As most eye care professionals (ECPs) will know, orthokeratology corrects myopia through the wearing of custom designed contact lenses overnight. These temporarily flatten the cornea and allow for improved vision during the following day. It is clear from the product profiles on the previous pages that orthokeratology contact lenses represent an impressive combination of technology and engineering but what are the benefits of offering them to patients and how can you go about it?
Lifestyle benefits
According to Katie Harrop, professional services director at No 7 Contact Lenses, the benefits of orthokeratology for patients can be split into two categories: myopia control and lifestyle.
‘The benefit that is being discussed most right now is myopia control for children,’ says Harrop. ‘That’s obviously a great thing to offer but if you compare orthokeratology to a soft lens myopia control option, it also offers lifestyle benefits for children and adults alike. With myopia control so prevalent in the conversation, there’s a risk that the lifestyle benefits are being forgotten. One group which benefits from these are really active or sporty younger adults who wear contact lenses because they don’t want to be spectacle wearers but would really rather not have to rely on anything at all. Then there is a slightly older age group that benefits from being lens-free in the day because it negates the environmental challenges that lead to dryness that lens wearers face.’
Josie Barlow, professional services manager at Menicon, emphasises the benefits of patients being free of any kind of spectacle or contact lens correction during waking hours. ‘This is marvellous for those who have an avid interest in sports, particularly water sports as there is zero chance of any water contamination that could lead to infection,’ says Barlow.
‘Also for patients who may suffer with allergies, particularly during the hay fever season, this can be a great alternative to conventional disposable lenses.’
For practices, orthokeratology can make financial sense. ‘Offering orthokeratology means you are providing your patients with a common and often optimum correction for their vision,’ says Scott Brown, director at Scotlens. ‘Orthokeratology wearers rarely discontinue as there are no dryness issues. This means there’s a good opportunity to grow a base of low issue patients that are on a profitable lens mode. It is arguably the best financial product to provide to a patient. Moreover, it is extremely satisfying as the patient response to the lenses is so enthusiastic.’
Harrop sees far reaching advantages for independent practices treating children’s myopia with orthokeratology.
‘The key benefit to independents is that they don’t see normal children, they don’t see normal young adults and they don’t see normal slightly older adults because they’re all off to multiples who can offer things that are cheaper. So the age of the patient base in independent practices has risen and they get left with the complicated patients. Orthokeratology offers a way of getting younger patients back and once you have a child registered to the practice, you gain the benefit of seeing their parents and siblings.’
Malcolm Hughes, director and co-founder of IGO agrees that orthokeratology can benefit independent practices greatly.
‘Orthokeratology provides a basis of recruiting long term patients to independent practices who are unable to try and shop around for better deals with the High Street chains who typically do not offer the treatment, says Hughes. ‘Since there is a higher clinical content to the treatment and more professional time is required for the initial fitting period (typically around one month), there is an upfront investment required by practitioners which pays back over time. This runs counter to the multiples’ business model of recruiting patients who generate immediate income so provides a differentiating proposition for independent practitioners.’
Training
Optometrists and contact lens opticians are best placed to provide orthokeratology to patients after undergoing specialised training.
‘Technically any qualified ECP can fit orthokeratology,’ says Barlow. ‘However, if you have little or no experience with RGP lens fitting generally then it is a steep learning curve. Most, if not all the manufacturers that offer lens designs, offer full training on the software and lens designs available. At Menicon we will be running workshops and training days focusing specifically on our lens design and software over the next year. We are happy to advise our practitioners via email or phone and our software allows them to ask for advice on fitting. We are also able to come out and see practitioners if they would like us to and we can dial in to their systems to assist with any adjustments or take a look at topography in advance.’
Brown assesses the difficulty of fitting orthokeratology lenses as easier than soft torics.
‘Any ECP with an interest in orthokeratology and any type of contact lenses experience can fit given some training,’ says Brown. ‘Scotlens provides training sessions and one-on-one practice sessions through a dedicated optometrist. These cover myopia control, OK fitting, topography and are all CET approved.’
No 7 Contact Lenses put on comprehensive training days at its head office in Hastings.
‘We offer a full day’s training,’ says Harrop. ‘The initial stages cover topography and useful background theory that helps prepare participants for the later sessions that we run on how to actually fit lenses and we then finish off with the myopia control session. The topography section includes a hands on practical because topography is so key to good orthokeratology practice.’
For ECPs who struggle to take a day out of practice, a useful option may be to take an online course with IGO.
‘IGO offer online training programmes which enable practitioners to become accredited for beginning with their first lens fits. Most importantly, new orthokeratology practitioners should not be too ambitious with their early fits: IGO recommends not to fit myopes with higher than -3.0D or significant cylinder (>-1.0D) for their first five to ten patients and to provide topography with their initial lens orders. This enables us to provide feedback on how new practitioners are using their topographers as well as giving guidance on any teething problems.’
With all manufacturers providing extensive clinical support and marketing materials, perhaps the question that most ECPs should ask themselves when considering moving into orthokeratology is why not?