ONE OF THE most common questions about implementing orthokeratology (ortho-k) in practice is how often patients should return for follow-up care and what testing needs to be done. This depends on the intent—ortho-k for myopia management or for temporary correction of myopic refractive error.

Start with an ortho-k consult to assess whether the patient is a good candidate. If they choose to move forward, do the evaluation that day, if time permits, or schedule for another day. Next, schedule an ortho-k class to review the care regimen and application/removal techniques. Finally, schedule one-day and two-week follow-up visits.

MAKE IT EXCITING!

At the one-day visit, talk about how the first night went and what kind of visual improvements they noticed. While we typically do not make any design changes at this visit, it is invaluable from a practice management standpoint.

Review everything with parents, commend patients on how well they are doing, and explain how things will continue to improve. Collect clinical data to see how the patient has responded to treatment.

1. Unaided Visual Acuity  Show the amount of improvement from pre- to post-treatment in the patient’s unaided vision after just one night; depending on the amount of initial refractive error, expect anywhere between 30% and 60%.
2. Manifest Refraction  A non-cycloplegic refraction is done to determine any residual refractive error. Retinoscopy can also be crucial to get a more objective measurement. Typically, we dispense loaner glasses or daily disposable lenses for any residual refractive error until full correction is achieved.
3. Corneal Topography  Axial, tangential, refractive, and difference maps are assessed to visualize centration and treatment effect of the ortho-k design.
4. Anterior Segment Evaluation  Slit-lamp evaluation checks for any damage to the ocular surface and includes assessment with fluorescein dye to ensure there are no signs of keratitis or epithelial defects. It is not uncommon to see trace amounts of superficial punctate keratitis (SPK). A review of care regimen and use of preservative-free rewetting drops is important. Greater than 1+ SPK can be a sign of inappropriate design or poor fit.

Review the care regimen protocol. We call it our “Day One Quiz” and always praise patients for how well they remembered the protocol; if parents allow, we give them a prize or treat as a reward.

ALL SMILES

During the two-week follow-up visit, perform the same assessments.

1. Unaided Visual Acuity  Praise the patient again on how well they are doing, comparing pre- to post-treatment.
2. Manifest Refraction  Another non-cycloplegic refraction is done. Again, retinoscopy can be helpful to get a more objective measurement. Expect anywhere from 80% to 100% refractive error correction.
3. Corneal Topography  This is repeated to check for centration issues as well as proper refractive error correction. Axial, tangential, refractive, and difference maps are reviewed again, looking for a full bull’s-eye pattern.
4. Anterior Segment Evaluation  Slit-lamp evaluation is done again to make sure there is no ocular surface damage. No staining should be noted at this visit; if it is, design changes may be required.
5. Over-Refraction  Have patients put on the retainers and check for over-refraction. This can help determine whether any base curve miscalculations have occurred. For most designs, expect anywhere from a plano to +1.00D over-refraction.
6. Fluorescein Assessment  Instill fluorescein, have the patient wear the retainers, and assess the overall fit under the slit lamp. The fluorescein pattern in combination with the topography aid in making design changes. If design changes are required, we typically will see the patient in two to four weeks until desired results are achieved.

CONFIRMING TREATMENT SUCCESS

Once a final design is confirmed, schedule a one-month follow-up visit to ensure that patients are doing well and have no ocular surface or vision issues. During this visit, the same assessments will be repeated to ensure that the ortho-k treatment has achieved the desired outcome. Many patients are referred for ortho-k, so we send them back to their referring physician for ongoing primary care and monitor the retainers annually. CLS