AFTER MORE THAN 20 YEARS in practice, it can be surprising to see what products have gone out of favor, like some contact lens solutions. This is also true regarding what remains popular, like frequent replacement lenses, and things that just have not caught on, like orthokeratology (ortho-k).
The Fitting of Orthokeratology in the United States (FOKUS) study revealed the stats on US ortho-k (Lipson and Curcio, 2022). The authors estimated that there are nearly 3,000 active prescribers of ortho-k in the United States. They also noted that prescribing ortho-k lenses is largely driven by myopia management. With ortho-k’s benefits during wear and its success rate in slowing myopia progression in children, this number is strikingly low.
Over the first decade of practice, we saw a major shift in our own clinics toward myopia management in our use of ortho-k. Early ortho-k fitting required frequent follow-ups to design and refine lenses to improve the appearance of patients’ topography. Even though correcting vision was the goal, many patients were asked to return for follow-up appointments to get the perfect topographical fit.
Several studies have changed our approach to fitting ortho-k, and technology has made the process more streamlined, particularly for myopia management. The Stabilizing Myopia by Accelerating Reshaping Technique (SMART) study showed that 80.5% of eyes fit were successful with the first lens with which they were fit and 95.5% of fits required 1 lens change (Davis et al, 2015). Two other studies looked at the effects of induced aberrations that are created by patients wearing ortho-k lenses and their likely effect on slowing of axial elongation (Hiraoka et al, 2015; Lau et al, 2020).
Although many clinicians may still see ortho-k as being too complicated, the times and resources have changed. Some clinicians fear that ortho-k may require too many follow-up visits and is cumbersome. A reason for these beliefs may be found in the continuing education courses related to ortho-k taught at eyecare meetings. Many of the ortho-k courses seem to be about troubleshooting the problems we encounter. This focus may give the impression that fitting these lenses is challenging, complicated, and very difficult to get right. Given that a decade-old study (Davis et al, 2015) found a more than 80% success rate of children achieving 20/25 vision with the first fit of lenses, we’d like to believe that first-fit success is the same or even better with newer designs.
The Verdict
We have found greater success in our own ortho-k lens fits in the last decade, and likely greater success in myopia management, by accepting a fit that is healthy and effective. If a patient does not have a “perfect” topography or ideal centration, but has clear vision and is performing well in sports and school, this should be considered a success. Although mapping the treatment area can be interesting and help identify changes over time, correcting vision is our main goal, and using this method to do so also may be just the thing helping to slow their progression.
If you consider ortho-k to be complicated, you are not alone. Here’s a challenge: If you are new to ortho-k, try fitting 10 patients. If the first set of lenses doesn’t give them clear vision, consider an alternative treatment. Chances are, you will have 8 or 9 very happy and successful myopia management patients from this group.
References
1. Lipson MJ, Curcio LR. Fitting of orthokeratology in the United States: A survey of the current state of orthokeratology (FOKUS). Optom Vis Sci. 2022;99(7):568-579. doi: 10.1097/OPX.0000000000001911
2. Davis RL, Eiden SB, Bennett ES, Koffler B, Wohl L, Lipson M. Stabilizing myopia by accelerating reshaping technique (SMART) study: three year outcomes and overview. Adv Ophthalmol Vis Syst. 2015;2(3):92-98. medcraveonline.com/AOVS/stabilizing-myopia-by-accelerating-reshaping-technique-smart-study-three-year-outcomes-and-overview.html
3. Hiraoka T, Kakita T, Okamoto F, Oshika T. Influence of ocular wavefront aberrations on axial length elongation in myopic children treated with overnight orthokeratology. Ophthalmology. 2015;122(1):93-100. doi:10.1016/j.ophtha.2014.07.042
4. Lau JK, Vincent SJ, Cheung SW, Cho P. Higher-order aberrations and axial elongation in myopic children treated with orthokeratology. Invest Ophthalmol Vis Sci. 2020;61(2):22. doi:10.1167/iovs.61.2.22
