Article

CLINICAL: CONTACT LENSES

KNOW WHEN TO WASH OUT

Accurate baseline data is crucial to the success of orthokeratology

Worldwide attention on myopia control and orthokeratology is on the rise. This advanced technology can create opportunities for our patients and our practices. Those known for providing this service may find themselves receiving patients who are already using orthokeratology and, for one reason or another, are unsatisfied or unable to receive treatment from the original doctor. Here is one such case and how I handled it.

HISTORY

A 12-year-old new patient who recently moved to the area, and his parents, presented to my practice. He has been wearing orthokeratology contact lenses for the past 10 months and was originally fit with these lenses in Taiwan. He states no discomfort with the lenses, but has noticed his vision getting slightly worse in the distance and is having trouble seeing the board in school. His entering VA was 20/30- both OD and OS- at a distance.

TESTING AND TREATMENT

His topography revealed his lenses were decentering nasally. (See Topography 1.)

Topopgraphy 1
Image courtesy of Dr. Jason Miller

Without any prior measurements or baseline data, it was almost impossible to troubleshoot this situation. I recommended he stop wearing lenses for a period of time to correct his vision, also known as a wash-out period.

During this time, I provided daily disposable lenses, which were updated regularly. After a month, I was able to obtain baseline measurements. His keratometry values were relatively flat for his amount of myopia OU.

With this information, I was able to successfully refit him in orthokeratology. (See Topography 2) After a short period of time re-adapting to his new orthokeratology lenses, he was seeing 20/20- OD and OS and reported he could see the board at school clearly all day.

Topopgraphy 2
Image courtesy of Dr. Jason Miller

BASELINE DATA

There are times — like this — where it is important to take a step back before taking a step forward. Other times when a wash-out period may be necessary include: recurrent ocular surface irritation, in which there may be a need to discontinue wear to allow the cornea to heal. Additionally, if the patient’s vision or fit has changed over time and the troubleshooting changes don’t work, consider a wash-out period to get the patient back seeing well. Having good baseline data and a healthy ocular surface is important to success with orthokeratology.

PRACTICE SUCCESS

Successful orthokeratology patients will talk, spreading word of your services to others who have myopia issues. This can separate your services from other providers. These patients are typically our most loyal, I have found. Market the technology both internally and externally to present patients with the opportunity to use this technology. OM