A 39-year-old female patient in your chair pleads with you, saying “I really want to be able to play tennis without my glasses, but my eyes got so dry with the last three types of contact lenses we’ve tried. What else can you do?” I’m sure this scenario is something you’ve heard in your office. Even with the latest designs and materials, some patients still experience symptoms of dryness that prevent them from enjoying comfortable and successful contact lens wear.

Many practitioners fail to offer a mode of correction that allows patients to enjoy clear vision and comfortable eyes with no need to wear correction during the day: orthokeratology (ortho-k). Use of ortho-k as an alternative mode of refractive correction has increased in popularity, especially for children. However, it is a viable alternative for adults as well.

The primary advantage of ortho-k for patients is that no correction is needed during waking hours. But, many adult patients using ortho-k report how much more comfortable their eyes feel during the day compared to when they wore soft lenses. This has prompted investigations into why this is so.

Proven Ortho-k Benefits

First, a group of investigators compared ocular surface symptoms, as measured by the Dry Eye Questionnaire, in a group of silicone hydrogel soft contact lens wearers compared to a group using ortho-k (GarcĂ­a-Porta et al, 2016). They found that the ortho-k wearers had significantly fewer symptoms of dryness and discomfort at the end of the day. In addition, bulbar redness, limbal redness, and conjunctival staining were less with ortho-k than with soft silicone hydrogel lenses.

Another study looked at goblet cell density (GCD), tear breakup time (TBUT), symptomology, and tear volume before ortho-k wear compared to one month after starting ortho-k (Carracedo et al, 2016). They reported no significant differences in tear volume and TBUT before and one month after starting ortho-k. In addition, subjects showed an increase in GCD and a better Ocular Surface Disease Index score after one month of ortho-k.

Patients wear ortho-k lenses only while sleeping and rarely find dryness an issue. If necessary, patients who have very dry eyes can use lubricating eye drops prior to lens application or just prior to removal.

Patients using ortho-k report that they enjoy a better vision-related quality of life (VR-QOL). In a randomized crossover study, 80 patients who experienced both soft lens wear and ortho-k had better VR-QOL scores when using ortho-k to correct their myopia (Lipson et al, 2005). At the conclusion of this study, patients were asked to choose their preferred mode of correction; 69% of the subjects preferred ortho-k and chose to continue using ortho-k after the study. Further questioning of those who chose ortho-k revealed that the most common reasons for their choice were freedom from daytime correction and better comfort of their eyes during the day. Subsequent studies have reported similar findings (Berntsen et al, 2006; Hiraoka et al, 2009).

Quality of vision with ortho-k use has been reported to be excellent (Liu et al, 2017; Berntsen et al, 2005), but symptoms of nighttime glare while driving increase with higher degrees of myopia (more than –5.00D). In the crossover study above, objective visual acuity was similar between soft lens wear and ortho-k use, but subjective ratings of visual acuity were higher with ortho-k for a majority of patients (Lipson et al, 2005).

The Bottom Line

Don’t hesitate to recommend ortho-k to your adult patients who have struggled with dry eyes and discomfort while wearing soft lenses. You can provide them with excellent vision, better daytime comfort, freedom from daytime vision correction, and improved VR-QOL. The most comfortable lens during the day may be no lens at all. CLS

For references, please visit and click on document #260.