The pace at which the product options for management of myopia has increased in the past two-to-three years has caused great excitement among practitioners. Whether it is one of several new soft contact lenses or a complex ophthalmic lens design, there are more accessible options for practices to tempt practices into the specialism of myopia management.
But there is one modality that has been around for much longer and could be in danger of missing out amid the fanfare surrounding newer products – orthokeratology or Ortho-K. The technique, which uses a rigid contact lens to reshape the profile of the cornea, has been used since the mid-2000s for low-to-moderate myopia refractive error correction, but in recent years has become a more common modality for longer-term myopia control.
Finding the right fit
Central Vision Opticians optometrist Bhavin Shah says Ortho-K is generally his most effective method for myopia control, but there are caveats, such as patient and parent communication and user compliance, as well as technical aspects of corneal profile analysis.
Assessing whether a patient is suitable for Ortho-K depends on several factors, says Shah. ‘I like to gauge whether the patient has a particular preference already or ask if they know someone who’s already having some kind of myopia management. If they know someone having Ortho-K treatment, then they’re often attuned to what’s involved,’ he says. Often, the patient’s lifestyle drives the decision, says Shah, with keen swimmers and those into sporting activity perfectly suited to the modality.
Although Shah has been fitting child patients with contact lenses for several years (Optician Awards 2018 Children’s Contact Lens Practice of the Year), the move into Ortho-K work came just over three years ago. Adapting to the new modality was a challenge: ‘Obviously we needed a topographer and we had to go through the process of doing some fittings to build up experience and confidence. That was the first step initially, but like anything, if you stick at it for a little while and do a few cases, you learn quite quickly. There’s a lot of support out there from the companies who are producing the lenses too, so that is always a great help,’ he
says.
Patients and parents
Communication with both patients and parents is a key factor in successful myopia management. For Shah, the biggest barrier with Ortho-K is explaining how the rigid lens will feel in the first few days in a particular patient, especially if they have tried soft lenses in the past. ‘Once they’ve got over the first week of adaptation, that’s really when they start seeing the benefits. You’ll find children just feel really happy that they wake up in the morning and they can see.’
And Ortho-K dropouts are virtually zero for Shah: ‘Pretty much all the children that have been on Ortho-K, especially the ones that have worn soft lenses previously and have been switched over, do not want to go back to wearing soft lenses.’
It would be easy to think that compliance with this particular modality and children would be low, but Shah says this really is not the case and has patients as young as six using Ortho-K. ‘You get an idea of whether this will be a problem at the first fitting,’ he says. ‘I can judge whether they’re tolerating the lenses and if they’re engaging in handling and cleaning.
‘But what really helps drive compliance is that the difference when lenses aren’t worn for a night is really noticeable, so that motivates children to keep them in.’
Parents are the gatekeepers when it comes to children and contact lenses, so how does Shah talk to parents when dealing with Ortho-K? ‘If the parents are already myopes, which a lot of them are, they then generally understand the process and what we’re trying to achieve. If it’s a new myope, then I’ll explain what myopia is, how it progresses and then what the risks are in the future, dependent on the age of onset.’
When explaining risks of Ortho-K to parents and patients, Shah outlines the rapid response support the practices offers. ‘I tell the parents if there are any issues, any redness or any pain or anything unusual, just let me know straight away and we book them in as soon as possible for a check-up.
‘The initial fitting is when you get an idea of what’s going to happen. I see them on the first morning, a week later and monitor very carefully at the initial stages. If everything is working well, then it’s very rare for them to have issues after that.’