There has never been a better time to add orthokeratology (ortho-k) to your practice: The prevalence of myopia is increasing worldwide. In fact, at the current rate, over half the people on our planet will be nearsighted by 2050, according to data from the Brien Holden Vision Institute. With higher levels of myopia comes an increased risk of ocular pathology, such as retinal tears and detachments. Something else to consider: Parent awareness regarding myopia has increased over the past few years, so they want this service for their children. Add the facts that ortho-k is a convenient method of vision correction for patients of all ages, and that it can create an annuity of revenue that is not dependent on vision plans, and it makes sense to seriously investigate fitting ortho-k lenses, if you don’t already.

Personally, over the past few years ortho-k has grown in my clinic to the point at which, today, about half my patients are children using ortho-k or some other form of myopia control. I started fitting ortho-k about eight years ago, and this segment of my clinic grew steadily through referrals from current patients, and by consistently providing education about this service to all appropriate patients.

Here, I discuss how to get started in ortho-k.

ACQUIRE TECHNOLOGY

Implementing ortho-k can be a relatively straightforward process. The only real expense is the purchase of a corneal topographer if you do not already have one. While some lens designs can be ordered based on keratometry, I have found that a topographer is essential for evaluating the overnight centration of the lens and troubleshooting the fit. Almost any topographer can provide the needed information as you are getting started. Any additional equipment would be optional.

Personally, I find an optical biometer to be very useful for accurately measuring axial length and tracking progression of myopia, but that can most certainly be added later if desired.

DETERMINE THE LENS TO FIT

Some lens designs utilize a diagnostic lens set, while you can order others empirically without the financial investment of a diagnostic lens set or a lens design software. Most manufacturers have a consultation department available to help with initial lens design and with making any needed changes. If you are unsure which design to start with, you can ask colleagues who already fit ortho-k. Another great source for education is the American Academy of Orthokeratology & Myopia Control (https://aaomc.org ). The organization has a wealth of information available, and a program called Boot Camp designed to help those new to ortho-k and myopia control.

GET CERTIFIED

Once you determine the ortho-k lens you would like to start with, there is often a certification course that teaches you the basics of fitting. While all ortho-k lenses are based on a similar concept, different products can have their own terminology for the parameters. The certification process ensures you understand how to fit the lens as you are getting started. If you choose to seek additional training, plenty of resources are available, such as books, CE lectures, and lab consultants (after you’ve set up your account with the manufacturer). Another great resource is Vision by Design, the annual meeting of the American Academy of Orthokeratology and Myopia Control.

TRAIN STAFF

As is the case with many aspects of eye care, your team can greatly impact the success of your ortho-k program. Therefore, you should take the time to educate your team on the benefits of ortho-k to both patients (e.g., slowing myopia progression, freedom from spectacles, etc.) and your business (i.e., increased practice revenue). If your team believes in this service, they will actively promote it to patients, so you may also want to consider fitting some of your staff in ortho-k lenses.

In my clinic, I utilize a myopia control coordinator. I committed to teaching this person about ortho-k and myopia control, so she has a higher level of understanding than the rest of my staff. She assists with myopia control education for potential patients. Specifically, I initiate the discussion with good candidates, and then hand them off to my myopia control coordinator for additional discussion. If the patient elects to move forward with ortho-k, the myopia control coordinator schedules the evaluation. Additionally, she assists with the evaluation process and does all the contact lens insertion and removal training for my ortho-k patients. She also tracks lens orders and notifies patients when their lenses arrive. She is the first point of contact for prospective myopia control patients calling our office, and when patients come to us from other offices, she coordinates requesting their records. Initially, this position will not be necessary; however, it is important to understand that, as your ortho-k practice grows, your team will get more frequent questions about the service.

PROMOTE THE SERVICE

Now, you need to let your patient base know that you provide ortho-k and why they should care. Our marketing materials include informational posters throughout the pre-test rooms and exam rooms, and brochures about myopia control and ortho-k. These brochures give parents something to refer to after they leave the office. While I do fit adults in ortho-k, my focus is on myopia control. Therefore, most of our internal marketing is centered around the problem of progressive childhood myopia.

I think the most important part of marketing ortho-k is to commit to presenting this option to every patient who would benefit. They may not be interested, but we owe it to them to at least give them the option. If a patient would benefit from myopia control but the parents are not ready to move forward, I’ll offer to schedule a refraction and axial length measurement in six months to assess progression.

MAKE ROOM IN THE SCHEDULE

I recommend scheduling additional time for the initial evaluations. We typically schedule new consults for one hour. This provides plenty of time for topography, patient education, Q&A, diagnostic lens fitting, and reviewing and signing informed consent paperwork. Since ortho-k is less common than traditional soft lenses, parents have more questions and tend to need a bit more “hand-holding.” I’m a big fan of putting on a diagnostic lens even if I plan to order a different design. I feel like there is a big advantage to seeing how the patient reacts to the lens, and it also gives the patient a good idea of what the process will be like. If the patient or parents have a lot of questions, you need to be able to take your time and address those questions. That can be difficult if you are running behind and have not scheduled enough time with that patient. In a way, the patient is not buying ortho-k; they are buying you and your expertise. With the higher fees involved, parents will feel much more comfortable moving forward if you have fully addressed all their concerns.

Note: If you plan to order lenses empirically, you may not need as much time, but you still do not want the visit to feel rushed. The patient’s/parent’s perception of value is important. This is a premium service at a premium price, so excellent communication is essential.

FULFILLMENT

Ortho-k is a fun challenge, and it is rewarding both professionally and financially. I enjoy getting to know my young myopia-control patients and watching them grow up. I love knowing that I’m limiting their myopia progression and, ultimately, keeping their eyes healthy. Ortho-k is a fast-growing field, and there is always more to learn. We owe it to our patients to continually seek new information about myopia control, so that we can provide up-to-date care. In my own practice, this comes from attending meetings annually and from having discussions with other doctors who are passionate about this specialty. With so many great products available today, it’s a great time to start fitting ortho-k. OM

DR. BARNES is the owner/myopia control specialist at Cary Family Eye Care, where he is an expert on orthokeratology and myopia control. He is a fellow of the International Academy of Orthokeratology and Myopia Control. Additionally, he is an educator and lecturer on myopia management.