I was first introduced to the concept of orthokeratology (ortho-k) some time around 2000 by David Ruston, now Director of Global Professional Education and Development with Johnson and Johnson Vision, but who was then working at Nigel Burnett Hodd’s practice in central London. I was totally intrigued by, though I admit also somewhat scared of, corneal reshaping and therefore did nothing. A few years later, around 2004, No7 Contact held a Procornea workshop for practitioners to learn how to fit ortho-k. I not only attended, but also had some lenses fitted personally.
I slept in the lenses and was totally flabbergasted with my vision when I removed them the following morning. I spent the next six months learning from my personal experiences with ortho-k. I wanted to know what my patients would experience when I decided to go live with this modality.
Since 2005, ortho-k has become a mainstream service within our contact lens portfolio. Initially, I was using it mainly for patients who had dry eyes, those with poor tolerance to soft lenses, those who were considering corrective surgery, and for those who were actively involved in sports, especially water sports. My colleagues and I then started fitting the lenses for some of our younger patients as a lifestyle option, as the lenses would only be used at home and under parental supervision. We also started to notice, albeit anecdotally, that we were seeing lower refraction Rx changes in some of our young patients. A few years later still, more and more reports were appearing, particularly from the Far East and the US, regarding ortho-k and myopia management. Today, ortho-k is recognised as an important option for minimising myopia progression.
Here are a selection of ortho-k cases from my practice.
Case 1
Female patient JB, date of birth 28/11/95
Baseline refraction aged 17 years:
- R: -2.00/-0.25 x 100
- L: -2.00/0.50 x 65
JB used monthly replacement soft lenses and was a keen swimmer.
I re-fitted with ortho-k lenses. Her visual acuity after one week of ortho-k overnight wear was:
- R: 6/4.8 (+0.25: 6/4.8)
- L: 6/4.8 (Plano: 6/4.8)
The lenses were changed six-monthly, and JB was still wearing the ortho-k lenses some 10 years later. Only one lens specification change has been needed during that time. Her current refraction, after a washout, is now:
- R: -2.75DS
- L: -3.00DS
As of December 2022, visual acuity was:
- R: 6/6 (+0.25: 6/6)
- L: 6/6 (+0.50: 6/6)
JB works with sea life in the US, Dubai and Scotland and says that ortho-k is perfect both for work and recreation. Figure 1 shows the baseline topography from 2012 and figure 2 the 2019 topography after washout.
Case 2
Female patient JG, date of birth 16/03/69. She worked part time as a hospital-based GP. She was a driver and non-smoker. Leisure activities were described as ‘kids, work and walking.’ Does not swim.
Initial consultation, February 2013, revealed JG had been a contact lens wearer for some 25 years. Initially, rigid corneal lenses had been worn and, for the past 10 years, she had worn 1-day Acuvue Moist lenses daily. However, JG used spectacles often as her eyes ‘get tired’. She had been advised by previous eye care professionals (ECPs) that she has flat eyes and lenses do not always fit, though acuity was always good.
She had no pain or soreness and no redness.
She wanted to wear contact lenses all day without worrying and with minimal care requirements. ‘It would be nice not to wear specs.’
Anterior eye assessment showed:
- Grade 2 meibomian gland dysfunction and anterior blepharitis
- No bulbar, limbal or tarsal hyperaemia
- Clear cornea and normal endothelium
- No corneal staining with fluorescein, grade 2 nasal conjunctival staining with lissamine green
Her baseline refraction was:
- R: -3.00/-0.50 x 15 (6/6+3)
- L: -4.25/-0.75 x 165 (6/6+2)
The baseline topography is shown in figure 3. She was fitted with ortho-k lenses which were successfully worn, the topography in 2018 shown in figure 4.
Her acuity, after ortho-k, in 2018 was:
- R: 6/6 (+1.00: 6/6)
- L: 6/6 (+1.00: 6/6)
By July 2022, JG was experiencing near vision problems with ortho-k so her lenses were adjusted accordingly. Figure 5 shows the topography after this adjustment, which allowed for some monovision near support.
Her acuity is now:
- R: 6/6 (+0.25: 6/6)
- L: 6/7.5 (-0.25: 6/6)
JG is currently ‘very happy’.
Case 3
Patient JD, date of birth 16/06/08, had his first sight test in 2017 and was emmetropic. By September 2020, his refraction had progressed to:
- R: -1.00 /-0.50 x 85
- L: -1.50 /-0.25 x 85
JD’s mother was a high myope of around -10.00DS and his sister was a -4.50DS myope treated with ortho-k. JD was interested in ortho-k, which had been a success for his sister. After fitting ortho-k lenses, there has been just a -0.50DS progression in myopia over two years and no change in axial length (figure 6).
Base line axial length measurements had suggested that JD was between 80 to 90% likely to progress to high myopia (> -5.00DS) but, since ortho-k treatment, there has been no significant axial length growth.
Case 4
Patient KS, date of birth 25/12/12, first attended practice in May 2019 aged seven years with the following baseline refraction:
- R: -4.50/-1.00 x 10
- L: -4.50 /-0.75 x 180
After fitting with ortho-k lenses, the acuity was:
- R&L: 6/6-2 (+0.25: 6/6-2)
In the four years that he has used ortho-k lenses, there has been just one -0.50DS change while his axial length measurement has shown an increase of approximately 0.25mm over this period (figure 7).
Final Comment
Orthokeratology has made a major difference to my practice and also to many of minor patients. Taking the first step is well worthwhile.
- Shelly Bansal is a contact lens specialist working in independent practice in North London.