MYOPIA CONTROL

Ortho-K Info

Children and young adults who want to be glasses-free but are too young for LASIK often are good candidates for ortho-k. People who participate in sports or work in dusty environments that can pose problems for contact lens wear also can be good candidates.

Orthokeratology lenses, which are customized contact lens molds, are worn each night and removed each morning. The molding that occurs overnight allows for clear vision at all distances during the day without glasses or contact lenses during the daytime. The lenses are comfortable and do not interfere with sleep.

What Is Ortho-K?

Ortho-k is the fitting of specially designed gas permeable contact lenses that you wear overnight. While you are asleep, the lenses gently reshape the front surface of your eye (cornea) so you can see clearly the following day after you remove the lenses when you wake up.

Ortho-k lenses are prescribed for two purposes:

• To correct refractive errors (primarily nearsightedness, but also astigmatism and farsightedness). In some cases, ortho-k also is used to correct presbyopia.

• To slow the progression of childhood myopia. 

About the lenses:

Ortho-k lenses are also called "corneal reshaping contact lenses" or "overnight contact lenses to correct or control myopia." Only highly "breathable" GP lenses that have been FDA approved for overnight wear should be used for orthokeratology.

How Long Does The Ortho-K Effect Last?

You should be able to see acceptably well without glasses or contact lenses for a day or two, sometimes longer. For best results, you should wear the ortho-k lenses every night. Because the corneal reshaping effect is temporary, little risk is involved, and you can discontinue wearing the lenses at any time — provided you are willing to start wearing glasses or contacts again when your myopia returns!

Who Fits Ortho-K Lenses?

Optometrists perform most orthokeratology lens fittings but Ophthalmologists and specialty contact lens technicians also fit these lenses.  It is important to know that orthokeratology is a very specialized type of contact lens fitting, and not all eye doctors who fit contact lenses also fit ortho-k lenses.

What Results Can You Expect From Ortho-K?

Eye care practitioners usually aim for 20/20 vision after ortho-k, but 20/40 vision (the legal minimum for driving in most of the United States) often is considered an acceptable outcome.

In the FDA clinical study for approval, one specific lens, 93 percent of patients achieved 20/32 vision or better, and 67 percent achieved 20/20 or better. In the clinical study for FDA approval of a different lens, about 95 percent achieved 20/40 or better, and 73 percent achieved 20/20 or better. Both studies followed patients for at least nine months.

What To Expect When You Begin Ortho-K

The eye doctor will begin by measuring the curvatures of your corneas using an instrument called a corneal topographer — a painless procedure that takes about a minute and produces a topographical map of your eye's surface.

You may need a series of temporary lenses to see properly until you reach the desired prescription. In most cases, up to three pairs of lenses are required to achieve the maximum vision correction effect.

When you begin to wear ortho-k lenses, you will likely have some awareness of the lenses on your eyes until you fall asleep. With time, the lenses typically become more comfortable immediately upon insertion.

How Long Does It Take For Maximum Ortho-K Effect?

This depends on many factors, especially the amount of nearsightedness you have when you begin the ortho-k process. Some people can have excellent vision after a day or two of overnight ortho-k. But for higher prescriptions it can take two weeks or longer for maximum correction.

Until your eyes are fully corrected, you might notice blurred vision and glare and halos around lights. In some cases, you may need to wear glasses (with a lesser prescription than you originally had) during the ortho-k process. Also, in some cases, mild glare and halos might persist even after maximum ortho-k correction.

Can you Have LASIK After Ortho-K?

Yes, it's possible to have LASIK after ortho-k if you later desire vision surgery to permanently correct your eyesight. Unlike LASIK, ortho-k is reversible. If you try reshaping lenses and later decide you want laser eye surgery instead, you can do that. If you want LASIK at a later time you will have to discontinue wearing the lenses and wait a period of time before surgery to allow your corneas to fully revert to their pre-orthokeratology shape.

Finally, keep in mind that, as with all contact lenses, there are some possible side effects and complications of wearing ortho-k lenses. Ask your eye care practitioner for details.

Here is a short instructional video in inserting and removing these lenses:

Atropine Info

Off-label use of low dose atropine

Until recently, doctors in the United States rarely used atropine eye drops for slowing myopia progression despite its proven success.  This is because the concentration of atropine that is commercially available (1%) has significant side effects, such as dilated pupils, blurred vision, and light sensitivity. However, recent studies have demonstrated that daily instillation of low dose atropine (0.01% - 0.05%) was successful at slowing myopia in young children with few side effects and lower rates of rebound myopia when the drops are stopped.  

Currently, these low concentrations of atropine are not available commercially or approved by the US Food and Drug Administration for treating myopia. Therefore, doctors must prescribe them for “off-label” use through a compounding pharmacy.   Fortunately, one drop per day of low-dose atropine is safe and well-tolerated by most young patients.  Should a child demonstrate any adverse side effects, the drops can be stopped at any time with no lasting effects. 

Who should consider using low-dose atropine? 

The doctors at Roosevelt Vision are generally recommending low-dose atropine for any myopic child between the ages of 6 – 12, whose level of myopia has increased by at least two to four steps (an increase of -0.50D to -1.00D) over the last 6-12 months. We may also consider using it in teenagers if their myopia is still progressing rapidly. The goal of using atropine is to slow down the rate of progression of myopia to reduce the overall amount of myopia your child ends up with.  There is no way to completely stop the progression until your child is fully grown.

My child’s doctor recommended atropine therapy and I want to proceed.  What happens next? 

When you decide that you want your child to use atropine eye drops, your child’s doctor will need to send a prescription for low-dose atropine to a local compounding pharmacy. We are currently sending prescriptions to Custom Prescriptions on 112th Street in Bellevue. Once the pharmacy receives the prescription, a pharmacy representative will contact you by phone to authorize the purchase and confirm payment and shipping options.  

Once you have received the medication, it is important to use the drops as prescribed—instill one drop per day in both eyes.   It is also important to apply the eye drops at approximately the same time every day.  Right before bed is an easy time to remember for many families and may lessen the chance of side effects during the day.  Please read the information from the pharmacy to learn more about any rare or unusual side effects to look for.

Your child will also need to be monitored more closely by his/her eye doctor after starting the atropine therapy.  You will need to schedule two brief office follow-up visits during the first six months of treatment.

The schedule for monitoring atropine therapy is as follows:

1. Initial follow-up – typically one month after starting the eye drops to verify that there are no adverse side effects.

2. 6-month follow-up – to recheck the level of myopia to help track the rate of progression.

Your child’s eye doctor will recommend resuming annual comprehensive eye examinations thereafter.