AS MYOPIA MANAGEMENT becomes more common in everyday clinical practice, the need for a streamlined approach to the conversation about each modality is essential. Discussions about pharmaceutical therapy and soft contact lenses are often simple and easy for parents to digest, but orthokeratology (ortho-k) inevitably requires a more in-depth explanation. Creating a succinct but thorough narrative that includes the answers to the most frequently asked questions will ease concerns and convert skeptical parents into excited ones.
How does it work? Ortho-k involves the overnight wear of a custom-designed rigid GP lens. While the patient sleeps, the lens gently and temporarily reshapes the cornea. This reshaping causes light to properly focus on the retina, which corrects myopia and mild astigmatism and ultimately prevents the need for daytime correction. Although ortho-k may seem like a new concept, it has been around since the 1960s (Jessen, 1962). The first lens design for overnight wear was approved by the U.S. Food and Drug Administration (FDA) in 2002, and designs have continually evolved and become more sophisticated over time.
Does it control myopia? Although ortho-k is not FDA approved for myopia control, certain designs are FDA approved for myopia management, which is essentially myopia correction. Because of the unique design of the lens, it creates an impression on the cornea during the day (Figure 1). This impression causes light to focus on the peripheral retina in a way that slows or prevents elongation of the eye--—in other words, slows or prevents myopia progression.
Studies have shown that ortho-k can reduce myopia progression by approximately 50% (Sun et al, 2015; Si et al, 2015). Thus, if a child’s prescription progressed –1.00D over the past year, we would expect no more than –0.50D of progression after wearing ortho-k lenses for one year.
Is my child ready for contact lenses? Children who are comfortable with the idea of contact lenses and have proven to be responsible in other aspects of their lives tend to also be successful with ortho-k. For example, if the child brushes and flosses his teeth every night without a reminder, this is a solid indicator that he may be responsible enough to start ortho-k lenses. Many parents help their children with application and removal of the lenses initially and then slowly transition to more independence once the child is ready.
Why choose ortho-k over soft contact lenses? Both soft contact lenses and ortho-k can be similarly effective in controlling myopia, but ortho-k may be the better option for certain patients (Si et al, 2015; Chamberlain et al, 2022). Ortho-k is especially beneficial for younger patients because contact lens wear and care are completely maintained within the household. Parents can supervise and assist patients when needed. Ortho-k is also the better option for patients of any age whose sports, activities, or environment would contraindicate daytime contact lens wear.
Are ortho-k lenses safe? Ortho-k has been shown to be safe for patients of all ages if proper contact lens hygiene is maintained. This includes ensuring handwashing before handling the lenses and use of an approved contact lens cleaning regimen during the day (Gispets et al, 2022).
During a busy clinic day, having this conversation with an anxious family can derail the rest of the schedule. However, preparing this dialogue ahead of time will improve both the patient’s and the practitioner’s experience and outcome. CLS
REFERENCES
1. Jessen GN. Orthofocus techniques. Contacto. 1962;6:200-204.
2. Sun Y, Xu F, Zhang T, et al. Ortho-k to control myopia progression: a meta-analysis. PLoS One. 2015 Apr 9;10:e0124535.
3. Si JK, Tang K, Bi HS, Guo DD, Guo JG, Wang XR. Orthokeratology for myopia control: a meta-analysis. Optom Vis Sci. 2015 Mar;92:252-257.
4. Chamberlain P, Bradley A, Arumugam B, et al. Long-term Effect of Dual-focus Contact Lenses on Myopia Progression in Children: A 6-year Multicenter Clinical Trial. Optom Vis Sci. 2022 Mar 1;99:204-212.
5. Gispets J, Yébana P, Lupón N, et al. Efficacy, predictability and safety of long-term ortho-k: An 18-year follow-up study. Cont Lens Anterior Eye. 2022 Feb;45:101530.
