Clinical Scorecard: Is This the New Norm?
At a Glance
| Category | Detail |
|---|---|
| Condition | Myopia and myopia progression |
| Key Mechanisms | Orthokeratology lenses reshape the corneal epithelium by applying pressure, causing central epithelial thinning and peripheral thickening to correct myopia |
| Target Population | Myopic patients seeking freedom from daily glasses or contact lenses and myopia control, including pediatric patients |
| Care Setting | Optometric and ophthalmic clinical practice with access to anterior segment OCT and epithelial thickness mapping technology |
Key Highlights
- Orthokeratology (ortho-k) is an established method for myopic correction and myopia progression control.
- Epithelial thickness mapping (ETM) via anterior segment OCT allows precise measurement of corneal epithelial changes pre- and post-ortho-k treatment.
- ETM reveals central epithelial thinning and peripheral thickening corresponding to the ortho-k treatment zone, aiding in lens fitting and treatment assessment.
Guideline-Based Recommendations
Diagnosis
- Assess baseline refraction and ocular health before ortho-k fitting.
- Use pre- and posttreatment epithelial thickness mapping to evaluate corneal epithelial remodeling.
- Perform corneal topography of anterior and posterior surfaces alongside ETM for comprehensive assessment.
Management
- Fit ortho-k lenses to induce central corneal epithelial thinning for myopic correction.
- Adjust lens parameters based on ETM findings to optimize treatment zone centration and alignment.
- Monitor lens fit and treatment zone positioning to ensure optimal visual outcomes.
Monitoring & Follow-up
- Conduct regular pre- and posttreatment ETM to track epithelial thickness changes.
- Evaluate lens alignment and landing zone tightness to prevent decentration or vertical displacement.
- Monitor visual acuity and refractive status without lenses to confirm treatment efficacy.
Risks
- Potential lens decentration leading to suboptimal treatment zone positioning.
- Improper lens fit causing epithelial irregularities or discomfort.
- Need for careful monitoring to avoid adverse corneal changes.
Patient & Prescribing Data
Myopic patients including pediatric cases (e.g., 13-year-old male with -3.00 DS myopia)
ETM assists in confirming appropriate lens fit and treatment zone centration, enabling tailored ortho-k therapy and improved visual outcomes.
Clinical Best Practices
- Incorporate epithelial thickness mapping into ortho-k fitting protocols for objective assessment.
- Use AS-OCT systems that provide simultaneous anterior and posterior corneal topography with ETM.
- Engage patients and guardians in treatment discussions emphasizing monitoring and expected corneal changes.
- Adjust lens parameters responsively based on ETM and topography data to optimize treatment effect.
References
- Bullimore MA, Johnson LA. Overnight orthokeratology. Cont Lens Anterior Eye. 2020 Aug;43:322-332.
- González-Pérez J, Sánchez-García A, Parafita MA. Epithelial and stromal thickness profile and lens decentration in myopic orthokeratology. J Optom. 2023 Oct 28;17:100485.
- Abtahi MA, Beheshtnejad AH, Latifi G, et al. Corneal Epithelial Thickness Mapping: A Major Review. J Ophthalmol. 2024 Jan 2;2024:6674747.
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