This article was originally published in a sponsored newsletter.
Practitioners face unique challenges in managing orthokeratology (ortho-k) patients who transition between practices. Refitting, washing out, and replacing lenses can become crucial, especially with the increasing mobility of patients. Colleagues may refer myopia management patients, and individuals may relocate, sometimes with lenses that are either poorly fitting or no longer available.
The Ideal Patient Transfer
In an ideal situation, patients transferring to a new practice are satisfied with their vision, exhibit clear corneas, and maintain stable refraction. Having access to previous records or measurable lens parameters allows for a smooth transition into a new lens design. Without previous records, suspension of lens wear for two to four weeks, which is termed washout, may be indicated. Discontinuing ortho-k wear allows the cornea to return to a new baseline to begin the refitting process.
Pro Tip: Changing only one or two major parameters at a time simplifies troubleshooting.
The Patient Who Should Be Doing Better
Patients who initially thrived with ortho-k may experience reduced visual acuity during follow-up, which is often caused by incomplete treatment as indicated by corneal topography. Before considering a washout period, practitioners should investigate factors such as inconsistent lens wear, lack of sleep, or missed nights of wear as potential reasons for their symptoms.
Pro Tip: Inquire about the patient’s wearing schedule. If the patient is a child, involve the parents in ensuring the lens is in the proper position before going to bed at night.
Indications for Washing Out
The following are situations in which a contact lens washout period may be recommended.
No Original Refraction and Ks Inaccurate or undisclosed patient information necessitates a washout. Baseline topography mismatches may prompt a reevaluation of treatment.
Recalcitrant Epitheliopathy Despite proper care, some corneas exhibit persistent superficial punctate keratopathy. Adjustments in correction to increase sagittal depth between the cornea and lens may help. If the changes resulting from those adjustments are insufficient, this may lead to a washout.
Undercorrection Patients who seemingly becoming more myopic may require practitioners to take axial length measurements to determine whether this is myopic creep. In these cases, certification of consistent lens wear and reassessment of initial refraction accuracy are crucial.
Washout Methods
Two approaches exist for patient washout. One is complete cessation. With this approach, patients stop wearing ortho-k lenses, potentially using disposable soft lenses or their previous glasses temporarily as their corneal topography rebounds. The other is sequential washout in which one eye undergoes washout while the other continues ortho-k wear, followed by refitting and subsequent washout of the second eye.
Determining Washout Completion
Completion is defined by two consecutive visits at which refraction, Ks, and topographies align with previous records (if available). The duration varies but can range from 14 days to several months, depending on factors like the patient’s age, treatment magnitude, and corneal stiffness.
Washing out an ortho-k patient should not be seen as a failure, but instead as a necessary step in the corneal reshaping practice. Despite the added effort, practitioners are rewarded with successful, satisfied patients who appreciate the extra steps taken for their vision care. Patient transitions in ortho-k require strategic decisions, balancing when to hold and when to fold, ensuring optimal outcomes.
