Ortho-K: ACCELERATED ORTHO-K VS. ORTHO-K:
A Night and Day Difference PART 1
How this emerging technology transformed this doctor's practice and how it can help you attract would-be LASIK patients.
BY ROBERT C. BAUMAN, O.D., Woodbury, Conn.

ILLUSTRATION BY ANTHONY CERICOLA

About a year ago, I decided to get involved with the most exciting opportunity I've seen in more than 20 years of private practice.

One of my colleagues suggested I try accelerated orthokeratology. I was immediately skeptical. I thought back to years before when I'd tried orthokeratology. When it often took many months to see even a slight reduction in myopia, results were frequently hit or miss and patient satisfaction might be less than desired.

Now, accelerated ortho-K is front and center in my practice, and for good reasons. Not only has it been a great option for non-surgical vision correction for my patients, but this procedure has also given me a unique way to differentiate my practice from those of others. Fees are very lucrative and managed care cost-containment constraints aren't an issue.

Unlike traditional ortho-K, accelerated ortho-K uses new technology that better measures the cornea and an improved lens design -- reverse geometry rigid gas permeable (RGP) contact lenses -- that give much better results far in less time.

Even some forward-thinking ophthalmologists are offering this procedure to patients, and in some cases, they're partnering with optometrists to provide it. I partner with both O.D.s and M.D.s, giving joint seminars and educational programs for potential patients and running advertisements for surgical and nonsurgical vision correction.

What changed my mind?

First, a colleague talked me into trying this technique. But what kept me interested were the results. New lens designs are making it easier to achieve these results.

FDA has recently approved lenses that have high oxygen transmissibility and excellent dimensional stability, which have greatly improved visual correction outcomes. Newer designs and technologies hold even greater promise. FDA has also deemed the procedure safe and effective.

As you're probably aware, for accelerated ortho-K you first map the patient's cornea using a topographer. Based on your findings, you select the appropriate reverse geometry RGP contact lenses that can, in many cases, provide an almost immediate substantial reduction in myopia and astigmatism. Once the patient has attained the desired refractive changes, he wears "retainer" lenses for several hours each day or, more commonly, several hours three to four times a week, on an indefinite basis.

A LASIK alternative

I was actively involved in co-managing laser assisted in-situ keratomileusis (LASIK) cases. In most cases, refractive surgery outcomes were good, but I've seen a few horror cases. A small number of patients were left with reduced visual acuity despite numerous surgical enhancements.

With accelerated ortho-K, I can offer many of the same vision benefits of refractive surgery but without the inherent risks of any surgical procedure, despite the low the percentage rate of LASIK complications.

Having performed accelerated ortho-K for 3 years, I've treated numerous patients who've experienced a 1D to 3D reduction in myopia within 24 hours of starting therapy. Corneas are pristine and topography shows excellent central flattening without distortion in most cases. Most patients are ecstatic with the rapid improvement in unaided acuity.

Not only are traditional refractive surgery patients potential accelerated ortho-K candidates, but myopes as young as age 8 (if the parent and doctor agree it's suitable) can benefit, because this procedure can slow or stop myopia progression.

With accelerated ortho-K you can intervene early in a patient's life before his refractive status has stabilized and long before refractive surgery would be appropriate for a young patient. As you may expect, young children are often excellent candidates and easily adapt to the daily routine of lens wear.

For both children and adults, we routinely treat refractive errors in the range of -.25D to -5.00D of myopia and astigmatic refractive errors up to -2.50D. Not every patient with a substantial refractive error is a candidate, but clinical nomograms are available to accurately predict just who will be the suitable patients.

In addition, we can confidently offer presbyopic patients the option of monovision correction with the understanding that should they experience difficulty adapting, we can then correct both eyes for distance and offer them reading glasses. With surgical intervention, of course, any patients experiencing difficulty with monovision must contemplate additional refractive procedures to provide distance correction in both eyes.

Setting the practice apart

You'll need a combination of things to successfully establish the perception that accelerated ortho-K is a high-value service that justifies substantial fees. Not only will you need to have a high-quality marketing strategy and to offer easy-to-understand patient informational materials, but you'll also need first-rate clinical skills and the appropriate equipment too.

By offering accelerated ortho-K and effectively marketing and promoting it, we've clearly set our practice apart from both refractive surgeons and most other optometrists.

Even some progressive refractive surgeons are beginning to offer their patients both surgical and non-surgical refractive vision correction options. By partnering with local optometrists who are knowledgeable in ortho-K, they can differentiate their practices from the multitude of ophthalmological practices strictly offering surgical options only. This is a powerful marketing tool that quickly sets their practices apart from others. Both the ophthalmologist and the optometrist can benefit handsomely from this type of arrangement.

Plan your marketing message

To successfully promote accelerated ortho-K, you should plan a well-thought-out marketing program. We've found that tasteful, conservative marketing materials are extremely helpful in properly promoting this clinical modality. For example, don't exaggerate what this procedure can accomplish, and make it clear that the patient must wear his lenses on a permanent basis to maintain the vision correction effect.

Aim to make all of your marketing materials accurately reflect the current state-of-the-art technology and realistically summarize the clinical results most patients can hope to achieve. We've produced several high-quality brochures that explain this procedure to prospective patients, and our staff members have been extensively trained to answer telephone inquiries.

Using a phone script, the staff would ask patients why they were calling. And if appropriate, they'd proceed to ask questions such as "Do you currently wear contact lenses? Have you ever worn them in the past? What types of sports do you play?" If the caller was willing, the staffers set up a free initial screening with me.

We're very careful in explaining exactly what accelerated ortho-K can and can't do. You need to be careful about what claims you make. You may recall the controversy regarding alleged exaggerated claims regarding this procedure that were brought to the attention of the Federal Trade Commission. I'm not going to guess about the political or economic realities that might have contributed to the vigorous investigation and subsequent sanctions brought against a very small number of practitioners, but it never hurts to be overly cautious in all of your wording.

The FDA tells us that we mustn't exaggerate our claims and must tell our patients to wear the lenses on an ongoing basis to maintain their effects. Beyond this, rely on the package insert that comes with every box of FDA-approved lenses.

We clearly emphasize the fact that accelerated ortho-K is a "non-permanent" vision correction and stress the ongoing need to wear "retainer" lenses on an indefinite basis. We never promise more than the current technology can realistically deliver.

Although I'd say we're very aggressive in promoting accelerated ortho-K, I'd recommend that you not oversell the procedure until you have a solid track record in fulfilling patient expectations and accurately selecting suitable candidates.

Patients appreciate a candid, conservative appraisal of their likely clinical outcomes. Plus, you want to prepare yourself for criticism from competitors who will scrutinize all clinical claims and may even resort to questioning your integrity and honesty. Solid clinical outcomes and conservative marketing materials are your best defense.

What you'll need to succeed

In order to successfully integrate accelerated ortho-K into your practice, you'll need to have a high degree of proficiency in fitting RGPs. A corneal topographer is an absolute must, and you must have the clinical experience to accurately interpret fluorescein patterns and feel confident interpreting complex lens-cornea interactions.

If you're just starting out in ortho-K, the National Eye Research Foundation (NERF; call 847-291-6820) offers a series of fine educational materials.

As with all clinical procedures, there's no substitute for experience. Start with simple cases to build your confidence. Patients with low degrees of myopia in the range of -.50D to -1.00D make excellent confidence builders. Try starting with a staff member who's anxious to experience improved acuity without surgical intervention.

In our practice, fees for accelerated orthokeratology are quite substantial and since most insurance plans will not pay for this elective procedure, we offer our patients a 6-month installment program, without interest.

We structure the program much as an orthodontist might structure fees for braces. Patients pay as they go and, so far, we haven't had a problem with timely collections. Patients are reassured to learn that they will not have to pay the entire fee before they see substantial improvement in their vision.

We require a flat fee of $1,999, payable after the initial evaluation if the person agrees to enroll as a patient. Most of the fee is refundable within 60 days if he changes his mind. If he agrees to stay, the fee is payable monthly over 18 months.

An alternative you may want to consider is using a medical financing company. This will allow you to directly finance patients and provide your practice with net fees immediately.

Surefire practice builder

In this era of managed care, many practitioners are striving to bring new services into their practices that can enhance their financial health. In my opinion, accelerated ortho-K offers us a unique opportunity to offer a new and highly valuable service to our patients.

I also feel that anyone involved in co-managing refractive surgical procedures has a moral responsibility to educate his patients about this non-invasive alternative. For many patients, accelerated ortho-K is an ideal therapeutic modality.

Refractive surgery marketing efforts will continue to intensify, so why not explore an effective, non-surgical approach to vision correction that will differentiate your practice from competitors, allow your practice to thrive and also offer patients a safe, effective option for non-surgical refractive correction?

Next month, in part 2 of this series, I'll discuss the types of accelerated ortho-K lenses that are approved and give advice on fitting your patients with them.

Dr. Bauman's a research and development consultant for Vistakon, and is director of special projects for OptiCare Health Systems, Inc. an integrated O.D./M.D. group practice. He's lectured extensively on promoting and growing refractive surgical practices. Direct any correspondence to bauman@pcnet.com.