Q: How do Ortho-K lenses work?
A: Ortho-k shaping lenses are to designed to progressively reshape the central surface of the cornea systematically, similar the effect of lasers in reversing nearsightedness. However, unlike laser surgery, the effect of Ortho-k treatment is temporary and reversible.
Q: Is everyone a candidate for Ortho-k?
A: No! While orthokeratology can help most individuals (including those with certain types and amounts of astigmatism and moderately high myopia) improve their vision, the procedure is often most effective for those prescriptions falling within a specific range. Additional factors may include individual corneal rigidity and shape factors as well as an ability to wear contact lenses. A thorough consultation and examination using advanced computerized diagnostic instrumentation can easily determine if orthokeratology is right for an individual.
Q: Who is not a candidate for Ortho-k?
A: While Ortho-k can be performed on practically anyone with healthy eyes who can insert a contact lens and follow lens care directions, it is not recommended for people with prescriptions above +6.00. Also, people with pupils that are larger than normal (> 6 mm in normal light) and having irregular corneal astigmatism or any corneal disorder such as keratoconus are not candidates.
Q: How safe is Ortho-k?
A: Ortho-k is believed to be safe when appropriately fitted and managed properly. Some people have been able to eliminate their dependence upon their glasses and standard contacts with no adverse effects. Unlike surgical procedures like radial keratotomy, photorefractive keratectomy (PRK), laser-assisted in-situ keratomileusis (LASIK), laser-assisted subepithelial keratectomy (LASEK), the corneal tissue is not incisions vaporized by a laser. As with all contact lenses, proper lens care and handling must be performed to maintain eye health. The state-of-the-art, high permeability GP materials now available provide adequate amounts of oxygen to the tissues of the eye.
Q: Is Ortho-k permanent?
A: After treatment, maximum results are achieved and retainer shaping lenses are provided to stabilize and maintain the new corneal shape. Failure to wear the shaping lenses on an ongoing basis will result in a return to the pre-existing prescription. Retainer shaping lenses will likely be prescribed for overnight wear.
Q: What are the risks of wearing lenses overnight?
A: The complications of wearing contact lenses include corneal ingrowth of Vessels, Ulcers, and Abrasions. The risks associated with wearing contact lenses overnight are higher than wearing contact lenses only while awake. Contact lenses cannot become lodged behind the eye (this is anatomically impossible) and it is rare for Ortho-k shaping lenses to become decentered from the cornea.
Q: How long does it take for the process to stabilize and provide functional vision the whole day?
A: It generally requires four to seven consecutive nights of wearing the shaping lenses to achieve the desired result. It may take somewhat longer for those with higher cases of nearsightedness.
Q: Are Ortho-k lenses uncomfortable to wear?
A: Overnight wearing of the shaping lenses are surprisingly comfortable. Most patients are unaware of their presence within a very short time after insertion. And because the Ortho-k shapers are made in large diameters and worn during sleep, the normal adaption process is very short.
Q: Will I still have to wear glasses or contacts?
A: Once the desired myopic reduction is obtained, the final shaping lenses act as retainers to maintain that level. Regular contact lenses are not needed. Glasses may be needed for reading or other part-time use. During the initial treatment period, if unaided vision does not last a full day, the patient will be given soft disposable contact lenses to wear to maintain normal distance vision.
Q: Once the treatment phase is completed, how frequently will I need to wear the overnight retainer lenses?
A: Most people will need to wear the shaping lenses six to seven consecutive nights in order to enjoy good, unaided vision during the entire day. Patients with lesser degrees of myopia (nearsightedness) may find that wearing them every other night is satisfactory. However, this will be determined on an individual basis by the eye care practitioner.
Q: How much myopia can a person realistically expect to be able to reduce using orthokeratology?
A: Generally, 5.00 diopters of myopia is the upper limit for myopia reduction. However, work is underway on designs that will hopefully correct higher amounts of myopia. Lower amounts of myopia are easier and faster to reduce.
Q: How about Ortho-k for astigmatism?
A: The amount of astigmatism reduction achievable will depend on the amount and the type. 1.50 diopters of “with-the-rule” corneal astigmatism and 0.75 diopter of “against-the-rule” corneal astigmatism are considered the upper limits for astigmatism reduction. Ortho-k will not have an effect on residual (internal) astigmatism.
Q: How long does it take to be able to see well without glasses?
A: Rapid visual improvement normally occurs in the first few days. Stabilization then follows over the next few weeks and months. Once the wearer’s eyes are stabilized, improved eyesight is maintained by wearing shaping lenses as recommended to maintain vision at the desired level.
Q: If the patient decides to return to wearing glasses, can vision be restored to its pre-treatment level?
A: The wearer’s eyes will return to their pre-treatment nearsightedness after about 2 weeks. Depending on how long Ortho-k lenses have been worn, this process may take as long as 30-90 days. In order to provide good vision during this transitional period, patients are refitted with gas permeable lenses or disposable soft lenses while the corneas recover their pre-treatment shape.
Q: If the patient becomes less nearsighted or presbyopic in later years how will it be handled?
A: Unlike laser surgery that cannot be reserved, corneas can usually be remodeled to accommodate the change in prescription by changing the design of the maintenance lenses to correct for near vision using a technique called “monovision.”
Q: How much does Ortho-k cost?
A: The actual cost will depend on the complexity of the case. Each doctor sets fees accordingly. Fees can range from $750-$2000 depending on the length of treatment and the number of shaping lenses needed. The doctor will be able to provide an estimation for each patient.
Q: What is the current prediction for the number of orthokeratology fits that will be done worldwide?
A: The use of orthokeratology will vary from market to market. Current estimates of orthokeratology show that there could be as many as 30,000 to 100,000 Ortho-k fits annually. Much of this will depend on the acceptance of the professional community, potential candidates, and promotion from GP lens manufacturers and the media.
Q: Is it necessary to use topography to fit today’s Ortho-k lenses or can I use keratometry as I always have to fit GP lenses?
A: Use of topography is recommended in all phases of the fitting and follow-up. Some fitting systems base initial shaping lens selection on topography instruments while others recommend the use of manual keratometry. Virtually all Ortho-k fitting systems recommend the use of topographical data to establish a baseline reference as part of the fit evaluation, to identify and help solve fitting problems and to monitor the progress of myopic reduction.