Have you ever had a great treatment option for a patient but didn’t know how to get them on board? Finding the right wording and strategies for patient acceptance and compliance can be difficult, especially for some of our littlest patients. When it comes to orthokeratology (ortho-K), the art of communication is vital when approaching the topic with both the patient and parent when initiating treatment.
As practitioners, we know the amazing benefits of ortho-K lenses and how they can be especially useful in combating myopia progression, but the parent and patient are likely not as familiar. It is our job to effectively educate the family and encourage them to accept ortho-K lenses and myopia management.
There are several ways to overcome any barriers to the somewhat daunting task of starting orthokeratology treatment, including incorporating simple yet effective communication strategies, addressing any concerns, and making the overall experience fun and exciting for the patient.
Implementing effective communication strategies about ortho-K
The first step in starting any type of treatment is education. It is best practice to use basic language to describe the process and draw similarities to other situations that the patient may already be familiar with. Using terms like “the front of the eye” instead of the cornea or “overnight contact lenses” instead of orthokeratology makes the process easier to understand.
Adding in comparisons to things kids may already be familiar with makes understanding ortho-K a lot easier. For example, we could draw parallels between ortho-K to braces or retainers, which is an experience many kids start at the same time they begin contact lens wear.
Together, we have a discussion about how reshaping the front of the eye is similar to how braces reshape teeth alignment. Like retainers that need to be worn daily to retain the teeth alignment, overnight contact lenses must also be worn nightly to hold the front of the eye’s shape.
Keeping conversations simple and using visuals
When discussing ortho-K as a treatment for myopia management, keeping the concept simple is key; the eye is growing too long, too quickly, and these lenses will slow that growth down. Endless medical jargon will bog down the importance and reasoning behind the treatment, and the patient or parent may get lost in translation.
Easy-to-read infographics or pictures are also a great resource. Visuals are proven to make the process easier to follow, allowing for better recall and adherence to health education information.1 Comparatively, using easy-to-read percentile charts when talking to parents about axial length makes the concept easier to grasp, as most parents are accustomed to pediatricians using this type of metric when discussing their child’s development.
Likewise, using a graph that shows the history of the child’s axial length growth can help the family know where the child stands on curbing myopia and can be used as a motivator to continue treatment.
Addressing patient and parental concerns about ortho-K
Even after thorough education, there may still be some resistance on the parent's or patient’s part. It is important to understand the reasons for any opposition and to properly address them by having an in-depth conversation that can be backed up by data.
A common challenge that we often hear is that the parent is worried about the safety of contact lenses for their child. Most parents are concerned about the child being too young for contact lens wear, compliance to cleanliness and hygiene, and the risk of bacterial infections.
Multiple research studies have dispelled the myth that children are too young and unable to care for their contact lenses. Data suggests that the incidence of corneal infiltrative events in children is not any higher than in adults. Children are not disadvantaged by wearing contact lenses due to their age or size.
Discussing the rate of corneal complications with parents
In fact, children aged 8 to 11 years old have the lowest rates of corneal infiltrative events.2 A great advantage of ortho-K lenses is that they are worn by the child at night at home, allowing for greater parental intervention as needed. In addition, children are impressionable at a young age and can pick up good habits on compliance with contact lens wear.
Some parents may presume that ortho-K lenses have a higher risk of corneal complications due to their inherent modality of being an overnight lens. However, we can reassure the parents that these lenses are made of high oxygen transmissible materials, which reduce the chances of corneal stress and edema when worn overnight.3
In addition, a new study from Japan has reconfirmed previous US studies showing that ortho-K lens complications are at a similar rate to those of daily wear soft contact lenses. It found the incidence rate of microbial keratitis in orthokeratology lens wear to be 5.4 per 10,000 cases.4
Weighing the benefits and risks of myopia control
Stressing the benefits of myopia management and outweighing the risk of contact lens complications can also go a long way in curbing any further concerns about their child wearing lenses. The main purpose of myopia control is to reduce the risk of sight-threatening ocular conditions such as myopic maculopathy, open-angle glaucoma, cataracts, and retinal detachment.
Going back to the data, with each diopter increase in myopia, the patient’s risk increases in developing ocular disease, which could lead to potential vision loss later in life. Bullimore et al. developed a model to analyze the benefit of slowing myopia progression by 1D compared to the risk of placing a patient on treatment over the course of 5 years.6
The model found that a 1D reduction of myopia lowers the predicted mean years of visual impairment by 0.74 years in a -3D patient and 1.21 years in a -8D patient. Additionally, the benefits have a greater impact with each diopter of potential reduction in higher levels of myopia.
In comparison, the years of visual impairment impact due to infection through 5 years of contact lens wear ranges from 0.0053 to 0.1312 years per patient. This shows that controlling myopia progression in patients has a larger benefit when compared to the low risk of corneal infiltrative events from contact lens wear.
Kicking off engaging treatment
While addressing the parent’s concern is half the battle, ultimately, it is up to the patient whether they are ready for contact lens wear. During the consultation visit, get to know the child and pay special attention to the patient’s hobbies, as these are great ways to motivate the patient to wear a lens. If they love swimming or practicing taekwondo, then help them envision a life where they don’t have to worry about glasses or contact lenses.
A 2007 study showed tremendous improvement in quality of life and self-esteem in children and adolescents who started wearing contact lenses after only 3 months of wear.6
By completing the Pediatric Refractive Error Profile (PREP), a quality of life survey that compared satisfaction while performing specific activities wearing contact lenses vs. glasses, subjects in the study were able to report a marked improvement in their appearance and involvement in their favorite activities.
Offering encouragement to patients new to ortho-K
After the parent and patient agree to start ortho-K treatment, start encouraging success early on through meaningful and positive conversations with both the child and parent. Phrases such as ‘‘your child is an excellent candidate for these lenses,” or “I know they will be amazing at wearing contact lenses” will help boost their confidence.
Before actually starting the fitting process, it can be helpful to send the patient home with some preemptive homework. Ask the patient to start by washing their hands and then gently touching their lids and the front of their eye. This will desensitize them to lens wear and overcome any anxious feelings about touching their eyes.
Another alternative would be to have the patient put artificial tears in their eyes to achieve a similar outcome. Having them perform these steps before the contact lens fitting appointment can help the fitting process in-office go much smoother.
Keeping the patient motivated
At our office, we try to make each interaction fun and rewarding during the fitting process and all subsequent follow-up appointments. Notes are taken on the child’s interests and upcoming life events, so when the patient comes in again, they feel special and remembered. It’s important to us that the patient feels as though they are hanging out with the office staff and team rather than coming in for a doctor’s appointment.
With each milestone reached, the patients are given prizes such as a gift card, candy, or other small toys. Examples of these milestones include successful insertion and removal, wearing the lenses for the first week, and successfully wearing the lenses for the first 6 months. This helps the child stay motivated and excited to continue their treatment.
Creating a fun care package, including a bottle of solution, mirror, and lens case, after the initial fitting for the patient to take home will give them a sense of ownership over their treatment. We also like to send a quick follow-up text or phone call that night or the next day to give them an extra boost of confidence on their first night of wearing lenses.
Conclusion
Presenting treatment options in a fun and exciting way for both the pediatric patient and the parents can lead to great outcomes and long-lasting patient relationships.
When it comes to orthokeratology, crafting the conversation of such a novel and complicated therapy can be a bit intimidating to everyone. However, with simple verbiage, data-driven knowledge, and a little fun, getting the child across the finish line can be a breeze.
