Orthokeratology

What is Orthokeratology?

Orthokeratology, or Ortho-K as it is more commonly referred to, is a non-surgical treatment for myopia (nearsightedness). It involves the use of special gas permeable contact lenses worn overnight to help reshape the cornea, the very flexible front surface of the eye, by flattening and gradually changing its curvature to reduce the need for glasses or contact lenses.

Orthokeratology Background

Reshaping of glass lenses was discovered by doctors in the 1940’s . They noticed that when their patients removed their glasses, they had relief from astigmatism. This discovery led to experimentation with the reshaping of lenses for this purpose and the creation of contact lenses for the reduction of the effects of myopia or nearsightedness. It is believed that orthokeratology was developed as a remedy to help those who had trouble wearing traditional rigid contact lenses.  George Jessen is credited with creating the first known orthokeratology design, known as “Orthofocus”, in the 1960’s though it was not considered to produce predictable results at the time.

It wasn’t until the 1990’s that orthokeratology technology advanced to become the procedure it is today. The first orthokeratology system (Ortho-K) was developed in Germany in 1993 and was a custom made disposable rigid frame prescribed by an ophthalmologist. While wearing the Ortho-K system, patients would wear the frames for a few hours at night for up to 6 weeks, after which they would switch from their glasses back to their contacts. Due to the large number of disposable frames being made and distributed, it was not long after the introduction of this product that other countries began developing systems as well. However, a difference in international regulatory controls caused a slight delay in FDA approval to enable this technology to initially be available to consumers in the United States.

Orthokeratology Process

The process of fitting Ortho-K lenses begins with measuring and mapping the surface and shape of the cornea which is done with an instrument called a corneal topographer. This procedure, which is quick and painless, enables the optometrist to design custom-made ortho-k lenses that specifically fit your eye.

Once the lenses are properly fitted and worn overnight, they begin flattening the cornea while altering how light is entered into the eye, subsequently correcting your vision.  The lenses are sturdy and gas permeable ensuring the health of the eye by allowing oxygen to penetrate.

Ortho-k lenses must be worn regularly at night or the shape of the cornea will return to its original form. Once the lenses are removed in the morning, the vision correction will typically last for approximately 1-2 days without the need for glasses or contact lenses. Exciting, right?

Orthokeratology Expectations / Results

The desired goal for an Ortho-K wearer is to achieve vision that is 20/40 or better. While some people experience an improvement with their vision within a few days (or even after the first night), it may take up to two weeks or a few lens modifications for others.  The lenses will be worn each night as directed by your optometrist, and will be finalized once the desired corneal curve is achieved, in order to maintain the vision correction.

Many people will have some awareness of the lenses on their eyes prior to falling asleep during the first few weeks of treatment, however, over time the eyes will adjust to the feeling of the ortho-k lenses and become more comfortable. Vision correction is expected to last between 24-36 hours without the need for eye glasses or contact lenses and can be enjoyed for many years with proper use and eye care.

How Safe is Orthokeratology

It is crucial for patients to have yearly comprehensive eye examinations with their optometrist in addition to follow up visits in specific intervals once they have decided on orthokeratology to improve vision refractive errors.  However, there are not many differences between wearing ortho-k lenses or any other contact lenses in terms of risk factors.  Proper hygiene is most important for the prevention of bacteria on the lenses which can cause infection, irritation or in extreme cases corneal ulcers which can lead to long term visual impairments.

Some people do develop temporary vision problems during the first month which may include ghosting, double vision or starbursts around lights.  However, these symptoms usually subside after a month of consistent lens wear and as the precision of the fit is improved.

When fitted properly, Ortho-k will correct nearsightedness (myopia), farsightedness (hyperopia), and astigmatism in about 99% of cases.

Who is Orthokeratology for?

Wearing eyeglasses or contact lenses on a daily basis to improve your eyesight can prove to be cumbersome or inconvenient for many people.  Many people turn to ortho-k lenses, because it is a low risk non-surgical option to correct mild to moderate myopia which also may or may not be accompanied by mild astigmatism.

While refractive surgery and LASIK are not recommended for children and young adults to correct vision problems because vision must be stable, Ortho-K, on the other hand, can provide a reshaping of the cornea to temporarily improve vision.  Others who would benefit from this form of vision correction are those who participate in contact sports or work in an environment that would make it increasingly difficult to wear contact lenses, such as a dusty or dry environment.

Orthokeratology and Myopia in Children

Children with myopia have difficulty seeing objects at a distance. The risk for becoming nearsighted increases for them when they spend a relative amount of time doing close-up activities such as reading, using a computer or playing video games and there’s also a genetic component for the development of nearsightedness.

Orthokeratology can be a good treatment option for children and adolescents with mild to moderate nearsightedness though there is no evidence currently that suggests that Ortho-K can slow down the progression of myopia.  The benefit of this procedure is that it gives children as young as six or seven years old the opportunity to see clearly without having to wear glasses or contact lenses and can be discontinued at any time. 

Orthokeratology and Sports

Participation in athletic activities can be awkward or burdensome at times when having to rely on eyeglasses or contact lenses to see properly, particularly for those who engage in activities that require quick bursts of speed and agility such as basketball, football, tennis, soccer, or other sports involving fast-paced movement and eye-hand coordination. Wearing glasses or contact lenses while enjoying these types of activities can lead to headaches, as well as dryness or eye irritation, due to the awkward feeling of an object pressing against one’s eyes when moving quickly.

Ortho-K treatment can enable physically active people to gain a certain degree of freedom while playing sports without the worry or discomfort of wearing eyewear.

Frequently Asked Questions

How much do Ortho-K Lenses Cost?

Eye care specialists set their own costs based on many factors, such as time requirements for each patient, lens costs and even the region of the country where the practice is located. The cost of Ortho-K lenses will vary from person to person depending on the severity of the refractive error. Insurance will pay for Ortho-K lenses in some instances, however, it is typically considered an elective treatment.  The out of pocket cost for the lenses as well as the follow up care can range significantly.

Is Ortho-K bad for your eyes?

While there are huge benefits to the use of orthokeratology lenses, such as improved eyesight without the need to wear glasses or contact lenses for a set period of time, there is also some risk associated with this type of treatment, especially in adolescents and children.  Eye infection is a big risk factor with any kind of lenses placed in the eye and it is important to maintain proper hand hygiene and lens cleaning with each application. This is why regular check ups with an optometrist are crucial to the health of your eyes if Ortho-K is being considered as an option for you or a family member.

Does Ortho-K Really Work

FDA trials have shown the success rate to be 20/20 eyesight for 65% of patients and 20/40 or better for over 90% of patients.  It often takes several weeks of wearing the Ortho-K lenses to see full results, however, maintaining the corrected corneal shape is dependent upon how regularly the lenses are worn each night.

Can Orthokeratology be permanent?

Improved eyesight can typically last from 24-36 hours without the need for glasses or contact lenses.  The cornea will remain flattened and preserved as long as the Ortho-K lenses are worn overnight and, if not done so regularly, the eyes will slowly return to their original shape and vision problems will continue to reoccur.  The benefits of Ortho-K can last for many years as long as your eyes remain healthy and the lenses used properly.

What vision problems does Ortho-K help with?

Orthokeratology is typically used as a temporary corrective treatment for myopia, or nearsightedness.  Patients experiencing other refractive errors, such as a milder form of astigmatism, hyperopia and presbyopia can also benefit from the use of Ortho-K lenses.

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