This article was originally published in a sponsored newsletter.

Success is the achievement of a goal or purpose, yet its meaning varies greatly between individuals. What one person considers a success might be viewed as a failure by another. Then there are the gray areas—success that comes in unexpected ways or to a partial extent.

What does all this have to do with orthokeratology (ortho-k)? The best way to answer that is to define a successful ortho-k (retainer) fit. Here is a simple three-step criteria for successful ortho-k fits:

1. The patient’s eyes must always stay healthy.
2. The patient must have clear, functional vision.
3. Except for adults, practitioners must make every attempt to slow myopic progression as long as they do not violate the first two steps.

By clearly defining expectations for the patient, their parents, and the eyecare practitioner before starting a program, variables unrelated to the ortho-k fit can be minimized. This, in turn, may help avoid unnecessary refits.

What We Tell Patients

Here is a good analogy to tell patients: “If you’ve ever worn a ring on your hand and pulled it down to your first knuckle, you may have noticed that the skin under the ring has been flattened (Figure 1). In that situation, there was no loss of skin, and the process of wearing the ring most likely didn’t hurt at all. You reshaped your finger by using a more rigid mold (the ring). The same thing happens to the clear (skin-like) tissue of your cornea under your ortho-k lens retainers.

“Using this same analogy—depending on how long you’ve worn this ring will determine how long your finger retains this new shape. With ortho-k, the longer a patient is on their program, the longer vision correction is retained.”  

What I Tell Our Colleagues

Early on in my ortho-k career, I was complaining to one of my mentors that I had a patient whose topography maps were slightly off-center and not totally symmetrical. As I was getting ready to redesign the ortho-k retainers, she asked me how the patient felt they were doing. I said, “Great.” Then she asked what their vision was. I said, “20/20 in each eye and 20/15 OU.”

What she said next has stuck with me since that day: “Remember Rob, we’re in the business of clearing vision and slowing progression, not making pretty pictures.”

When in doubt, ask the patient how they feel they are doing and follow the three-step criteria of a successful ortho-k fit. Doing so will decrease your remake rate while improving office efficiency and patient outcomes. 

ROBERT GEROWITZ, OD, practices at Eyecare of Palatine in Illinois. He is a charter member of the American Academy of Orthokeratology and Myopia Control. He has received remuneration from Euclid Systems.