DUE TO THE numerous benefits of orthokeratology (ortho-k), it is a highly sought-after option for those seeking myopia management. For many young patients, ortho-k is the holy grail—excellent vision without the need for daytime correction and reduction in myopia progression. Unfortunately, there are occasional barriers to patient success—one of the most common being application and removal challenges.

A major advantage of ortho-k is the potential parental role in application and removal; in some cases, however, even the best parental support may not be enough. This is particularly true for very young patients and for patients who have exceptionally sensitive eyes. Looking at this process from a child’s perspective—a hard lens that is slept in—it is totally understandable why children could be fearful and intimidated.

The trick is to provide a calm and reassuring environment and conquer the initial application of the lens. For most kids, once the lens is on for the first time, they quickly realize that the experience is far less frightening than they imagined.

TIPS TO EASE THE DISPENSE

Here are some tips to ensure success with dispensing ortho-k lenses:

• Avoid certain words that could trigger fear. When describing the lenses, refrain from calling them “hard lenses.” Refer to them as “rigid” or even “custom” lenses. In addition, when describing how the lenses feel on the eye, use words like “awareness” in lieu of “uncomfortable.” Words are powerful, especially when describing a novel concept, so choose very carefully.
• While in the office, allow the child to handle a demo lens. Often, the patient will be surprised at the small diameter and the fact that the lens is fairly flexible and not actually that “rigid” after all.
• Send home written instructions and a tutorial video to ensure the parent and child are comfortable with the logistics of application and removal. This introduction will empower the family and the child, which will help ease their nerves on dispense day.
• Have the child or parent practice gently touching the conjunctiva at home after thoroughly washing hands. This prepares the child for the initial sensation of the contact lens and, hopefully, will prevent a strong blink reflex on dispense day.
• Instruct the child or parent to instill one drop of an artificial tear on the ocular surface before bedtime. This exercise increases the child’s comfort level with something touching his or her eye and potentially decreases sensitivity.
• If your ortho-k lens manufacturer allows you to order different colors, allow the child to choose two different colors for his or her lenses—a different color for each eye. You will be surprised how excited this makes your pediatric patients!
• Do not assume that the child wants his or her parents to apply and remove the lenses. Some children perform much better when they are in complete control of their environment. In addition, some prefer to be involved partially but not fully. For example, the child may want to secure the lids while the parent applies and removes the lenses, or vice versa. The key is to create a smooth, seamless protocol regardless of who’s in control.
• Incentivize your patients! Most kids will do remarkable things for a nominal prize; have a treasure box full of inexpensive but attractive toys and allow the child to choose one after they have mastered application and removal in the office.

MAKE A DIFFERENCE

Initiating some or all of these suggestions prior to the dispense visit can make an extraordinary difference. Even the most fearful child will likely present back to the office confident and excited to start this new journey with you. CLS