Published in Myopia

Fitting Orthokeratology into Your Myopia Practice

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7 min read

Learn how optometrists can add orthokeratology to their myopia practice, with tips on how to identify good candidates and educate parents and patients.

Fitting Orthokeratology into Your Myopia Practice
Although we have several myopia management options in clinical practice, orthokeratology often elicits the most excitement from parents and patients alike. The freedom from daytime visual correction coupled with effective myopia control is a unique attribute of orthokeratology.
Despite being considered an off-label option for myopia control, orthokeratology has a plethora of scientific and clinical evidence supporting its efficacy. Most studies agree that orthokeratology reduces axial lengthening by slightly less than 50%.1,2
Because most parents have never heard of orthokeratology, it takes valuable clinical time to provide them with the necessary information about this option. Proactively planning for these patients will create effective communication and, ultimately, increase the number of interested and successful orthokeratology patients.

Identify good candidates for orthokeratology

Theoretically, orthokeratology can benefit not only myopic patients interested in myopia control, but also myopic patients who are simply seeking freedom from daytime correction—which could include non-progressive myopes and adult myopes.
For patients interested specifically in myopia control, orthokeratology is often most attractive for: (1) younger children; (2) children who participate in activities that could be prohibitive to daytime correction (i.e. water sports or dusty environments), and; (3) children who are in need of parental support with lens care.
For best results, strongly consider staying within the Food and Drug Administration (FDA) or manufacturer guidelines for your chosen design, which is typically up to -6.00D of myopia and up to -1.75D of astigmatism. Certain designs can accommodate even higher myopic and astigmatic prescriptions, but every patient is unique, and effective treatment depends on their individual corneal anatomy and biomechanics.
Lastly, ensure that the ocular surface is free from any pathology, especially corneal irregularities and diseases such as keratoconus.

Leverage staff for patient education on orthokeratology

Highly trained staff members are arguably just as valuable to a practice as the doctor. Thus, it is imperative to invest time in thoroughly educating them. Consider centering staff meetings focused on the basic science behind orthokeratology, how to identify eligible patients, and tips on how to initiate the conversation.

For example:

“Based on your previous prescription and contact lens history, it appears as though you may be a great candidate for orthokeratology. This is a custom-designed rigid gas permeable lens that is worn overnight so you do not have to wear any correction during the day! Would you like the doctor to share more information?”

In this scenario, the stage is now set for the doctor, and more detailed information can ensue during the exam.
Furthermore, fit any eligible staff member or their children in orthokeratology lenses. The organic conversation that flows between an experienced orthokeratology wearer or parent and an interested patient is an invaluable segue for the doctor.
This same staff member can also be in the exam room or readily available when further testing is needed, continuing the conversation about logistics, scheduling, and fees, and providing application and removal training at the time of dispensing.
Continuity of care with a recognizable and trusted team member is invaluable to a patient’s overall experience.

Create a protocol for patients interested in orthokeratology

During a busy clinic day, it does not take much to derail a schedule. Having a solid protocol in place for interested patients is vital as opposed to back-tracking and creating unnecessary inefficiencies.
Topography is the most important piece of clinical information when deciding on an individual’s eligibility for orthokeratology. Thus, the desired scans should ideally be performed during pretesting.
However, in most cases, parents do not decide on orthokeratology until they have had a conversation with the doctor. For maximum efficiency, once orthokeratology has been decided upon, even if only preliminarily, have a technician perform topography while continuing the conversation with the parent(s).
Another common clinical hurdle is the additional time it takes to discuss all of the nuances of orthokeratology. Most often, patients and parents have never heard of orthokeratology, thus the questions can seem never-ending.

Tip: Having at least one articulate and knowledgeable staff member who can seamlessly step in will allow the doctor to move on and then circle back when time allows.

Showcase orthokeratology technology

The concept of orthokeratology is quite tricky for a layperson to understand, but oftentimes, demonstrating the before-and-after effects with a topography image can provide clarity that even the best verbal description cannot achieve.
To save time, have a generic baseline topography image and a fully treated topography image handy or preloaded onto your computer (Figures 1 and 2). Be sure to explain the basics of the corneal shape and how it relates to vision and then compare the baseline to the altered corneal shape which results in clear, uncorrected daytime vision.
Figures 1 and 2 show topographies clearly demonstrating the physical changes that occur during overnight orthokeratology lens wear.
Ortho-k Lens Before
Figure 1: Courtesy of Ashley Wallace-Tucker, OD, FAAO, FSLS, Dipl ABO.
Ortho-k Lens After
Figure 2: Courtesy of Ashley Wallace-Tucker, OD, FAAO, FSLS, Dipl ABO.
Patients are typically amazed and appreciative of this visual. In addition, most patients have never seen a rigid lens and cannot imagine how a contact lens can alter the shape of the cornea. Allow both the parents and child to handle a trial lens—this will certainly drive home the mechanical aspect of orthokeratology!

Choose a manufacturer for orthokeratology lenses

Most modern orthokeratology lenses are created with the busy practitioner in mind. Thus, they are typically designed with online calculators or are topography-based. Choose a lens design that works for your office structure and available equipment.
Next, consider the accessibility of their consultation team. Although most lenses are highly successful with the first design, inevitably, you will need the support of a consultant. A solid relationship with the consultation team is an invaluable resource.
Two important points to consider include:
  1. Do their office hours align with your availability?
  2. How many consultants are readily available?
Lastly, be sure to thoroughly understand the warranty, remake, and refund policy. All of these are imperative when managing orthokeratology patients—you will need a manufacturer that is reasonably generous with each of these items.

Conclusion

Orthokeratology can be an exciting aspect of patient care, but without the proper systems in place, stress will ensue, and doctors may miss out on this golden opportunity.
Simply take time to create an environment and staff that empowers you and streamlines the mundane aspects of orthokeratology.
With this in place, you can spend your valuable time on the more exciting aspects—designing and fitting lenses!
  1. Walline JJ. Myopia Control: A Review. Eye Contact Lens. 2016;42(1):3-8. doi: 10.1097/ICL.0000000000000207.
  2. Hiraoka T, Kakita T, Okamoto F, et al. Long-term effect of overnight orthokeratology on axial length elongation in childhood myopia: a 5-year follow-up study. Invest Ophthalmol Vis Sci. 2012;53(7):3913-9. doi: 10.1167/iovs.11-8453.
Ashley Wallace-Tucker, OD, FAAO, FSLS, Dipl ABO
About Ashley Wallace-Tucker, OD, FAAO, FSLS, Dipl ABO

Ashley Wallace-Tucker, OD, FAAO, FSLS, Dipl ABO, graduated from the University of Florida with a Bachelor of Science in microbiology and cell science before going on to graduate from the University of Houston College of Optometry (UHCO), where she earned her Doctorate of Optometry.

Dr. Tucker completed a cornea and contact lens residency at UHCO where she received extensive training and experience in the diagnosis and treatment of corneal diseases and in complex contact lens fits, including patients with keratoconus, corneal transplants, and refractive surgery. Currently, she is the course master for the Ophthalmic Optics laboratories at UHCO.

Dr. Tucker has earned fellowships from both the American Academy of Optometry (AOA) and the Scleral Lens Education Society (SLES). Dr. Tucker is honored to be a member of the Speaker’s Bureau for the specialty division of Bausch & Lomb, a member of the professional advancement consultant team for CooperVision, a consultant for SynergEyes, and a lecturer for the STAPLE (Soft Toric and Presbyopic Lens Experience) program.

Dr. Tucker also serves on the advisory board for the Gas Permeable Lens Institute, is a council member for the Contact Lens and Cornea section of the AOA, and is the Community Outreach Chair for the Scleral Lens Education Society.

Ashley Wallace-Tucker, OD, FAAO, FSLS, Dipl ABO
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