In my experience, the patient experience with orthokeratology (ortho-k) lenses is very positive, and kids are proud of their ability to care and handle their lenses. However, kids will be kids, and some will experience the big “oops” of a broken lens. Educating our patients and their parents on how to handle this scenario ahead of time can reduce the frustration of going without lenses while a new one is shipped from the laboratory. If an ortho-k contract or information form is used, consider adding a broken lens section to ensure the information is communicated in written and verbal forms.

The Perfect Scenario: Backup Pairs

Many companies offer a discounted backup pair after finalizing the ortho-k prescription. This is the simplest approach to ensure patients always have lenses on hand for consistent vision correction. However, purchasing additional pairs of lenses that might not get used is not feasible for every family. The following tips can also help diffuse the urgency of a broken lens:

• Handle with care. A common scenario in which lens breakage occurs is during lens handling. This includes dropping during lens removal, breaking during removal of the lens from the plunger tool, and when placing the screw top on a flat pack case.
  
• Remember to lubricate. During removal of the lens, remind patients that lenses do become drier during a closed eye state, which can cause the lens to fit a bit tighter compared to when first applied to the eye. Lubricating the eye in the morning with artificial tears or even strong blinks can loosen the lens and reduce the likelihood of the lens “popping” off the eye, leading to loss or breakage.
  
  
• Use caution when storing. Instruct the patient to place a few drops of multipurpose solution (MPS) in the bottom of the lens case when preparing the lens for storage. After placing the lens, top it with additional MPS. Ensure the lens is toward the bottom before tightening the cap to prevent catching the lens between the cap and the case, which may lead to a broken lens.

Proactive Lens Design

With proper instruction on care and handling, most patients will not experience a broken lens. However, for younger patients or those who have already broken a lens, increasing the lens center thickness can make the lens a little less likely to crack during general handling. A small increase of 0.02 to 0.03 mm has decreased the incidence of broken lenses for my patients who are “repeat offenders.”

Bridging the Gap

Patients and parents should be educated that it takes at least a few days to rush order a lens from most laboratories. If parents forgo the option to have a backup pair of lenses, a strategy should be in place for the child to continue to have functional vision until the new lens arrives. A back-up pair of glasses is a simple go-to option in many cases. 

As a child continues to wear ortho-k lenses year over year, remind parents to periodically check to ensure the frame is still in good condition and fits the child’s face. The glasses may feel overpowering for the first day but should otherwise provide good vision. Back-up glasses are also helpful at times when the child is ill, develops conjunctivitis, or spends time away from home. 

Thankfully, the instance of a broken ortho-k lens is infrequent. However, every family should be aware of the possibility and understand their options on navigating the scenario.

Brooke M. Messer, OD, FSLS, FAAO, practices at Vance Thompson Vision in West Fargo, ND. She is also a fellow of the American Academy of Optometry. She has received remuneration from Bausch + Lomb SVP, Glaukos, Heidelberg, and Tarsus.

This content supported by Bausch + Lomb