Ortho-K: Success Without Surgery?
BY JOSEPH T. BARR, OD, MS, EDITOR
I just saw a very happy, though not fully successful, orthokeratology patient. She started as a 2.50D myope OU. Her left eye now refracts at plano, and her right eye is -1.00 - 1.00 x 90. Her unaided VAs are 20/25 and 20/20. I confess she was 20/10 with refraction at baseline. Once I center her right lens better, she will probably approach a post wear plano in that eye, too. Is she an exception? Well, it does take some work and experience, but we are not the most experienced orthokeratologists on the planet. Is she as happy as most of the refractive surgery patients I see? Absolutely. In fact, she's enthusiastic. She keeps saying how great it was to snorkel, without contact lenses, with her husband on their recent trip to Hawaii. And as a young mother with two little boys, she has no lenses to be knocked off or knocked out.
It occurred to me that she resembles a lot of other patients who have refractive surgery with good results in one eye and off results in the other. At age 31, she doesn't need the add for monovision from the undercorrection. We can redesign her right lens and get her closer to plano.
If she were a refractive surgery patient, she'd need to wait to see where she stabilized, and then see if someone would "touch up" her myopic toric cornea. Those of you who understand the vision system know that I jest. I sure feel a lot better looking at her corneas, which looked perfect this afternoon, without having to tell her she'd need a flap lifted or her epithelium removed to get a better result...even though her corneal map looks like that of a PRK or LASIK patient. And when she does become presbyopic, we could try an ortho-k lens on just one eye.
Of course, the benefit of the surgery is it's permanent. But the benefit of ortho-k is that it's not permanent, and this patient is fine with it. Experienced orthokeratologists out there know all about this. Modern reverse geometry (secondary curve steeper than the base curve) designs are much better than the flat-fitting ortho-k lenses of the past. Those of you who are not using this procedure might take a course, get a trial set, get on the learning curve and help these low myopes improve their lives without permanent alteration. I'm not saying every 2.50D myope will want it, but shouldn't they have a choice? See Peter Bergenske's article on Page 27 which discusses all the options.