If you prescribe orthokeratology (ortho-k) lenses, you’ve seen their benefits—for your patients and practice. If not, consider starting; they have been extensively studied for safety, efficacy, myopia control, and improved vision-related quality of life (VR-QOL).
In the United States, ortho-k safety had to be established to gain U.S. Food and Drug Administration (FDA) clearance. Since then, studies have shown that ortho-k poses less risk of serious complications (e.g., microbial keratitis) than does overnight wear of soft lenses and comparable risk to daily wear of soft lenses (Santodomingo-Rubido et al, 2012; Lipson, 2008; Bullimore et al, 2013). Although there were reports of serious complications in Asia in 2005, these cases were attributed to unregulated fitting and manufacturing, poor lens care, questionable materials, and inadequate follow up. Longterm studies in the United States and worldwide have consistently shown extremely low incidence of complications and that, with proper lens care and follow up, ortho-k is very safe (Liu and Xie, 2016).
Studies with adults and children show that 95% experience 20/25 or better vision (Lipson, 2012, 2008; Berntsen et al, 2005; Lipson et al, 2005). With consistent wearing time of seven to 10 hours per night, vision is clear immediately after lens removal and remains clear for all waking hours. That said, some patients report decreased vision later in the day due to individual response differences, degree of baseline myopia, and wearing time.
Another potential visual distraction is nighttime glare. This is more often reported in patients who have a higher degree of baseline myopia (> –5.00D). If glare occurs, most report it to be less bothersome after a few weeks. But, a crossover study showed that patients reported equal or better vision with ortho-k versus soft lenses (Lipson et al, 2005).
Case studies, randomly controlled trials, and meta-analyses have shown that ortho-k slows myopia progression by 40% to 60% over three to five years compared to spectacles or soft lens wear (Walline et al, 2011; Cho et al, 2005; Walline et al, 2009; Kakita et al, 2011; and others. Full list available at www.clspectrum.com/references ). Other studies found that 65% to 70% of ortho-k wearers showed little or no increase in axial length over a three-year period (Cho and Cheung, 2012; Lipson, 2016). However, while ortho-k has FDA clearance for correction of refractive error, ortho-k for myopia control is an off-label indication. Overall, a growing body of evidence supports the clinical observation that ortho-k wearers show less myopia progression compared to those using spectacles or soft lenses.
Patient-reported outcomes have become a standard to measure various medical treatments. Validated surveys are used to rate patients’ perception of how a treatment affects their life on a daily basis. Studies of ortho-k wearers report better overall eye comfort, less worry, greater self-confidence, and less activity restrictions versus soft contact lens wearers (Lipson et al, 2005; Hiraoka et al, 2009; Queiros et al, 2012). In addition, these studies show that ortho-k patients rate their visual acuity comparable to spectacle and soft lens wearers. As a final measure of ortho-k’s effect on a patient’s quality of life, of those who experienced both ortho-k and soft lenses in a crossover study, 68% preferred ortho-k (Lipson et al, 2005).
You can confidently prescribe ortho-k to your patients knowing that studies show it is safe, provides good vision, and slows myopia progression in children. In addition, you can be confident that your patients will love it. CLS
For references, please visit www.clspectrum.com/references and click on document #266.