When providing an orthokeratology (ortho-k) consult, it’s easy to get swept away with the excitement over all the benefits that ortho-k can provide for young patients. The benefits, which are well documented, include the management of myopia, increased self-confidence, and an increased willingness to try new things.¹ However, parents also want and need to understand the safety and risks of this modality. Using evidence-based education, clinicians can help parents feel informed and reassured about selecting ortho-k as part of their child’s eye care.

The first step in educating patients on ortho-k safety is acknowledging that all contact lens wear comes with corneal health risks. Reviews of published literature show that ortho-k lens wearers do report adverse events; however, these events are considered mild. Examples include dimple veiling, corneal and conjunctival staining, conjunctivitis, lens binding, and corneal erosion.^2,3 In a 2024 meta-analysis of the risks and benefits of ortho-k lens wear, it was reported that there have been case reports of microbial and acanthamoeba keratitis; however, no cases were reported during the reviewed interventional studies.² Another safety and efficacy study reported that the rate of mild adverse events associated with ortho-k lens wear was similar to that experienced by daytime soft lens wearers, and no events of microbial keratitis were reported.

After the potential risks are discussed, it is crucial that parents understand that compliance in lens care and handling is essential for reducing the risk of adverse events. Reviewing the prescribed cleaning regimen at each patient visit is important for maintaining healthy lens wear long term, and encouraging parental supervision also improves compliance. In a 2018 study on ortho-k lens care, it was found that only 18.5% of patients were fully adherent to care instructions, and children who cared for their lenses independently were less compliant than those who were supervised by their parents.⁴

Another important aspect of protecting long-term corneal health during ortho-k lens wear is maintaining an appropriate follow-up schedule. When patients are not experiencing lens discomfort or other concerns, they are less likely to attend their follow-up care visits, citing that appointments are inconvenient and/or that they don’t have time to schedule a visit.⁴ Consider offering appointments for after-school hours for adolescent lens wearers, sending out reminder calls, and including reasons why attending these visits is important even when the lens-wearing experience has been uneventful since the last appointment.

Lastly, remind parents that ortho-k is a great option for vision correction and myopia management in young patients. Ensuring a safe lens-wearing experience is a partnership between the provider, parents, and the patient. 

References

1. Lipson MJ, Boland B, McAlinden C. Vision-related quality of life with myopia management: a review. Cont Lens Anterior Eye. 2022;45(3):101538.
2. Sartor L, Hunter DS, Vo ML, Samarawickrama C. Benefits and risks of orthokeratology treatment: a systematic review and meta-analysis. Int Ophthalmol. 2024;44(1):239.
3. Hiraoka T, Sekine Y, Okamoto F, Mihashi T, Oshika T. Safety and efficacy following 10-years of overnight orthokeratology for myopia control. Ophthalmic Physiol Opt. 2018;38(3):281-289.
4. Jun J, Zhiwen B, Feifu W, Lili L, Fan L. Level of compliance in orthokeratology. Eye Contact Lens. 2018;44(5):330-334.

This content is sponsored by Bausch+Lomb

Brooke M. Messer, OD, FSLS, FAAO, practices at Vance Thompson Vision in West Fargo, ND. She is also a fellow of the American Academy of Optometry. She has received remuneration from Bausch + Lomb SVP, Glaukos, Heidelberg, and Tarsus.