There’s a mobile app for everything these days, but what happens when orthokeratology (ortho-k) patients go mobile? What should practitioners do when a long-term ortho-k patient moves across the country? How do you handle existing ortho-k wearers, fit elsewhere, who now find their way to your chair for ongoing care or, more likely, to solve a problem?
When Patients Are Moving
When ortho-k patients head off to college or move out of the area, prepare them for establishing care with a qualified provider in their new location. Supply them with the following information for a smooth transition:
- Dates, history, and all pre-ortho-k baseline exam information
- Original color topography (not a black-and-white copy)
- Original lens specifications
- Date and all information from latest exam (include the latest lens specifications and the date of the last replacement lens)
- Color printout of the latest topography
- The specific lens care regimen prescribed
Give patients a referral list of experienced ortho-k practitioners in their new area. You can get these from professional ortho-k or specialty lens organizations or through networking at specialty conferences.
Provide a cover letter for both the patient and the new provider that clearly states when the patient is due for his or her next exam and any specific information that may be helpful. Ask the patient to let your office know when he or she makes an appointment with the new practitioner. Once that appointment is made, send an additional copy of the documents listed above directly to the practitioner, either by mail or email (not by fax, as it will not be in color).
If patients are doing well with their current ortho-k treatment, sending this information will make lens replacements or slight modifications easy for the new provider. If significant changes are required, the past history will be critical to establish refitting measurements.
Occasionally, long-term ortho-k patients will make arrangements to return to their original provider for ongoing care. But, to maintain a regular follow-up schedule or in case a problem develops, this information will make the transition to a new provider much smoother.
Ortho-k Patients from Another Practice
Existing ortho-k users who were fit elsewhere can be much more challenging to manage compared to new wearers, especially if their previous records and lens specifications are not available.
If a patient is seeing well, has a clear cornea, ideal topography, and clean lenses, replacing lenses with duplicate specifications may be all that is needed. But, it is more likely that such patients are experiencing an issue that initiated their visit. Here is where the challenge in caring for these patients begins.
Make every attempt to get records from the previous practitioner. Most critical are baseline refraction, topography, and the latest lens brand and specifications. If unaided vision is inadequate or if topography is not ideal and/or shows significant decentration, patients need to discontinue ortho-k lens wear until the eye returns to baseline or stabilizes at its “new baseline.” Many of these patients do not have spectacles to wear and will need some time until a relatively stable refraction is achieved. Manage this transition period by providing daily disposable soft lenses of gradually higher powers to provide functional vision until spectacles or a stable prescription of daily disposables can be dispensed.
Once the refraction and topography have stabilized (usually in three to four weeks, but this can vary from two to 12 weeks), initiate refitting with the design and specifications that you feel will work best and using your preferred method (topography-based, empirical, diagnostic evaluation, etc.). Each refitting case may be quite different. Establish policies and a plan for these situations. Fees to refit existing wearers should reflect the time, expertise, complexity, and number of visits required to complete the fit. CLS