• Caring for the eyes of Mackay since 1952

Vision Correction While you Sleep (Orthokeratology)

Using specially designed retainer moulds; similar to contact lenses you can improve your vision by sleeping with these retainers at night and not require glasses, contacts or surgery to see clearly all day. Suitable for prescriptions from +4.00 to -9.00 and for most astigmatism. Like contact lenses multifocal correction in possible. We have helped hundreds achieve clear vision all day since 2006. Myopia control is also attained through orthokeratology.

There are several Case Studies available to read.

You can also view the most frequently asked questions about Orthokeratology HERE.

There is more information in out Ortho-k Study Summeries which can be viewed HERE.

Another Website that has a lot of information on Orthakeratology is HERE.

A GUIDE TO ORTHOKERATOLOGY

Dr. Ieuan H. Rees

B.A.Sc.(Optom)Hones Grad Cert Ocular Therapeutics. MBCO, MOOA. Specialty Contact lens Practitioner, Orthokeratologist, Behavioural Optometrst

What Is Orthokeratology?

Orthokeratology is a program of corneal lens wear which when worn whilst sleeping adjusts the shape of the cornea to a shape which allows the user to achieve quality visual acuity throughout the day without need for glasses or daily wear contact lenses. Orthokeratology is a safe, viable and reversible alternative to refractive surgery.

In the last 15 years new technology has become available to accurately scan the cornea and create topographic analysis allowing the manufacture of corneal molding lenses that will achieve a controlled and precise reduction in the eyes optical imperfection. New developments in lens materials have been made that enable safe overnight wear contact lens wear possible. Advancements are still being made and we endeavour to stay at the forefront of these changes as they present.

The cornea, whilst being moldable, always returns to its original shape if lens wear is stopped. For this reason lenses are always worn every night, (occasionally every other night), in order to retain the correction achieved.

            Original Shape                                             Modified Shape
1   2   3

Why Have Orthokeratology (Ortho-K)?

The main purpose of Ortho-K is to be free of both contact lenses and spectacles for the majority of all waking hours. The freedom from any artificial aids appeals to all spectacle and contact lens wearers and is ideal for sportsmen, those who work in dusty or dirty environments or people who find spectacles and conventional contact lenses inconvenient. In addition, those who need to have a certain degree of uncorrected vision to satisfy their employers, or a licensing body (e.g. pilots, police), can also be helped by Ortho-K. Patients wear the lenses overnight and remove them on awakening.

One of the ideal situations for using Ortho-K is for the child or teenager with early myopia. Not only does it have all the advantages already given above, but the procedure has been shown to control the progression of the myopia.

Is Ortho-K Suitable for Everyone?

No, not everybody can have Ortho-K. Only after a thorough eye examination can our orthokeratologist determine your suitability for Ortho-K. Originally the procedure worked best up to a maximum of 4.00 dioptres of myopia and 1.25 dioptres of regular astigmatism, however more recent technological advancements allow refractive errors from -9.50 to +3.50 dioptres to be corrected along with astigmatic correction to 2.00 dioptres. The complexity of the corneal shape, the prescription being corrected and the expectations of the patient need to be fully assessed before suitability can be determined.

What Does The Initial Visit Involve?

The initial assessment appointment includes a full eye examination and computerised corneal topographical scanning. The cornea and tear film is assessed as are the eyelids and conjunctiva under both lids. All other ocular pathology is assessed. This gives the practitioner a chance to assess both the general condition and health of the eyes and also to determine the likely effect of the procedure in that individual.

Ortho-K Program

Our Ortho-K Program is designed to suit various levels of complexity dependant on the original presenting prescription, corneal shape and required outcome. The program commits us to providing you the best possible care and commits you to maintaining that care. You sign up each year to a program of care which includes initial upfront assessments and corneal lens moulds and yearly replacement corneal lens moulds with ongoing maintenance. The program of care is required as these moulds are “active” and without medical supervision by qualified orthokeratologists, could cause medical problems. You are enrolled in a program of medical care, for your own protection. We will manage any corneal infections, inflammation, conjunctivitis or other anterior eye pathology that may present. To help prevent warpage of corneal moulds induced by insertion, removal, rubbing, dropping, exposure to temperature variations, chemical insult and deposit, which in turn will reduce the effectiveness, they need to be replaced on a timely schedule and that is done annually within the program.

Ortho-K moulds, made from highly oxygen permeable rigid material, are then fitted using the results of the corneal scan to gently reshape the cornea towards the desired shape which will allow full optical correction.

Moulds will be worn overnight and the response evaluated the next morning. The effect should be a reduction of the refractive error with improvement in the unaided visual acuity. The corneal health will be carefully evaluated to ensure that it is not compromised. Initial response in unlikely to be 100% and daily disposable contact lenses may be used to correct residual refractive error for the first few days of treatment.

What Does The Program Involve?

Initially we will instruct you on insertion and removal of the lenses, the do’s and don’ts of lens handling and wear and provide you with lenses and a starter kit of solutions. Following overnight wear the response to wear is reviewed the next morning. Often 2 to 3 days response is required to reveal a pattern of change to ensure the original corneal lens mould is creating the desired change in the correct position.

Once a patient has shown the appropriate response to the first few nights of wear, solutions adequate for the first 3 months of wear are given to the patient and the cleaning and maintenance procedure fully explained. Review periods will vary dependent on response. Generally within the first 2 week period we will need a morning and a late afternoon assessment on the same day to evaluate effectiveness of treatment over the course of the day.

After the first month, excellent vision and comfort are normally maintained whilst doing Ortho-K. Occasionally more than one set of devices is required to achieve the desired change. The final wearing schedule depends on many variables; but the treatment aim is good unaided vision all or most waking hours, with lenses being worn overnight or part of each day only. Some patients will be able to wear their lenses every second night, however this is the rarity rather than the norm. Others may chose to leave lenses out occasionally and daily disposable lenses can be calculated to suit the vision degradation that will occur when lenses are not worn.

As most of the visual changes occur rapidly in the first few weeks, fairly frequent examinations and possible lens changes may need to take place. Stabilization procedures then follow at a slower pace over the next few weeks. The initial frequent reviews within the program vary depending upon the degree of visual error. The fees for the Ortho-K program include all visits in the first year.

Following the first month reviews are generally set for 3 months, 6 months and 12 months. At 12 months you will be requested to sign up to a new program (60% of the initial fee) which will include new corneal moulds, a maximum of 4 reviews and a $50 credit towards contact lens solutions.

Reactivation program: Former patients not seen in the office for over 3 years and successful ortho-k outside patients.

This is a bit more expensive and it covers the above and we have to be able to access prior records to verify successful fit and also to be able to reorder. Failure to resign to an ongoing program will result in us, being unable to provide you, with replacement corneal moulds, and should a subsequent refitting be required the full initial program costs will be recommenced plus a further 15% fee as a return to baseline will be required before continuing Ortho-K. This will result in a great inconvenience to both you and us, as we wait for the corneal shape to recover from distortion induced from over worn lenses. Often refits are more complicated than the initial fitting.

Got your corneal moulds from someone else?

With all Ortho-k patients from somewhere else we need information on how the corneal was and what the prescription was before and since the start of Ortho-K. Without any information we are putting you the patient and ourselves at risk as we will be making lots of assumptions….and you should know about”assumptions.” Without access to this information we will need to recommence a treatment plan and return to baseline before any corneal moulds can be dispensed.

Program Inclusions

Materials:
One pair of hyper oxygen permeable Corneal Reshaping Devices will be included at the start of the treatment program. If refitting for clinical reasons is required during the first six months no further charges for moulds will be made.

Loss of Lenses:
Cost per replacement corneal moulds is at 25% of the initial program costs per mould replaced. (It takes up to 12 working days to make a new lens.) No insurance from the practice is available for loss. A 3-month warranty on breakage from date of first treatment device order is included. Broken lenses must be returned to the practice.

Spare Moulds:
Spare Moulds are not included in the program but can be purchased within the first 3 months at 20% of the initial program cost. After 3 months corneal moulds cost 25% of the initial program fee.