This article was originally published in a sponsored newsletter.

Managing myopia with orthokeratology (ortho-k) is like tackling a challenging rock-climbing route. Both require careful planning, precise technique, and the ability to navigate various holds, each representing different challenges in the journey.

The Ascent: Starting with Ortho-k

Ortho-k has shown significant success in controlling myopia progression in children. Like planning a climbing route, initiating ortho-k involves selecting the right lenses, ensuring the proper fit, and patient education. The initial period is critical, much like the first few moves on a climb, requiring focus and adjustment to new routines.

The Crux: Challenges Along the Way

In both rock climbing and myopia management, challenges are inevitable. For ortho-k, this includes maintaining compliance, managing lens-related complications, and monitoring eye health. The “crux” of the journey might involve dealing with these issues while ensuring the treatment’s efficacy in slowing myopia progression.

Topping Out: The Right Time to Stop Ortho-k

Stopping orthokeratology is a decision that should be made carefully and individually. Discontinuing at or before the age of 14 can lead to a more rapid increase in axial length.¹ Watch axial length carefully for six months and restart ortho-k if rapid elongation is noted. Tell parents that the late teens to early 20s is when myopia is stabilized—it is variable.² Generally, ortho-k treatment can be considered for tapering off when:

• There are no significant changes in axial length for a year or two.³
• The patient has reached late teenage years (18) or early adulthood (24), when myopia progression typically slows down.⁴
• The practitioner and patient agree on the right time based on lifestyle and visual needs.⁵

Controlled Descent: Minimizing the Rebound

The rebound effect in myopia is similar to carefully planning your descent in climbing to avoid falls. This can be managed effectively with a gradual reduction in lens wear.¹ Here’s a suggested tapering schedule to keep a firm grip on the myopia:

• Jug Hold Phase: Initial Reduction (first one to two months).  Have the patient switch from nightly wear to every other night. This phase offers a big, comfortable hold, making the transition easier.
• Crimp Hold Phase: Intermittent Wear (next two to three months).  Have the patient reduce wear further to every third night if vision remains stable. This phase requires more precision, just like a crimp hold, as the patient adjusts to less frequent wear.
• Sloper Hold Phase: Further Reduction (following two to three months).  Have the patient wear lenses twice a week, with the practitioner continues to monitor for vision changes. Like a sloper, this phase demands careful balance and monitoring.
• Pinch Hold Phase: Minimal Wear (final one to two months).  Finally, have the patient wear lenses once a week before complete cessation. This last phase needs a firm, controlled grip, ensuring minimal rebound effect.

Other Routes: Exploring Alternative Methods

As ortho-k lens wear is reduced, consider integrating other myopia management strategies like low-dose atropine eye drops or multifocal contact lenses to maintain control over myopia progression.³

Climb Completed

Just like navigating different holds on a climbing wall, managing myopia requires skill, balance, and precision. By gradually reducing ortho-k lens wear and regular follow-ups, rebound effects can be kept in check while maintaining clear, comfortable vision. Stay focused and you’ll be sending that next project! That’s climber talk for the “ability to complete the climb without falling.”

1. Cho P, Cheung SW. Discontinuation of orthokeratology on eyeball elongation (DOEE). Cont Lens Anterior Eye. 2017 Apr;40:82-87.
2. COMET Group. Myopia stabilization and associated factors among participants in the Correction of Myopia Evaluation Trial (COMET). Invest Ophthalmol Vis Sci. 2013 Dec;54:7871-7884.
3. Hiraoka T, Kakita T, Okamoto F, Takahashi H, Oshika T. Long-term effect of overnight orthokeratology on axial length elongation in childhood myopia: a 5-year follow-up study. Invest Ophthalmol Vis Sci. 2012 Jun 22;53:3913-3919.
4. Cho P, Cheung SW. Retardation of myopia in Orthokeratology (ROMIO) study: a 2-year randomized clinical trial. Invest Ophthalmol Vis Sci. 2012 Oct 11;53:7077-7085.
5. Chen C, Cheung SW, Cho P. Myopia control using toric orthokeratology (TO-SEE study). Invest Ophthalmol Vis Sci. 2013 Oct 3;54:6510-6517.