MYOPIA MANAGEMENT ISN'T A MODALITY CONTEST. Passionate practitioners love fitting orthokeratology (ortho-k) so much that they can become hyperfixated on it. However, it’s important to be sensitive to the patient journey and open to the idea that what was once the ideal solution for a patient may not remain so over time.
The Patient Who Just Can’t Make Ortho-k Work
Ortho-k isn’t just about the perfect fit. Factors such as hygiene, responsible lens care, frequent lens loss/breakage, and nightly compliance with lens wear impact success. Sometimes difficult anatomy can play a role as well. For example, significant trichiasis with resultant superficial punctate keratitis can tip the scales in favor of a soft lens option. New circumstances, such as a bout of herpes simplex keratitis, can interfere with successful ortho-k wear.
Unanticipated or unresolvable lens awareness issues or a treatment result that never quite satisfies the patient can be frustrating. At some point, troubleshooting becomes over-troubleshooting.
The Lifestyle Change
College. Travel. Sleepovers. Irregular work schedules (think firefighters, nurses, etc.). Shared custody between households. There are countless reasons why a patient who has been a successful ortho-k patient for many years may suddenly become unsuccessful. The best practitioners are nimble and willing to meet patients where they are in their journey. Sometimes this means presenting non-ortho-k options to patients. Remember to have open conversations and ask probing questions that will both help reveal these lifestyle changes and make the patient feel comfortable discussing them.
The Patient Who Needs a Bridge or a Backup
Sometimes soft contact lenses are used alongside successful ortho-k wear(Figure 1). Having a small supply of 1-day lenses can provide a temporary solution after 1 night of missed wear due to circumstances such as travel or a sleepover. Soft lenses can also be worn successfully during longer interruptions in ortho-k wear. Consider a soft lens designed for myopia management in situations such as summer camp, extended illness, waiting on new ortho-k lenses, or managing residual refractive error during washout.
It Isn’t About Making Ortho-k Work at All Costs
Fitting ortho-k is extremely satisfying because it checks important boxes in both helping patients now and protecting their future eye health. Practitioners who are highly focused on ortho-k can become myopic and miss the bigger picture. At the end of the day, successful myopia management isn’t defined by keeping a patient in ortho-k lenses. It’s defined by keeping the patient in myopia management throughout the various stages of their journey.