Orthokeratology: Principles and Practice

There have been very few dedicated textbooks on orthokeratology published. The only one I have in my bookcase is The Orthokeratology Handbook, by Winkler and Kame, a slim spiral-bound book published in 1995. So the publication of this book has been eagerly awaited. The aim of this book is to provide a background to orthokeratology development, design and fitting philosophies, scientific principles behind orthokeratology and patient selection, trial lens fitting and problem solving for the neophyte. The history is fascinating because, although orthokeratology has been used for the past 40 years, reverse geometry lenses were first used in 1989 and John Mountford developed the first effective computerised and predictable orthokeratology fitting regime in 1994. This means that the discipline is barely 10 years old and those of us who have been involved have seen many exciting changes, both in lens design and basic philosophy. Another development which made orthokeratology possible was the availability of corneal topography and this is covered in detail along with a chapter on extended wear with RGP materials. Chapter 4 covers both early designs and most of the present lenses available for myopia. I have found at least three areas of research that I wish to pursue after reading this chapter and, although it is not essential for the beginner, any experienced practitioner will benefit from reading it. There are some minor errors in the labelling of some of the illustrations which will be corrected in the second edition. Chapters 5, 6 and 9 are really a handbook on orthokeratology fitting. Any practitioner new to the discipline will be able to make a start after reading these chapters. I really wish I had had this when I started out. In Chapter 5, patient selection and preliminary examination are covered in detail and, although I issue all my patients with a handbook, I am going to revise my paperwork in the light of the suggested information pack. Chapter 6 on trial lens fitting covers three approaches: empirical, trial lens and use of corneal response data. There is a fourth approach combining trial lens and corneal response data with final dispensing from an in-practice inventory. This is the CRT system from Paragon which is discussed in the chapter, though not distinguished from the other trial lens systems.