal is to not create stress. If children are initially unsuccessful, do not force the treatment. If the parents are motivated, which they usually are, schedule a follow up in three-to-six months. This will allow time for the children to mature a little more and to adapt to the idea of ortho-k.

Motivation Lenses must be worn on a regular basis for ortho-k to provide adequate vision and myopia control. This is rarely an issue for younger children due to the parental involvement with application and removal, but it does become an issue for older children and teenagers. Motivation to wear the lenses properly and consistently must be determined prior to prescribing ortho-k. Clearly delineating the expectation that the lenses must be worn nightly is key, as some patients will admit that the necessary commitment is unlikely, in which case another form of correction should be chosen.

In other cases, a little more probing must be done. Asking patients about their nighttime routine and whether they are consistent with flossing/brushing is a good indicator as to whether they will maintain the motivation necessary for success.

Achieving Success

Take an extra moment to determine whether the treatment modality that you choose is the most appropriate; this can save us and the patient time and energy in the long run. CLS

For references, please visit www.clspectrum.com/references and click on document #314.