Orthokeratology or ortho-k contact lenses.
What are ortho-k contact lenses? Contact lenses that are worn at night.
Ortho-K (or orthokeratology) are contact lenses that are worn at night that improve vision during the day without the need for daytime wear of glasses or contact lenses.
These contact lenses are designed to manage nearsightedness also referred to as myopia. They are often prescribed by eye care professionals who have ‘myopia management’ or specialty contact lens experience. The short term “quality of life” vision benefits include an increase in self-esteem and freedom of being able to see during the day without glasses or contact lenses. Longer-term benefits are associated with slowing the progression of nearsightedness which may lead to more complicated vision issues later in life.
In 2002, Ortho-K lenses were FDA approved to be worn overnight for the temporary reduction of nearsightedness. They are not indicated for the ‘reduction in progression of myopia’, there is a growing body of research that demonstrates that ortho-k contact lenses slow down the progression of myopia.
If the lenses have been around for 20 years, why haven’t I heard of them?
Ortho-K contact lenses have been prescribed for over two decades. During this time, researchers conducted studies and noticed that the children wearing the lenses were exhibiting a slower progression of nearsighted vision compared to the children utilizing other forms of vision correction like glasses or daily wear contact lenses.
At the same time, the number of children with nearsighted vision started to increase around the world, raising the awareness of eye care providers and researchers around the world. This brought more attention to the causes of this increase and possible treatment options. More longitudinal studies supported that ortho-k was having a positive impact on the progression of myopia.
In the past four or five years in the United States, eye care professionals are recognizing the long-term benefits of slowing myopia progression that ortho-k lenses offer. As a result, more and more eye care professionals are practicing myopia management and/or prescribing ortho-k.
How does Ortho-K work?
When worn overnight, the Ortho-K (orthokeratology) lenses gently reshape the curvature of the eye (the cornea) resulting in improved vision. After the lenses are removed in the morning, the child’s vision is clearer and remains stable throughout the day, reducing the need for glasses or daytime contact lenses. Since this is temporary, the eye rebounds to its original shape necessitating that the lens be worn on a regular basis at night. Some kids may need to wear their lenses every night while others may vary their wearing time to once every few nights. Consistent wearing of the lenses is important to achieve the best possible results.
What are the benefits of Ortho-K?
Moms tell stories about when they figured out they couldn’t see the chalk board like other kids. Or, they feel guilty that the reason their child isn’t doing well in school is that they didn’t know their child couldn’t see at a distance. Teachers sometimes catch it, with the kids squinting in the front row. The truth is that being nearsighted may impede your child’s ability to learn.
Another point to consider is that while your younger child may not mind wearing glasses, at a certain age, what he or she wears and how he or she looks becomes more important, which could lead to self-esteem issues.
If left untreated, nearsightedness may lead compromise the ability to learn and lower self-esteem.
Finally, there are active kids, who want to play volleyball or soccer or karate, who have to deal with the extra hassle, challenge or safety issues of wearing glasses.
The primary benefits are:
Ortho-k provides provides clear, lens-free vision during the day.
Research has shown that ortho-k lenses may slow the progression of nearsightedness with children.
This lens-free vision gives your child the freedom from wearing glasses or contact lens during the day.
Allows your child to be active in sports or other activities without having to wear glasses or contact lenses to participate.
Allows you, the parent, to be involved in the contact lens wearing process and be available when your child is wearing the lenses.
The treatment occurs at home, at night, under parental supervision. This removes concerns that might arise from your younger child wearing contact lenses while at school.
Ortho-K can correct a wide range of prescriptions that may not be as treatable with soft lenses.
What else should I know about Ortho-K?
- Ortho-K is a specialty contact lens and not all eye doctors prescribe them.
- The lenses are worn at night while your child sleeps and are made out of an oxygen permeable material that is rigid, not soft.
- Similar to other contact lenses, they requiring cleaning and disinfecting after each use.
- Ortho-K lenses are FDA approved and indicated for overnight wear for the temporary reduction of myopia. The indication for the reduction in the progression of myopia is not FDA approved and is considered off-label use.
- With overnight wear of contact lenses, there is a theoretically higher risk of adverse infections. The have a twenty year history of being worn by millions worldwide. The actual risk has been estimated between 13 out of 10,000 wearers. 1,2
- Ask you eye care professional about the specific design. It’s important to find an OrthoK lens design where the central area of the cornea is flattened to restore clear vision and the mid-peripheral area is steepened to control the myopia progression.
How much do Ortho-K contact lenses cost?
There is a cost difference between Ortho-K and daily wear contact lenses or glasses. Ortho-K lenses are a specialty product and may cost more. This varies from person to person and practice to practice. For example, how many pairs of glasses does your child break or lose each year? And, is your child wearing daily disposable or monthly contact lenses?
Some eye care providers charge a fixed fee that includes the exam, the fitting process and the physical lenses. Others charge a initial exam and fitting fee and a separate amount for the lenses.
The exam costs are higher that an annual exam for a pair of glasses, since the process requires multiple visits to your eye care professional as well as additional specialty contact lens training.
After the first year, the replacement cost may be comparable to soft lenses depending on the soft lenses selected.
What does the research say about slowing the progression of nearsightedness (aka myopia)?
Several multi-year studies conducted between 2005 and 2013 have shown that orthokeratology lenses reduced the progression of myopia in children from 36% to 60% and slowed the eye growth 40-60% compared to spectacles. The average reduction in progression compared to single vision contact lenses is around 50%.
An article “Global trends in myopia management attitudes and strategies in clinical practice" published Contact Lens and Anterior Eye provides an overview of the global view of eye care professionals. The findings state, “Orthokeratology was perceived to be the most effective method of myopia control, followed by pharmaceutical approaches and approved myopia control soft contact lenses (p < 0.001).
Although significant intra-regional differences existed, overall, most practitioners did not consider single-vision distance under-correction to be an effective strategy for attenuating myopia progression (79.6 %), but prescribed single vision spectacles or contact lenses as the primary mode of correction for myopic patients (63.6 ± 21.8 %). The main justifications for their reluctance to prescribe alternatives to single vision refractive corrections were increased cost (20.6 %) and inadequate information (17.6 %).”3
Sources:
1 Lipson MJ. Long-term clinical outcomes for overnight corneal reshaping in children and adults. Eye Contact Lens. 2008;34(2):94-99.
2 Bullimore MA, Sinnott LT, Jones-Jordan LA. The risk of microbial keratitis with overnight corneal reshaping lenses. Optom Vis Sci. 2013;90(9):937-944.
3 Wolffsohn JS, Calossi A, Cho P, Gifford K, Jones L, Jones D, Guthrie S, Li M, Lipener C, Logan NS, Malet F, Peixoto-de-Matos SC, et al. Global trends in myopia management attitudes and strategies in clinical practice - 2019 Update. Cont Lens Anterior Eye. 2020 Feb;43(1):9-17. doi: 10.1016/j.clae.2019.11.002. Epub 2019 Nov 21.
