This article was originally published in a sponsored newsletter.

Most parents are excited about utilizing orthokeratology as an option for their child’s vision correction and myopia management. When I encounter pushback from parents though, it often involves hesitation about their child’s readiness for wearing and caring for their contact lenses. As a fellow parent, I can appreciate their concern around introducing something like contact lens wear to a young child. However, armed with the knowledge that the age of myopia onset correlates to the risk for high myopia¹ and subsequent ocular pathology, I focus my conversation with parents on decreasing long-term risk of ocular pathology. We can ease parents’ apprehension by teaching them how to prepare their child for successful lens wear, handling, and care.

Child Readiness for Lens Wear

Naturally, children will be hesitant to let someone touch around their eyes and attempt to place a lens on the ocular surface. That doesn’t mean the child isn’t ready for the use and benefits of orthokeratology! Set the child up for a smooth application and removal training session by asking them about their experience wearing glasses during their favorite activities and proposing that they could do everything, including those activities, without glasses.

Next, consider beginning the process of application and removal training by teaching some at-home techniques to decrease eyelid sensitivity so the first approach at handling the eyelids isn’t with a new lens in hand during a busy clinic day. First attempts at application and removal should be without a lens to show young patients what it feels like to pull the lids away from the eye. Then move on to practicing placing an artificial tear drop in the eye, or even have the child hold their own lids while looking in a mirror. Any practice to decrease eyelid sensitivity will build patients’ and parents’ confidence for the actual dispensing visit. These techniques show parents that we are both prepared for and experienced with working with young new contact lens wearers, and can help ease their apprehension about initiating the process.

Lens Handling

Before placing the lens on-eye for the first time, review the techniques from the consultation visit. Explain everything to the child and parent first, so they can ask questions or share how they are feeling. Remind them that the lenses are less noticeable with closed eyes, so as soon as the lenses are placed, have the child rest with their eyes closed for a few minutes. If needed for the lens evaluation at the slit lamp, apply a drop of anesthetic. By the time the assessment and over-refraction is completed, just enough of the anesthetic effect will remain to assist with the initial application and removal training.

The Contact Lens in Pediatrics (CLIP) study group demonstrate that young kids can safely wear, handle, and care for soft contact lenses and, on average, take only 15 more minutes of chair time compared to teens.²While this study was on soft contact lenses, clinical experience shows similar results with orthokeratology lenses, and parents are often impressed by their child’s ability after just a single training session.

Lens Care Compliance

Given the overnight aspect of orthokeratology lens use, proper lens disinfection and compliance with provider instructions is key to successful wear. Parents must be educated on the risks to fuel their compliance at home. Microbial keratitis is the most serious complication with orthokeratology lens wear, and the main risk factors include poor care system compliance and continued use of the lens despite discomfort.³ To keep families confident and compliant at home, teach both children and parents proper lens care, even if the parents are familiar with the care system prescribed. This instruction includes care system directions, cleaning and replacement of tools like the lens case and plungers, and proper avoidance of tap water. Thankfully, most adverse events related to ortho-k lens use are not serious and can often be remedied with a lens adjustment or solution change, like corneal staining or lens binding.³

The BCLA CLEAR paper on orthokeratology³ offers a wealth of information on all aspects of safe ortho-k use and serves as a great resource for providers. Access it here.

1. Hu Y, Ding X, Guo X, Chen Y, Zhang J, He M. Association of Age at Myopia Onset With Risk of High Myopia in Adulthood in a 12-Year Follow-up of a Chinese Cohort. JAMA Ophthalmol. 2020 Nov 1;138(11):1129-1134.

2, Walline JJ, Jones LA, Rah MJ, Manny RE, Berntsen DA, Chitkara M, Gaume A, Kim A, Quinn N, CLIP STUDY GROUP. Contact Lenses in Pediatrics (CLIP) Study: chair time and ocular health. Optom Vis Sci. 2007 Sep;84(9):896-902.

3. Vincent SJ, Cho P, Chan KY, Fadel D, Ghorbani-Mojarrad N, González-Méijome JM, Johnson L, Kang P, Michaud L, Simard P, Jones L. BCLA CLEAR - Orthokeratology. Cont Lens Anterior Eye. 2021 Apr;44(2):240-269.