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Clearing the Hurdles of Myopia: How Ortho-K Benefits Kids Beyond Vision Correction

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The safety and efficacy of Ortho-K as a means of decreasing myopic progression have been well established in studies, including those focusing on Asian children, where myopia prevalence is notably high.

Benefits of Ortho-K for Children

Orthokeratology (Ortho-K) offers a compelling non-surgical intervention for managing myopia (nearsightedness) in children, providing several significant benefits that make it an attractive option for both parents and eye care professionals. The advantages of Ortho-K, including its non-surgical nature, reversibility, and the daily freedom from corrective eyewear, are supported by recent clinical evidence and expert opinions from various studies and reviews.

Non-Surgical Intervention

Ortho-K is a non-invasive method that does not involve surgery. The safety and efficacy of Ortho-K as a means of slowing down myopic progression have been well established in studies, including those focusing on Asian children, where myopia prevalence is notably high [2].

Reversibility

One of the most significant advantages of Ortho-K is its reversibility. If for any reason the treatment needs to be discontinued, the cornea will return to its pre-treatment curvature, and the refractive error will reappear. The ability to reverse the treatment effects by simply ceasing to wear the Ortho-K lenses provides an added layer of safety and control over the treatment process.

Ortho-K lenses are worn overnight, reshaping the cornea to correct myopia temporarily, which allows children to go through their day without the need for glasses or contact lenses.

Daily Freedom from Corrective Eyewear

Ortho-K lenses are worn overnight, reshaping the cornea to correct myopia temporarily, which allows children to go through their day without the need for glasses or contact lenses. This freedom is particularly beneficial for children engaged in sports and physical activities, where glasses can be cumbersome, and contact lenses may pose a risk of injury or loss. The convenience of not having to wear corrective eyewear during the day also contributes to better compliance and satisfaction with the treatment among children [1].

Recent clinical evidence supports the effectiveness of Ortho-K in slowing down the progression of myopia in children. Studies have shown that Ortho-K can slow myopic progression by 36-56% compared to children who wear glasses or conventional contact lenses [2]. This myopia control effect is crucial for reducing the long-term risks associated with high myopia, such as retinal detachment and glaucoma.

Considerations and Customization in Orthokeratology

Orthokeratology (Ortho-K) is a non-surgical method used to correct vision by reshaping the cornea using specially designed contact lenses. The effectiveness of Ortho-K is influenced by several factors, including refractive error, corneal curvature, and lens design. Personalized treatment plans and professional fitting are crucial for achieving optimal results and ensuring patient safety.

Factors Influencing the Effectiveness of Ortho-K

1. Refractive Error

The degree of refractive error, particularly myopia, is a significant factor in the effectiveness of Ortho-K. Ortho-K is traditionally used to correct low to moderate myopia, typically up to -6.00 diopters, and astigmatism up to -1.75 diopters [3] [4]. The success rate of Ortho-K decreases as the amount of myopia or astigmatism increases. However, recent advances have allowed for the correction of higher amounts of myopia and even other types of refractive errors such as hyperopia and astigmatism [3].

Modern ortho-k lens designs allow for fast and predictable treatment. (A) Topography of a young myopic astigmatic patient before treatment and (B) after 20 minutes of wear. [Image Source: https://clspectrum.com/issues/2021/october/recent-advances-in-orthokeratology/.]

2. Corneal Curvature

The corneal curvature, or the shape of the cornea, also plays a vital role in the effectiveness of Ortho-K. Corneal topography is used to map the cornea’s surface and guide the treatment [3]. The cornea’s shape can influence how well the lenses fit and how effectively they reshape the cornea. For example, individuals with steeper or more irregular corneas may require more specialized lens designs for effective treatment [4].

3. Lens Design

The design of the Ortho-K lenses is critical for successful treatment. Modern Ortho-K employs reverse-geometry lenses, which have a flat central curve and a steeper adjacent reverse curve, connected to flatter peripheral curves that align with the mid peripheral cornea [3]. The design of these lenses centers well and is highly stable, which is essential for rapid and predictable correction. Variations in lens design can stem from different assumptions about average corneal shape, and the precision of lens manufacturing can affect the outcome [4].

Average corneal height differentials at three chord lengths of 114 eyes, organized by amount of corneal astigmatism. [Image Source: https://clspectrum.com/issues/2017/march/the-anatomy-of-a-modern-orthokeratology-lens/.]

The Importance of Personalized Treatment Plans and Professional Fitting

Personalized Treatment Plans

Every individual’s eyes are unique, and therefore, a one-size-fits-all approach is not suitable for Ortho-K. Personalized treatment plans are developed based on a thorough examination of the patient’s eyes, including refractive error, corneal curvature, corneal diameter, and overall eye health [5]. These plans consider the patient’s specific visual needs and lifestyle, aiming not only to correct refractive errors but also to slow the progression of myopia, especially in children [3] [5].

Ortho-k design software linked to corneal topography is also available when a high degree of customizability is desired. [Image Source: https://clspectrum.com/issues/2021/october/recent-advances-in-orthokeratology/.]

Professional Fitting

Professional fitting by an experienced eye care practitioner is essential for the success of Ortho-K. The fitting process involves selecting the appropriate lens parameters and making necessary adjustments to ensure optimal lens performance and comfort [6]. A well-fitted lens will have a good central position, appropriate movement, and adequate tear reservoirs, which are crucial for corneal health during overnight wear [6]. Follow-up appointments are necessary to monitor the fit, evaluate the treatment’s progress, and make any required changes to the lens design or wearing schedule [6].

Orthokeratology: Effective Vision Correction with Essential Care and Compliance

Orthokeratology (Ortho-K) is a non-surgical method used to correct refractive errors by reshaping the cornea with specially designed contact lenses worn overnight. While Ortho-K has been found to be effective for vision correction and myopia control, it is not without risk as with any contact lens wear. Nevertheless, these risks are minimal and can be efficiently mitigated by adhering to scheduled follow-up appointments, maintaining strict compliance with cleaning routines, and using suitable solutions to safeguard the wearer’s well-being. 

Prevention of bacterial keratitis involves proper contact lens hygiene, including regular cleaning and disinfecting of lenses.

Proper lens care and hygiene are critical to minimizing the risks associated with Ortho-K. Inadequate cleaning and disinfection of lenses can lead to lens contamination and increased risk of infections. A study from “Myopia Profile” emphasized that children who are solely responsible for lens care are less compliant than those whose parents are involved, underscoring the importance of parental involvement in the lens care process for paediatric Ortho-K wearers [7].

The importance of parental involvement in the lens care process for pediatric Ortho-K wearers.

Regular Follow-Ups

Regular follow-up appointments with an optometrist are essential for monitoring the success of Ortho-K treatment and for early detection of any complications. Compliance with follow-up appointments is typically excellent at the beginning, but a drop-off can occur over time. The same study from “Myopia Profile” found that 40% of Ortho-K wearers cited “lack of time” and 22% cited “no discomfort” as reasons for non-attendance at follow-up appointments [7]. This highlights the need for consistent follow-up care to ensure the safety and effectiveness of Ortho-K treatment.

Regular follow-up appointments with an optometrist are essential for monitoring the success of Ortho-K treatment and for early detection of any complications.

References

This Article is Medically Reviewed by Oh Poh Ling

Poh Ling graduated as an optometrist from SEGi University. She believes that a person will be able to fully enjoy life when they have comfortable vision and healthy eyes. Poh Ling is involved in numerous vision screenings for the underprivileged school children and also for the public in an aim to promote awareness about the importance of regular eye examination. She enjoys travelling and playing tennis.

Her Specialties includes:

1. Specialty contact lens fitting: Keratoconus

2. Orthokeratology

Favourite Quote: “While there’s life, there is hope.” – Stephen Hawking

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