It can be overwhelming to get started with prescribing for and managing orthokeratology (ortho-k) patients, but the effort can be extremely beneficial for both patients and practitioners. Here, my associate, Brittany Boland, OD, shares her experience with learning how to prescribe ortho-k lenses in our clinic.
You Don’t Know What You Don’t Know
Orthokeratology, overnight corneal reshaping, and corneal reshaping therapy are all terms that just a few months ago were intimidating and daunting to me. I had a preconceived notion that fitting these lenses was just too complicated; and, in some ways, many eyecare practitioners also seem to have this notion: In 2017, out of all of the contact lens fits in the United States, only 11% were with GP lenses and, of these, only 6% were ortho-k (Nichols, 2018). There aren’t many practitioners who are actually fitting these lenses. Another potential reason for this general lack of knowledge is that ortho-k is sometimes considered a fringe topic at educational institutions—for example, it was not covered extensively in my recent optometric education.
Thinking back, I simply lacked the knowledge base of how ortho-k works. Misinformation and myths about ortho-k create a negative impression for many practitioners. For instance, a common misconception is that ortho-k contact lenses physically compress corneal tissue, making them unsafe particularly with overnight wear. In addition, the thought of instructing children to sleep while wearing contact lenses is concerning; but, the reality is that very few adverse events have actually happened with overnight ortho-k lens wear. In fact, one study showed that the rate of microbial keratitis with ortho-k lenses is no greater than with extended wear (Bullimore et al, 2013).
My Experience with Ortho-k
Since starting to fit ortho-k lenses about five months ago, I have been ecstatic about how truly rewarding the experience has been thus far. My first ortho-k patient was very memorable—a frightened 8-year-old girl who had to fight back tears during lens application. She was so shy and timid on the initial fitting that she barely said three words. But on the day-one follow up, she was smiling ear to ear and had so much to say about her vision. She not only could see much better, she also was proud of herself, and her confidence level skyrocketed.
The fact that we can give many of these children clearer vision on day one, confidence in themselves, and freedom from glasses or soft contact lenses, all while providing a way to possibly slow eye growth, is highly motivating. After my first few fittings, I knew that I wanted to become an ortho-k expert. My patients deserve it.
Build Your Own Experience
I encourage all of you who are looking to offer ortho-k but are new to prescribing for and managing these patients to find a mentor. Sure, you can learn how to fit these lenses from online resources and from webinars, but having a mentor who is skilled in ortho-k can help you troubleshoot and work through those challenging cases. The manufacturers can also be of tremendous help.
Fitting these lenses has been a game changer for me. It is our opportunity as eyecare professionals to offer ortho-k to patients not only as a way to correct refractive error, but also for myopia management.
Staying up to date on current trends and clinical studies regarding myopia control, being ready to answer the tough questions from patients (and especially parents), and being confident in the ability to fit these lenses has helped me find joy and success with ortho-k. I’m excited for what the future holds for myself and others who are new to ortho-k. With studies indicating that the prevalence rates of myopia in most parts of the world are rising (Holden et al, 2016), what a fantastic time to get involved and make a difference in the lives of our patients. CLS
For references, please visit www.clspectrum.com/references and click on document #280.