Although orthokeratology (ortho-k) is a core control option for childhood myopia, many parents remain hesitant about committing to it. I have found that the main reasons for this are a lack of understanding that it is a progressive, vision-stealing disease, safety concerns regarding wear, and the cost of the treatment.

Here, I discuss how I have been able to overcome parent hesitancy in each of these areas, so the ideal candidates for this form of myopia control can benefit from it. (See “The Art of Communication,” below.)

LACK OF UNDERSTANDING

To overcome this hurdle, I dispel the long-held belief by the public that myopia can be “cured” with a prescription pair of glasses or contact lenses. Specifically, I discuss its progressive nature. (See “Ortho-K By the Numbers,” p.26.)

A patient script on this:

“Myopia is another word for nearsightedness, or the inability to see images clearly in the distance, but it’s important to understand that myopia can be and often is progressive, so single vision glasses and contact lenses won’t stop it; in fact they may make it worse. In looking at your child’s records, his prescription for his glasses is changing at a pace that could place him at great risk for myopic macular degeneration, cataracts, glaucoma, and retinal detachment.

A caveat: The blunt approach to myopia education, which describes progressive and high myopia in the harshest terms, may not work with the parent of an early emerging myope who has no family history of myopia. In such cases, I find it more effective to start with a talk about preventive care and how it applies to my patients.

Next, I utilize data displayed in a table or graph format to communicate the need for myopia control. The table I use displays axial length at 26 mm, 28 mm, and 30 mm, with the expected percentage of the probability of possible disease state outcomes as a result.

Ortho-K By the Numbers

3,000The amount of eye care providers actively fitting and managing ortho-k patients in the United States.

68%Those who prescribed ortho-k with the intent of managing myopia.

53%Those who prescribed ortho-k with the intent of monitoring axial length.

61%Those who start ortho-k in patients age 13 or younger.

7.8 YEARSThe mean number of years a patient wears ortho-k.

Source: Lipson M, Cucio LR. Fitting of Orthokeratology in the United States: A Survey of the Current State of Orthokeratology. 2022;99(7): 568-579. Optom Vis Sci. doi: 10.1097/OPX.0000000000001911.

I then “translate” to parents that higher levels of myopia mean longer eyeballs. Once that message is relayed, the parent understands that preventing the myopia creep keeps the percentages in their child’s favor. I have found that discussing these measurements with my patients and parents has been easier than I expected. Pediatricians make a point in a child’s development to discuss the percentile of their height, weight, and head circumference and their implications. I do the same with axial length.

Now, I explain what ortho-k is, and how it will work.

A patient script on this:

“Ortho-k is the use of a customized contact lens worn overnight to slow myopia progression. What happens is that while your child is sleeping, the dynamic fluid forces underneath the lenses gently and smoothly reshape the cornea. The procedure is reversible, unlike refractive surgery, and requires only six to eight hours of sleep to accomplish the molding.”

SAFETY CONCERNS REGARDING WEAR

To overcome this parent hesitancy, I discuss with parents the literature that shows ortho-k is safe, my dedication to safety, and I talk about my personal track record in fitting and managing young patients with ortho-k.

A patient script I’ve used on the literature:

“We have confirmed through several studies that ortho-k is as safe a modality as any other contact lens. In fact, a study comprised 23,049 fits of adolescents reveals that ortho-k wearers had similar risks as those who wore daily wear contact lenses, and a 10-year study on ortho-k shows it presented no more additional risks.”^1,2

A patient script on my dedication to safety:

“I take the safety of my patient’s eye health extremely seriously. My youngest ortho-k patient was age 4 ½. To set this patient up for success, I prescribed a proven lens disinfection solution and wetting drops, discussed with the patient’s parents the importance of ‘taking the night off,’ should their child’s eyes appear red or irritated, and I gave them my personal cell phone number. That patient did very well with the treatment.”

A patient script on my personal track record:

“In my over 40 years of prescribing ortho-k, which has included more than 10,000 fits, I’ve only had one case of microbial keratitis. There are risks to any procedure, but risks of eye infections during lens wear are far outweighed by allowing a youngster to experience the reality of progressive myopia and all its implications for eye health and the disabilities that myopia can create if left unchecked.”

COST OF THE TREATMENT

To conquer the preconceived sticker shock that creates hesitancy on the part of parents to enlist their child in ortho-k, I am able to justify the cost by explaining the fact that ortho-k is a specialty that, therefore, requires a great deal of training and one-on-one time with the patient:

A patient script on this:

“Orthokeratology is, perhaps, the hardest of the myopia management options to master, as it involves ensuring an accurate fit of the lenses, a discussion on the insertion, wear and care of the lenses, and a series of imperative follow-up appointments to assess ocular health, vision, and corneal shape. For these reasons, it doesn’t fall under vision care plans. Additionally, after the first year of wear, ortho-k is a fraction of the cost. This is reflected in less chair time and lower material cost.”

With the introduction of other modalities to treat myopia, it has become very much a bargain for the patient, as well as for the eye care provider. (See “Tips for Continued Success,” above.)

GETTING THE NOD

I have found that getting parent buy-in to ortho-k comes down to identifying the specific hurdles and crafting and preparing action steps, such as those outlined above, that overcome them. To accomplish this, the OD must be totally immersed in the specialty and develop dialogues and talking points when addressing patients. OM

References: 
1. Bullimore M, Mirsayof DS, Khurai AR, et al. Pediatric Microbial Keratitis With Overnight Orthokeratology in Russia. Eye Contact Lens. 2021 Jul 1;47(7):420-425.
 doi: 10.1097/ICL.0000000000000801.
 
2.  Bullimore MA, Sinnott, LT, Jones-Jordan,LA. The Risk of Microbial Keratitis with Overnight Corneal Reshaping Lenses. Optom Vis Sci. 2013;90(9):937-44.doi:10.1097/OPX.0b013e31829cac92.