Robert Kiyosaki, an American Author and Business man said: “inside of every problem lies an opportunity.” Even though he talks about business here, it is very applicable to the world of Optometry we know today.
Our opportunity is to assist our patient with myopia control AND to see clearly during the day without wearing spectacles or contact lenses, all without undergoing refractive surgery.
In our blog post by Mardeen Tait “Is myopia control our new normal?” she addressed what myopia control actually is and what it can offer us in the form of preventative therapy. She also listed a few ocular risk factors for higher myopes (people who are short-sighted), stipulating the urgency for myopia control to reduce the amount of myopia one ends up with later in life.
There are numerous myopia control options available. Your optometrist will assess your eyesight, visual condition and your day-to-day lifestyle to help guide you towards your best suited myopia control treatment option. The biggest thing to know is, the sooner you start, the better. No matter what age.
Myopia control can come in all forms such as
- Orthokeratology (Ortho-K)
- Soft multifocals contact lenses
- Pharmaceuticals
- Innovative spectacle lenses
I am going to focus on one of the contact lens myopia control treatment modalities – Orthokeratology (Ortho-K).
How does it work?
Ortho-K lenses were first described in 1962 as a concept and have undergone numerous adaptations to where we are able to fit these lenses on patients safely today. The Ortho-K lenses are gas-permeable contact lenses designed to be worn overnight and removed in the morning. The lenses are designed to float on top of the eye’s tear film and gently apply water-based (hydraulic) pressure to the front layer of the cornea. The pressure causes the epithelium cells (top layer of the cornea) to move from the central cornea to the peripheral cornea. As these cells migrate, it temporary reshapes the cornea by flattening the corneal curvature. Flattening the cornea neutralizes the myopia by bringing the light to focus on the retina (the back surface of the eye) as demonstrated in the image below.
An easy example to understand this process is to think about two glass slides, like the kind you may have had in science class. Placing these two slides on top of each other when they are dry, it is very easy to pull them apart. However, if you place a couple of drops of water between these two slides and try to pull the slides apart it becomes very difficult. The attraction between the two slides when water is present is due to ‘surface tension.’ Surface tension is part of a group of forces called fluid hydraulic forces. Orthokeratology harnesses the hydraulic forces created by the tears of your eye to mold or reshape the cornea.
Does it slow the progression of myopia?
Orthokeratology has been demonstrated to be one of the most effective treatments for myopia management, with up to ten years of studies. It has been shown to slow progression of myopia in children by about a half, and currently has the most research supporting its myopia control characteristics. Myopia is one of the greatest health threats of the 21st century. By 2050 it is predicted that the prevalence of myopia will reach 50% of the population. Professional associations such as the World Council of Optometry, the American Academy of Optometry and the American Academy of Ophthalmology recognize that myopia control should be the standard of care.
Is it permanent?
The results of Ortho-K lenses only last as long as you wear the lenses. The cell migration can fully reverse when you stop wearing the lenses. An analogy that might be easier to visualize is to imagine sitting in the same position on a couch for the whole night - when you get up you will leave your imprint in the couch cushion, which will gradually bounce back during the day. If you were to sit in the same spot night after night the impression would become stronger and last longer - in ortho-k this is why it typically takes up to 1-week of overnight wear to achieve the full effect - but even with repeated sitting on the couch overnight, the impression will still gradually bounce back after you get up.
Who are good candidates for Ortho-K lenses?
- A map of the corneal curvature needs to be taken to see if you are a good candidate
- Regular corneal shape
- Free of corneal pathology or scarring
- From as young as 8 year olds for myopia management
- Adults wanting to be free from spectacles or contact lenses during the day
- Low to moderate prescriptions (higher prescriptions can be fitted, but the risks lies in the Ortho-K not masking the full prescription)
What is the process?
Once we’ve established that you are a suitable candidate for Ortho-K lenses the fitting schedule is as follow:
- Initial fit of the first lenses – if the fit is good and stable you can go home with the lenses and wear them that night
- Follow-up schedule
- 7 Days – we evaluate the molding that took place over the last week and make sure the cornea is healthy
- 14 Days – we re-evaluate the fit of the lenses to determine if minor adjustments needs to be made (a second set may then be ordered)
- 1 Month – monitoring the health of the cornea, your vision and the progress of the molding
- 3Months (ongoing) – monitoring the health of the cornea and your day time vision
It is important to understand that ortho-k lenses are custom designed. We need to fit you with the lens to fully understand how your eye will respond to ortho-k lens wear.
Will it hurt?
Ortho-k lenses are custom-made for an individual eye. Due to the lens closely aligning to the eye, it removes most of the discomfort that could otherwise occur, however, for anyone new to ortho-k, there is still the initial sensation of having something in your eye like a piece of dust. This is simply due to the top eyelid feeling and highlighting the presence of the lens on the eye. Typically the eye will create tears to try and wash the ortho-k lens out because it thinks it’s like a piece of dust. Over a short period of time this usually settles down to the point where the lenses can be as comfortable as to not be felt in the eye at all.
Summary
We at Spectacle-Warehouse fit Ortho-K lenses. If you think that you can be a candidate for it, please reach out to us to start the process. Ortho-K lenses can be life changing and it definitely falls into the category of a “life-changing opportunity” that we identified. If you have any questions about these lenses, please do not hesitate to phone any of our branches.