SELECTING THE “right” type of contact lens modality is of paramount importance in helping patients achieve optimal vision. But deciding what modality is “right” can be elusive and subjective.

GP contact lenses aren’t always at the top of the list. Why? Some practitioners perceive GP lenses as obsolete or impractical; others may inadvertently suggest that they are cumbersome or unprofitable, which likely results in a higher dropout rate and patient dissatisfaction.

Nevertheless, according to the recent Continued Learning Evidence-Based Academic Reports (CLEAR) on contact lens practice that was published by the British Contact Lens Association (BCLA) in the journal Contact Lens and Anterior Eye, the choice between soft and rigid contact lenses is multifactorial (Wolffsohn et al, 2021).

In fact, it largely depends on the patient’s age, previous history of surgery or treatments, and a myriad of ocular considerations, such as congenital aphakia (Kooshki et al, 2022), penetrative ocular trauma (Pradhan et al, 2014), and microphthalmos (Ozcelik et al, 2023).

In a survey of U.K. eyecare practitioners’ attitudes toward the fitting of GP contact lenses, most respondents said that while GP lenses offer advantages for patients, they remain hesitant to prescribe them or consider them a part of their “regular repertoire” due to perceived discomfort or a longer fitting process (Gill et al, 2010).

When it comes to prescribing GP lenses, including orthokeratology (ortho-k) lenses for children, practitioners should be well assured that they are remarkably safe and effective for the pediatric population for slowing myopia progression (Santodomingo-Rubido et al, 2024; Zhang et al, 2024; Hiraoka et al, 2018).

In the Contact Lens and Myopia Progression (CLAMP) study, 116 8- to 11-year-old children were surveyed to help understand the subjective perception of and receptiveness to wearing GP and soft contact lenses (Jones-Jordan et al, 2010). Those who wore GP contact lenses showed significantly better visual acuity than the soft contact lens cohort group, and comparable adaptation with initial lens awareness.

Meanwhile, a surprising finding was recently reported by Zhang and colleagues (2024): The effectiveness of ortho-k lenses is not directly influenced by age or the initial level of myopia. Children of varying age groups treated with ortho-k lenses showed comparable levels of axial
length control.

While this finding is not yet definitive, it could likely challenge or upend the common belief that ortho-k contact lenses do not work for patients who have low myopia or who are at an older age. This may spark greater interest and increase opportunities to prescribe them for patients who may appear to fall outside the typical lens parameters or who are perceived as poor candidates.

With the resurgence of practitioners prescribing GP lenses for patients, the future of GP lenses is far from being a “dead end.” Indeed, their use has continued to thrive and inspire the contact lens industry. GP lenses are certainly no longer considered antiquated; rather, there have been many exciting clinical developments that show great promise for expanding the clinical applications of GP lenses.

Notably, deep learning models or artificial intelligence-assisted algorithms are being used to design ortho-k, scleral lenses, and other GP lenses, which can significantly enhance their clinical effectiveness and productivity for patient care (Lan et al, 2024; Yang et al, 2024; Cao et al, 2024). Finding the right match is not impossible; it may soon become easier with a signature stamp.

References

1. Wolffsohn JS, Dumbleton K, Huntjens B, et al. CLEAR—evidence-based contact lens practice. Cont Lens Anterior Eye. 2021 Apr;44:368-397.

2. Kooshki AM, Kooshki AM, Yaseri M, Nouri L, Alipour F. Experiences of Treatment With Contact Lenses in Aphakic Children With Unilateral Congenital Cataract: A Retrospective Study. Eye Contact Lens. 2022 May 1;48:222-227.

3. Pradhan ZS, Mittal R, Jacob P. Rigid gas-permeable contact lenses for visual rehabilitation of traumatized eyes in children. Cornea. 2014 May;33:486-489.

4. Ozcelik F, Erdogdu E, Altan C. The Comparison of Soft HydroCone (Toris K) Silicone Hydrogel and Rigid Gas-Permeable Contact Lenses in Patients With Posterior Microphthalmos. Eye Contact Lens. 2023 Apr 1;49:168-171.

5. Gill FR, Murphy PJ, Purslow C. A survey of UK practitioner attitudes to the fitting of rigid gas permeable lenses. Ophthalmic Physiol Opt. 2010 Nov;30:731-739. 

6. Santodomingo-Rubido J, Cheung SW, Villa-Collar C; ROMIO/MCOS/TO-SEE Groups. The safety of orthokeratology contact lens wear in slowing the axial elongation of the eye in children. Cont Lens Anterior Eye. 2024 Jul 12:102258.

7. Zhang S, Zhu H, Zhang L, Gao M, Liu C, Zhao Q. Effects of orthokeratology on corneal reshaping and the delaying of axial eye growth in children. Heliyon. 2024 Jun 20;10:e33341.

8. Hiraoka T, Sekine Y, Okamoto F, Mihashi T, Oshika T. Safety and efficacy following 10-years of overnight orthokeratology for myopia control. Ophthalmic Physiol Opt. 2018 May;38:281-289. 

9. Jones-Jordan L,Walline J, Mutti D, et al. Gas permeable and soft contact lens wear in children. Optom Vis Sci. 2010 Jun;87:414-420.Lan WZ, Tang H, Wen LB, et al. Artificial Intelligence-Assisted Prescription Determination for Orthokeratology Lens Fitting: From Algorithm to Clinical Practice. Eye Contact Lens. 2024 Jul 1;50:297-304. 

11. Yang HW, Liang CL, Chou SC, Wang HH, Chiang HK. Development and evaluation of a deep neural network model for orthokeratology lens fitting. Ophthalmic Physiol Opt. 2024 Sep;44:1224-1236.

12. Cao Y, le Yu X, Yao H, et al. ScLNet: A cornea with scleral lens OCT layers segmentation dataset and new multi-task model. Heliyon. 2024 Jun 29;10:e33911.