There is an easy way to find out whether your patients are interested in orthokeratology (ortho-k). At the end of your exam, as you make your recommendations and explain options, ask patients one simple question: “Would you like to be able to see clearly during the day without surgery and without using glasses or contact lenses?” Many patients will react to this question with a surprised response such as, “I’d love to, but is that even possible?“ That gives you the opportunity to explain that you can make it possible with ortho-k.
Whom to Ask
Ideal candidates to whom you should present ortho-k include myopic children; adults who have low myopia and who have struggled with soft contact lenses due to dryness or allergies; any myope who is active in sports, especially water sports; and myopes who do not want to undergo or who are not candidates for refractive surgery.
Children who use ortho-k enjoy the freedom from daytime vision correction during their various activities. They report excellent unaided vision, less activity restrictions, greater self-confidence, and higher overall vision-related quality of life (Queirós et al, 2012; Hiraoka et al, 2009; Lipson et al, 2005).In addition, studies and clinical experience indicate that children using ortho-k have slower progression of myopia and less increase in axial length compared to those wearing glasses or soft contact lenses (Cho and Cheung, 2012; Hiraoka et al, 2012; Santodomingo-Rubido et al, 2012; Huang et al, 2016; and others. Full list available at www.clspectrum.com/references .)
Adult patients who have complained of dryness or discomfort with soft lenses report excellent vision with ortho-k and comment on how much more comfortable their eyes feel during the day. This is especially true for the many patients who put in so much screen time at work and home. Myopes involved in water activities often feel more confident with ortho-k because they are not worried about losing their glasses or contact lenses.
With no correction needed during the day, ortho-k gives patients the effect of refractive surgery without surgery. While regular nightly wear is critical to maintaining good vision throughout the day, most patients quickly adapt to the routine of applying lenses at bedtime and removing them upon waking. Therefore, for patients who are not candidates for refractive surgery, ortho-k provides an option for clear vision all day without the use of glasses or contact lenses.
If you think that your patients are happy with their soft lenses and would not be interested in ortho-k, think again. One randomized crossover study gave patients the chance to wear soft lenses for two months and ortho-k for two months (Lipson et al, 2005). After experiencing both modalities, 70% chose ortho-k as their preferred mode of correction and elected to continue using ortho-k after the study.
Worth the Conversation
Certainly, not every patient to whom you present ortho-k will jump in immediately. But, your patients may consider ortho-k in the future or may tell others about it.
Never pre-judge your patients’ interest or motivation for a particular procedure or treatment. Patients deserve a full picture of all options to decide what’s best for them. And, you’ll never know what they may want unless you ask. CLS
For references, please visit www.clspectrum.com/references and click on document #276.