This article was originally published in a sponsored newsletter.

It’s tough to match the emotion that comes along with the experience of a new patient using orthokeratology (ortho-k) lenses. From the growth with lens handling to confidently reading that 20/20 acuity line, the excitement never gets old. However, practitioners can’t overlook the importance of their examinations on established ortho-k users so that their success can continue.

The Health Exam

We need to remind specialty lens patients that it’s easy to forget that we have a back of the eye when we so often focus on the cornea and contact lens. Since ortho-k patients have myopic eyes, it’s important to ensure that they are receiving complete health exams, including dilated fundus exams and even macular scans, if warranted by the axial length. These eyes should also have routine tomography done, as something like early keratoconus could be masked by ortho-k lens wear. In addition to these screenings, assessing the cornea for fluorescein staining, as well as the palpebral and bulbar conjunctiva for papillary reaction and injection can deliver clues on care system tolerance and compliance.

The Contact Lens

Once patients are in “cruise control” with their myopia management, it can be tempting to bypass lens assessment when vision is excellent and the corneal topography shows a nice and clean bullseye treatment pattern. The ortho-k lens itself should be checked periodically for a consistent fit to the eye, as well as for surface scratches and deposits. If a patient comes in with a subtle decrease in visual acuity, consider a surface deep clean with a deposit and protein remover before jumping to order new lenses.

Another important conversation with the patient (and parent) is to find a lens replacement schedule that makes sense for your practice and patients. GP lenses can last a long time; however, they are more prone to breakage and warpage with time. A fresh set of lenses ensures that the optics and peripheral curves of the lenses are accurate and precise for best lens centering and myopia reduction.

Transitioning from pair to pair every one to two years is typically seamless for the patient, compared to lenses that are five or more years old. Older lenses can warp a corneal surface, which makes re-fitting even duplicate lenses less predictable and can even require a complete washout to re-achieve a successful lens fit.

Care System and Hygiene

As patients get more comfortable with their lenses, there may be a lapse in care system compliance. This can lead to lenses that are uncomfortable, or storage cases that need a little clean up. Recommend that patients replace their case with every new bottle of their care system solution. Additionally, re-visiting written instructions on how to clean hands, lenses, case, and removal tool at periodic follow up visits can keep hygiene and safety at the forefront of the lens wearing experience.

Our established ortho-k patient base is a loyal group of young patients and their parents. Re-committing to their ocular health year-over-year reminds them that we are managing both a device and a condition that can affect their long-term ocular health. Your excitement and education about “no changes” can reinforce good habits at home for continued success.