In the current landscape of optometry, the "business as usual" model of primary care is insufficient. While routine exams remain the foundation of many practices, relying solely on high-volume, low-margin primary care is not enough to increase long-term profitability.
The economic reality of optometry is changing. Declining reimbursements from vision plans are squeezing margins, forcing many ODs to work harder for the same return.
At the same time, there has also been a rise in patient demand for myopia management and alternatives to surgical vision correction. Currently, roughly 30% of the global population is affected by myopia and is projected to grow to 50% by 2050.1
Patients are no longer just looking for a pair of glasses and are searching for solutions tailored for active lifestyles, while also protecting long-term ocular health. Orthokeratology (ortho-K) represents a powerful intersection of purpose and profitability to allow doctors to treat both types of patients.
Ortho-K through a primary care lens
Ortho-K should not be viewed as a boutique service, but rather as a natural extension of comprehensive care. One key benefit of ortho-K is that by utilizing overnight corneal reshaping, patients enjoy clear vision throughout the day without the need for glasses or daytime contacts.
This is a great option not only for children, but also for adults. Many children do not wish to wear glasses during the day, and compliance issues can lead to further increases in myopia. Parents often worry about hygiene during the day with regular contact lenses, but with ortho-K, they can directly oversee the insertion and removal at home without the need to worry about lenses throughout the day.
Additionally, ortho-K is a good option for adults who wish to retire from corrective daytime lenses, but are too concerned or scared to have surgery.
Moreover, it is vital to discuss ortho-K as medical management rather than an upsell. It is a non-surgical, reversible clinical intervention that integrates with broader myopia management strategies. Education is key when discussing with patients and their families.
Many are not aware of the various medical risks associated with high myopia. Having a thorough discussion can help families and patients be more proactive about their eye health.
Clinical benefits of orthokeratology at a glance:
- Pediatric Patients: Significantly slowing of myopia progression and axial elongation by 40 to 60% compared to untreated.2
- Active Adult/sTeens: Lifestyle freedom for sports, swimming, dusty environments, active occupations, and more.
- Dry Eye Sufferers: Relief from daytime contact lens discomfort and end-of-day/all-day dryness.
Overcoming barriers to adoption
Many practitioners hesitate to implement ortho-K due to perceived complexity. However, modern topographers and calculators have flattened the learning curve significantly and many specialty contact lens companies have consultants who can help with both new and existing fits. With simple recommended instructions and clear suitability parameters, the fear of initial lens selection is decreased.
- Chair Time Concerns: While the initial fit requires more time and focus, a structured protocol and having trained staff can minimize the "chair time" impact.
- Fear of Low Demand: You likely already have dozens of candidates in your chair every week—active children and frustrated soft lens wearers who simply don't know this option exists.
- Limited Exposure: If you aren’t regularly fitting specialty lenses, it may be daunting to start. Selecting the right candidates, having early follow-ups, managing expectations, and utilizing lens consultants can drastically help with initial fits.
Integrating ortho-K into your practice
You do not need to overhaul your entire business model overnight. Success comes from starting small and scaling strategically.
The first step you can take is by simply identifying candidates. You often do not even need to think about searching for new patients. Look at your existing patient base for progressing myopes or athletes. If you see pediatric patients, chances are there will be opportunities to talk about myopia and management options.
Many clinics already possess the tools necessary for a good fit. A good refraction goes a long way, along with a patient’s HVID (horizontal visible iris diameter). Having a topography is highly recommended in order to see how the treatment is going. Ideally, having a way to measure axial length is nice to have in order to directly track progression, but it is technically not needed for the fitting process.
Empowering staff in ortho-K workflows
Educating your staff is one of the most powerful tools a practice can have. By having your staff educated on myopia management and how ortho-K works, they can help educate your patients before they even get into your chair. Empower your team to handle initial screenings and lens handling education.
Just like having your staff help with insertion and removal training with soft contact lenses, they can help reduce your chair time by helping with insertion and removal training for ortho-K as well, along with obtaining topography/axial length results. A well structured office and team will immediately boost productivity and revenue.
Discussing orthokeratology with patients
The key to a conversion is framing. Do not try to sell a lens; sell a lifestyle and long-term health benefits.
When speaking to parents, focus on the risk of health concerns that can occur with high myopia when their child is older, and then also add on how freedom from lenses can also help with many children’s active lifestyles. When speaking to adults, focus on the convenience of a lens-free lifestyle, improving dry eye symptoms, and eliminating discomfort that are caused by daytime contact lenses.
Many patients or parents may have concerns regarding sleeping in lenses. It is common practice to warn patients to NEVER sleep in their soft contact lenses. It is very important to educate parents and patients that although they are usually advised against wearing soft lenses to sleep, ortho-K lenses are actually FDA approved for overnight wear.
The risk factors are about the same as those of any contact lens, in which lens hygiene plays a critical role. Based on research, it was found that the infection risk for ortho-K was about 1 to 1,000 - 2,000, while the risk factor for soft daily contact lenses was 1 to 1,000.3
To review three success cases on utilizing ortho-K for myopia control, check out the article Real-World Myopia Control: Successes, Failures, and Lessons Learned!
Mastering follow-up protocols for ortho-K
In order to successfully integrate ortho-K into your practice, it is important to have a general follow-up schedule in place. The general schedule for patients is to have a comprehensive eye exam, including a good refraction, flat/steep K measurements, and their HVIDs. The next exam will be the initial fitting of the lens, along with insertion and removal training.
After the initial lens fitting, usually a next day follow up with the lens in place is done to assess fit and initial treatment ring appearance. If things look okay, usually a 1- to 2-week follow-up is put in place. Higher prescriptions will generally require more time to treat. It is important to educate and set expectations of initial vision for the patients.
The remaining follow-ups may vary depending on how well a patient’s vision is and how good their treatment ring looks. If you are unsure, you can start by following more frequently.
The economics of ortho-K: Profitability and differentiation
Ortho-K is a powerful driver of measurable success metrics. Because it is a specialty service, it commands a higher per-patient revenue than traditional refractive care. Due to ortho-K currently being self-pay in nature, you don’t have to wait for insurance reimbursements or delays and can have instant revenue.
You can come up with your own fee structure, but it may be beneficial to know the average rates in the area your office is located in order to remain competitive. For your adult patients or current soft contact lens wearers, advising them that wearing ortho-K can be a cheaper option compared to an annual supply of regular contact lens over time.
Strategies for connecting with patients interested in ortho-K
Ortho-K patients are often very loyal, and you will be a face they remember due to the nature of follow-ups. The power of word of mouth still exists. Kids will often want to be lens free and will mention it to their parents.
Parents will often talk to other parents in schools/groups and referrals are often made. If a family consists of more than one child, the parents will more likely start treatment earlier due to already being familiar with it.
You want to become the go-to myopia management provider. It's important to be familiar with local pediatricians and schools. Just by introducing yourself to nearby pediatricians/primary care providers, you will more likely be a referral consideration for them.
If you go a step further and educate them on myopia management, they can educate their patients too. Hosting informational sessions after school to talk about health risks regarding progressive myopia and different ways to manage help educate the community. While there may be many doctors that provide myopia management, there are more patients that are still unaware that treatment options even exist.
Final thoughts
In conclusion, integrating ortho-K into your practice may not be as daunting as it seems. Having a structured protocol and a well-educated office staff will help in the long run.
Remember that education is key and that you are helping prevent medical risks and not just selling a lens. Knowing that you don’t need to search for new patients and in fact may have many existing patients who might be interested is a great place to start.
The choice to integrate ortho-K is a choice to reassess your practice mix. Innovation does not require abandoning primary care; rather, it strengthens it. By offering advanced solutions like ortho-K, you provide your patients with superior care while building a more resilient, profitable business.
Orthokeratology is more than a clinical tool—it is a strategic, patient-centered path to sustainable growth in the modern era of optometry.
