Lens design, technology, and effectiveness get a lot of attention during orthokeratology (ortho-k) lectures and events. The ability to reshape the cornea to provide clear vision continues to impress both practitioners and patients. However, even a perfectly fit ortho-k lens needs a solid lens care routine in order to be successful long term, and this part of the process cannot be overlooked.
While the idea of wearing contact lenses at night can spark some safety concerns with parents,1 recommending the correct care solution and routine for ortho-k patients is an important part of the prescribing process to promote safe and compliant lens wear.
Hydrogen peroxide systems provide excellent disinfection, and eliminating the preservative exposure can be beneficial for sensitive eyes. In a study of adult soft contact lens wearers, hydrogen peroxide care system users were more compliant compared to multipurpose solutions (MPSs) users.2 However, proper use of hydrogen peroxide can pose a challenge to young patients. Exposure to nonneutralized peroxide is both painful and toxic to the cornea, so adherence to the neutralization process is essential. Consider a hydrogen peroxide solution for kids with chronic allergies and irritated eyes.
MPSs are convenient in that a single bottle provides the ability to clean, rinse, and disinfect the lens. The lack of stinging upon exposure to the eye keeps the experience positive for the parent and the patient. Further, MPSs have been shown superior to hydrogen peroxide in removing surface deposits from ortho-k lenses when the cleaner is used to rub the lens surface.3 Maintaining the habit of rubbing lenses can be a challenge, as patients wearing ortho-k lenses longer than 6 months are less compliant that those wearing lenses for less than 6 months.4 Consider an MPS for new lens wearers who are willing to commit to a proper care routine.
Current evidence does not clearly support one care system over another for all ortho-k users. However, we do know that children who are supervised by their parents during lens care are more compliant and have less complications compared to children that care for their lenses independently.5
Regardless of the disinfection system selected, there are several non-negotiables when it comes to ortho-k lens care and ocular health.
● Digital rubbing removes deposits and biofilm
● Storage cases can develop biofilms and microbial contamination.6 Replace cases with every new bottle of solution.
● No tap water exposure to lenses or storage cases
● Regular follow-ups are required, with care habits reinforced at each visit
Ultimately, the best care system is the one that patients can perform safely and correctly. Consider patient maturity, ability to understand instructions, and overall ocular surface health when considering a lens care system.
References
1. Gifford K. Kids and contact lenses: benefits, safety and getting to “yes.” Myopia Profile. www.myopiaprofile.com/articles/kids-and-contact-lenses-benefits-safety. Published March 2021. Last accessed June 25, 2026.
2. Jones L, Woods J. Lens care compliance. Contact Lens Spectrum. 2019;34(4):36-40. clspectrum.com/issues/2019/april/lens-care-compliance
3. Cho P, Poon HY, Chen CC, Yuon LT. To rub or not to rub? Effective rigid contact lens cleaning. Ophthalmic Physiol Opt. 2020;40(1):17-23. doi:10.1111/opo.12642
4. Chang L, Sun C, Liao L. Compliance with orthokeratology care among parents of young children in Taiwan. Cont Lens Anterior Eye. 2021;44(5):101427. doi: 10.1016/j.clae.2021.02.013
5. Jiang J, Bian Z, Wang F, Lian L, Lu F. Level of compliance in orthokeratology. Eye Contact Lens. 2018;44(5):330-334. doi: 10.1097/ICL.0000000000000516
6. Szczotka-Flynn LB, Pearlman E, Ghannoum M. Microbial contamination of contact lenses, lens care solutions, and their accessories: a literature review. Eye Contact Lens. 2010;36(2):116-129. doi:10.1097/ICL.0b013e3181d0d2df
This content is sponsored by Bausch + Lomb