Ortho-K reshapes cornea while you sleep
Move over laser vision correction! Orthokeratology, or Ortho-K for short, is opening some eyes as an option for some who don’t like wearing glasses or contact lenses during the day. Dr. Monica Nguyen, an optometrist at the New England Eye Center at Tufts Medical Center, answers questions about Ortho-K.
Q. What is Ortho-K?
A. Orthokeratology (or Ortho-K) is a way to correct your vision so that you don't have to wear contacts or glasses during the day to see. You wear a small, rigid contact lens that reshapes the front of your eye while you sleep, and by morning when you remove the lens, your vision is 20/20. It's like a retainer for the eye! The results are not permanent, however; if you don't wear the Ortho-K lenses regularly, your cornea goes back to its original shape and your sight will need correction again full-time.
Q. Who is a good candidate for Ortho-K?
A. Ortho-K can correct nearsightedness, farsightedness, and even slight astigmatism. The best candidates have refractive error between +1.00 to -4.00 and no more than 1.00 diopters of astigmatism. For those over the age of 40 who need reading and distance correction, Ortho-K can be tailored to help them see functionally without glasses using a technique called monovision Ortho-K. Children can benefit as well—Ortho-K is perfect for young kids or teens who have a hard time keeping up with their glasses or continually break them because of sports or other activities.
Q. What is the success rate?
A. Success rates for Ortho-K are high, but as with any medical treatment, they are not always guaranteed. Lots of outside variables come in to play, such as patient expectations, patient compliance with wear schedule and lens cleaning, and any pre-existing ocular conditions, such as dry eye. But if there's a will, there's a way, and a good optometrist will work with the patient to identify possible obstacles, manage expectations, and solve any problems that arise.
Q. What does Ortho-K cost?
A. Ortho-K is generally not covered by insurance, unless deemed absolutely medically necessary. If your vision policy has regular contact lens coverage, there may be a small discount, but for the most part, Ortho-K is paid for out-of-pocket by the patient. The cost can range from $900-$1500 for both eyes, and this covers a pair of lenses with fitting, diagnostic imaging to help create your custom lens, one-on-one training on how to safely insert, remove, and take care of the lenses, and follow-up care with the doctor. It may seem like a lot, but to put it into perspective, Ortho-K eliminates the need for contacts or glasses without the higher sticker price of laser refractive surgery.
Q. There seems to be some evidence that Ortho-K can actually slow the progression of myopia in children; have you seen evidence of this?
A. To me the most interesting benefit of orthokeratology is its effect on slowing down myopia progression in young kids. Myopia, or nearsightedness, is a growing epidemic, particularly in the Asian population, where the occurrence is as high as 80% or more. High myopia can lead to other complications such as glaucoma, retinal detachments, and cataracts. The results from the research on what Ortho-K can do to prevent myopia is really exciting to see, especially when I think about my pediatric patients who come to me year after year with big jumps in their prescription—their parents will look at me and say "Is there anything we can do to stop it?”. Stopping it altogether may be tough, but slowing it down is definitely doable.
Q. What are the risks?
A. The risks for Ortho-K are low and are similar to that of any contact lens that is approved for overnight wear. Some adverse events that have been reported include microbial keratitis (an infection of the cornea), punctate keratitis (inflammation of the cornea), corneal abrasions, and corneal infiltrates. All of these conditions are treatable and usually preventable, with no lasting complications. With proper lens hygiene and care, patients should not have any problems.
Q. Would you recommend Ortho-K to your patients?
A. I highly recommend Ortho-K to my patients who qualify as good candidates. With thorough discussion on patient expectations and goals, I believe Ortho-K can be a very successful option in improving a patient's vision and quality of life.
To make an appointment with Dr. Nguyen, call 617-636-4600.
Posted March 2017
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