Russell & Jones Optometrists

Orthokeratology

Ortho What?

Orthokeratology or Ortho-K is quite simple: as in orthodontics and orthopaedics, the ortho in Ortho-K is for correction. Orthodontics corrects teeth. Orthopaedics corrects skeletal injuries. Orthokeratology corrects the cornea (front surface of the eye).

Orthokeratology is a non-surgical, reversible procedure in which specially designed contact lens devices are used to gently and gradually re-shape the front surface of the cornea. The Ortho-K lens devices are only worn during sleeping hours. On waking the lenses are removed. The reshaped corneal surface allows clear and natural vision for the rest of the waking day without the need for prescription glasses or contact lenses.

Orthokeratology is a process of gently moulding the cornea to reduce or eliminate nearsightedness, farsightedness, presbyopia (the need for reading glasses) and astigmatism by the programmed therapeutic application of contact lenses.

Orthokeratology is ideas for children and adults with prescriptions ranging from -1.00 to -10.00 dioptres of myopia (nearsightedness) and from +1.00 to +5.00 dioptres of hyperopia (farsightedness). Currently only low to moderate amounts of astigmatism can be corrected.

New designs are currently being tested which will allow for the correction of high astigmatism, presbyopia and post-LASIK (refractive surgery) patients who still have some residual myopia or irregular treatment areas.

How Does Ortho-K Work?

While you sleep, the contact lens moulds the cornea using fluid forces to conform the cornea to the lens’ reverse geometry design. This produces a flatter central cornea and steepens the peripheral cornea correcting the nearsightedness.

In the case of hyperopia and presbyopia the cornea is conformed to the contact lens’ double reverse geometry design steepening the central cornea and flattening the peripheral cornea, correcting the farsightedness.

Improvements in vision can usually be seen the next day with the procedure stabilising after a week. With the high minus powers (correcting myopia) over -6.00 dioptres (the procedure takes from two to four weeks to stabilise) Ortho-K does not make any permanent changes to the eye surface. Your eyes will revert to their former state within 1–4 weeks if you stop using the lenses.

The risks involved with the treatment are the same risk as for any contact lens wearers ranging from allergies to bacterial infections due to poor hygiene.

The lenses are surprisingly comfortable to wear and most people comment that they forget they have lenses in the eyes after the first night of sleeping with them in.

Who Benefits from Ortho-K?

Ortho-K holds particular appeal for:

People who participate in sport, especially contact and water sports
People working in dusty or dirty environments
People who are contact lens intolerant due to dry eyes, allergies or environmental factors
Children

In short, Ortho-K works best for people who don’t want to wear glasses or contact lenses all day, but don’t mind wearing contact lenses while they sleep.

Ortho-K is not for everyone. You must have a healthy cornea that is free of any disease. The same corneal health criteria that holds true for any of the refractive error surgery corrections—such as LASIK—holds true for Ortho-K.

Ortho-K and Children

Myopia, or nearsightedness, is a condition of the eye that refers to a person's ability to see objects at a distance. People who are myopic have blurry distance vision and clear near vision.

What causes myopia? Myopia occurs when the eyeball grows too long in relation to the power of the lenses of the eye. This causes light rays to focus at a point in front of the retina, rather than directly at its surface.

Blame Mum and Dad? Myopia runs in families and usually appears in childhood. Traditionally, optometrists would tell concerned parents that their child is myopic due to heredity. However, a disturbing trend has emerged. More and more children are becoming nearsighted even though their parents have no vision problems. So if genetics is not the only factor, what else contributes to myopia?

In addition to genetics, the development of myopia seems to be influenced by environmental factors such as near work activity. Studies have shown that the more near work performed the more likely your child will become nearsighted.

In one study, boys in Orthodox Jewish schools were found to have a higher rate of myopia (81.3%) compared to boys in general Jewish schools (27.4%). The boys in the Orthodox schools spent upwards of 16 hours a day studying! Another report published in the British Journal of Ophthalmology, studied 429 people applying to enter the Singapore military. The report found that nearsighted applicants generally had more education than their 'clear-seeing' counterparts.

One of the unforseen advantages of wearing Ortho-K lenses seems to be 'control' of myopia. Researchers in Hong Kong and the US have conducted clinical studies that specifically investigated myopia progression and Ortho-K. Both studies demonstrated that children who wear Ortho-K lenses show 50% less progression in myopia than children who wear spectacles.

Ortho-K Fine Print

Orthokeratology is an option for vision correction for people with shortsightedness, longsightedness, presbyopia and astigmatism. Orthokeratology works by altering the corneal shape. It only treats myopia but does not cure myopia. It is only a temporary measure and the effect will be reversed if you stop wearing your Ortho-K lenses.

The treatment time is dependent on the individual and involves a number of scheduled and unscheduled visits. Unscheduled visits are usually necessary if there are any unexpected problems. Missing or turning up late for any of the scheduled follow-up appointments will delay the treatment. The number of lenses required for this treatment is patient dependent.

During the treatment you need to return for regular follow-up visits and to strictly follow the instructions given by your optometrist during the treatment period. This is extremely important, as failure to comply may lead to complications and in severe cases you may need to stop the planned treatment with no refund.

Common lens complications include:

Mild lens binding on awakening (you will be taught how to dislodge a bound lens safely and easily).
Mild (superficial) corneal staining (which will normally heal after a few hours).
Solution allergy (you will be switched to anther care system).
Fluctuating vision on certain days after myopia reduction (this could happen if your lenses did not centre properly when you wore them the night before).

All these complications can be kept to a minimum if you follow instructions properly. During the treatment, before complete myopia reduction, you may need to temporarily wear spectacles/disposable contact lenses to correct any remaining refractive error during the day. When the treatment is completed, you will need to continue to wear the final pair of Ortho-K lenses to maintain the myopia reduction effect.

Regular after-care visits (3—6 monthly) are still necessary to ensure the health of your eyes. It is important that you come for these regular check-ups even if you are happy with your vision.

Please note that severe complications in contact lens wear without early detection or intervention include corneal infection and possible permanent vision loss.

Appointments and Pricing

Treatment includes two Ortho-K lenses, a contact lens care solution value pack, comfort drop, lens sucker and a minimum of eight appointments over 12 months.

The appointment program is as follows:

Initial eligibility assessment: Refraction, examination of ocular surface and digital corneal topography.
Fitting of Ortho-K lens, teaching of insertion and removal and care and maintenance regimes.
Lenses are then worn for the first time that night. The following morning the lenses are worn to the first appointment at 9:00am.
Aftercare one week later.
Aftercare two weeks later.
Aftercare one month later.
Aftercare three months later.
Aftercare every six months thereafter.

Total cost of Ortho-K treatment:

Low Myopia: 2 eyes $1300, 1 eye $950
High Myopia: 2 eyes $1550, 1 eye $1,100
Repacement Lens Pricing: $350 per lens

All lenses come with a 30 day warranty and contact lens solution with starter kit.

Ortho-K Instructions

Handling and care — what to do:

Before Bed — Inserting Ortho-K Lenses

Wash your hands (never touch your eyes without washing your hands). Dry your hands but be sure not to leave lint on your fingers.
Remove the lens from your case and fill the back of the lens with comfort drops (Celluvisc.
Place the lens straight onto eye over the pupil (black part).
Rinse your case out with hot water, dry with a tissue and leave to dry overnight in your bedroom, not the bathroom.
Go to bed and try to go to sleep as soon as possible, as your new lenses are more comfortable when you are asleep.

In the Morning — Removing Ortho-K Lenses

After washing your hands, place a drop of the comfort drops into each eye.
After five minutes use your index finger to push up your bottom eyelid and ensure that the contact lenses are moving.
Use your lens sucker to remove the lenses by looking straight at the sucker, or use the "tight blink" to remove your lenses.
Clean your lenses in your hand using the Boston cleaner (brown cap) and then rinse with sterile saline.
Place your lenses into your dry lens case and cover with the Boston conditioner (blue cap).

We recommend that all RGP (hard) lens wearers, including Ortho-K, use the Boston enzyme cleaner fortnightly. This ensures that your lenses are clean, healthy and will last as long as possible.

Once a week rinse your lenses case and lids with water, then dry and place your case open on a plate. Place in the microwave for 40 seconds on high.

Note: Russell & Jones Optometrists would like to acknowledge Lachlan Scott-Hoy of Innovative Contacts as the author and source of information found on this page.