What is Orthokeratology?

Read on for a transcript of the Ortho-k video above:

– Damon, can you tell me what is Orthokeratology?

– So, Orthokeratology I’ve been practising for about 20 years, but in the USA, they’ve been practising Orthokeratology I would say for about 35 or 36 years.

It’s a process where we flatten and change the curve on the front of the eye.

So, what we’re trying to do is predominately for patients who are short-sighted. So, patients who are short-sighted, their eye is stretched. And what we do is we get them to wear a rigid lens that just applies a little bit of pressure.

So we’re just changing the curve on the front of the eye by microns, so ever so slightly, and taking that focus, so instead of being in front of the retina, we’re taking it onto the back of the retina.

So, when they go to bed at night, they apply these rigid lenses. They sleep with them, they’re perfectly comfortable overnight. In the morning, they remove the lenses and the vision for distance, close, everything is sensational. So, it’s fantastic! It works really well.

The important thing to know is Orthokeratology is not for everyone. So, if I offered to do everyone in my practise my success rate would be very small. The patients that it’s applicable to, we get a fantastic success rate. So, it just depends on the prescription.

Same again, the curve on the front of the eye is utmost important. So, patients who are struggling with contact lenses during the day because of their work environment, it’s dry, it’s dusty, staring at a computer you get a lot of dry eyes. Or, you know, they’ve just had enough of wearing glasses. This is a fantastic technique where you wear the lenses overnight in a clean, dry environment. You’re asleep, you do all the hard work while you’re asleep. How fantastic is that? In the morning, you pop them off and your vision’s terrific. 

– That’s awesome!

– It’s a slow, it’s a gradual process. In terms of, you know, the more nights you wear the bigger the change and the longer it lasts for. So, you know, it’ll take a few nights maybe a week, 10 days to build up that accumulated change. So, in the morning, from morning to evening the difference in vision down the track most patients can’t even tell. But, initially, it takes a few nights to get the change under your belt, for things to be all day fantastic vision.

– And you start off wearing the lenses every night?

– Yes, so the majority of my patients will wear the lenses every night. We do have some patients who are lucky enough to skip one night a week. I have some who wear it, or skip one or two nights a week. We have some patients who only wear them twice a week. So, it, same again, one of the lovely things that we do at our practise is we custom exactly for where we’re at for you. Not everyone fits in the same square box. We need to tweak things and work out what’s going to work for you. So, we play and manipulate depending on what you require.

– For sure, and how comfortable are Ortho-k lenses to wear?

So, being a rigid lens, we need to do this with a rigid lens so that we can manipulate and change the curve of your eye. So, a rigid lens is not amazingly comfortable because when it’s sitting on your eye, your top lid is hitting the lens. So, if your top lid goes over the lens, they’re perfectly comfortable. So, if you pop a lens on, it’s like “Wow, that’s amazing!” So, to sleep with the lenses on is fine.

I normally inform my patients “Tonight, first night. You’re going to be aware of them. Tomorrow night, probably not.” And then away you go. So, it’s like anything new. Give it a little bit of time, and the outcome long term, that’s what we’re looking at, is fantastic.

– And if you wake up in the middle of the night, and you need to be able to see, can you still see through the lens?

– That’s a great question! So, the way these lenses are made, they have a very small prescription on the front. And that enables you that when we fit them, and this is when we fit them in my consultation room, we make sure that you can see normal vision 6/6 (20/20). So, when you put them in at night, yes you can see, you can get around the house, do your teeth, jump into bed. And if you do need to get up in the middle of the night, yes, your vision is fantastic. So, there’s no qualms about having them in and not being able to see. If you need to get up in the middle of the night, yeah, everything’s going to be great.

– Awesome! That’s good. And the lenses themselves, what’s the typical span you would get out of a pair of lenses?

– So, with the rigid lens, we like to replace them every two years. Just through wear and tear, we need to keep these lenses nice and clean. Over time, they will warp and change shape and then they’re not going to do the job that we want them to do. So, we start off flattening by a certain amount. It’s just not going to happen to the same degree the older lenses get ‘because they warp and change shape. So, normally we aim on about two years.

– Fantastic! And you can claim these on your private health insurance?

– You certainly can, you can claim through your private health. And the beautiful thing is, Ortho-K does cost more than a normal … Because you’re signing up for therapy and we need to see a reasonable amount of you over the span of two years before we update again. So, they will cost you more than just getting soft lenses, but every time your prescription changes with a soft lens, you change your clear glasses, and you change your sunglasses. So, there’s all these different things that change, change, change, change.

So, over time, Orthokeratology is actually going to be a lot more cost effective. The beautiful thing is, if you stopped wearing Orthokeratology in ten- or 12-years’ time, whatever that number is that suits you, your prescription’s going to come back to exactly what we started with today, okay? So, it’s fantastic, they’re going to stop things as they are.

– Yeah, that’s good. So, there’s no, it’s not like laser surgery those permanent changes on your eyes.

– No, and that’s one of the downsides. It’s not permanent, but we’re not, we’re just subtly manipulating the curve on the front of your eye. It is totally reversible. Which I know some patients are not happy about. But we’re not changing the integrity of the cornea on a long-term basis.

– Yeah, that’s good. And they’re safe to wear, there’s no problems?

– Absolutely! The maximum amount of oxygen we get is when we are awake during the day. So, once we sleep at night, we get very little oxygen from within the eye and through the lids. So, in the morning, you’re going to pop your lenses out, plenty of oxygen during the day so nice and healthy. One of the most important things that we, like with any contact lenses there are always complications, so we really emphasise to the patients “You must have clean hands. Clean hands and clean case.” So, whether you are wearing contact lenses through the day, overnight, however you do it, whether it’s just social or sport, cleanliness of hands, lenses, case is so, so important.

– Yeah, looking after them well, treat them well, you’ll get a long time out of them.

– Absolutely, yeah.

– That’s great.

– And we just like to have a boring existence in our practise and no complications.

– Yes, absolutely! What are some of the comments that people give you when they’ve got Orthokeratology and what’s the feedback like?

– I guess the most important, or the first thing we hear is most patients, when we tell them about this type of lens that they could wear, think that I’m completely mad. Because they’ve never heard of it. But once they play with them, and they’ve worn them for a few nights they are like “O my god, this is amazing! I can’t believe that here I am waking hours, I can see I’ve got normal sunglasses on I don’t have to worry about dust, wind, drying of an air conditioner or looking at my computer screen.” and there’s no dryness, dust and issues like that. It’s just fantastic! And they are completely blown away!

So, when I see them at their next review they’re like “You can’t be serious! Why didn’t somebody tell me about this earlier?” And it’s not that every optometrist fits Orthokeratology. It’s a very specific fitting modality. There’s a lot of chair time and that’s what we do at Ezekiel Eyes. We spend the chair time and we treat you as a person and not just a number. We want to work out what you need, what you desire and we’ll custom to what you require. Whether that’s overnight lenses or lenses during the day That’s the excitement of what we do. Everyone that walks in the door, “What do you need?”

– Yeah, helping each person as an individual.

– Absolutely, yeah.

– Fantastic! Damon, if someone’s interested in trying Orthokeratology and exploring that option, what’s the best way to make an appointment with you?

– So, on our website, we’ve got some information about Ortho-K. They’re more than welcome to read there. Otherwise, give us a ring at 9386 3620, or you can tap this link

– Fantastic! Well, if you like this video please tap “like on the video and share it with a friend as well. And also consider subscribing to our channel. Thanks so much for watching and look forward to staying in contact!

Let’s go into another important question now-

What is the normal process for getting fitted with Ortho-k?

 First, there is an initial assessment appointment. This gives the optometrist a chance to both assess the general condition and health of the eyes and also to discuss the likely effectiveness of the procedure in an individual’s case.

Most of the visual changes occur rapidly in the first few days and weeks requiring frequent examinations.

Stabilisation procedures then follow at a slower pace over the next few months.

The program length varies between three and six months, depending upon the degree of visual error and the rates of change.

After maximum results are achieved, Ortho-K lenses are worn to stabilise the new corneal shape.

These are typically worn full time initially and can be reduced to several nights wear, but this varies from patient to patient. Failure to wear the Ortho-K lens on an ongoing basis will result in the return to the pre-existing prescription. Ortho-K patients are reviewed on a six-monthly basis.

In general, those optometrists who practise orthokeratology believe that Ortho-K lenses can slow the progression of myopia, however there has been no authoritative scientific study that proves this.

Many studies on myopia agree that extensive close work may play a significant role in the progression of short-sightedness. Some studies have stated that 85% of myopia develops from close work. Clinical reports abound of youngsters who have had increasing myopia that is slowed once they are fitted with Ortho-k contact lenses.

Specific myopia control designs now appear to slow myopia progression as long as the patient practices good visual hygiene.

The results of a pilot study suggested a potential slowing of myopia progression, finding an average reduction of 50%. The authors added that there was no way to predict the effect for individuals. Due to the limitations of this study these results are not definitive.