Ortho-Keratology Treatment (OrthoK)

Gentle Vision Shaping Treatmnent by Dr Walji (since 1988)

Wouldn’t it be great if your nearsightedness could be corrected while you sleep? It might sound far-fetched, but it’s a reality for many of our patients since 1988. It’s called orthokeratology, or ortho-k for short.

Here’s how it works: when you sleep, you wear special contact lenses that gently reshape the surface of your eye, so you can see clearly even after you remove the lenses. The effect is temporary – generally enough to get you through a day or a week.

Ortho-k, not a New Idea

Reshaping the cornea with contact lenses to improve vision isn’t new. Orthokeratology has been practiced by some eye doctors since 1962. However, in the past ortho-k produced mixed results and wasn’t approved for overnight wear, so the procedure had limited appeal.

Now, overnight wear is available with many types of corneal reshaping systems and are called by different
names such as Corneal Refractive Therapy (CRT), Vision Shaping System, Fargo, Dreim Lens etc.

At the same time, new manufacturing methods and lens designs we enabling orthokeratology lenses to achieve much higher success rates than experienced in the past. The performance of so-called “reverse geometry” or “return zone”” designs have fueled new excitement about orthokeratology.

How does it work?

Myopia (nearsightedness) is caused by light coming into the eye in such a way that it doesn’t focus properly on the retina. Typically, this problem is corrected by using eyeglasses or regular contact lenses to re-focus the light rays.

A similar result can be achieved by reshaping your cornea. LASIK is a surgical way to do this. Ortho-k contact lenses flatten your cornea without surgery, enabling light to focus properly on your retina, resulting in better vision.

Corneal Reshaping Options

Many brands have approval for overnight corneal reshaping: Corneal Refractive Therapy (CRT) from Paragon Vision Sciences, and Bausch & Lomb’s new Vision Shaping Treatment (VST). Both are fit only by Doctors who have been through each company’s certification procedure. CRT is already widely available; Bausch & Lomb is still rolling out VST and so far, about 1,200 practitioners have been certified including Dr. H. H. Walji.

Other ortho-k lens brands w.ithout overnight approval are sometimes fit by practitioners for daytime ortho-k, or for overnight ortho-k as an “off-label” use at the doctor’s discretion.

Who is a Candidate?

Orthokeratology is for people of any age who are nearsighted. It is successful for people with up to six diopters of myopia (- 6.00 on your prescription); the VST approval is for up to five diopters. Astigmatism can also be treated: up to – 1.75 with CRT, and – 1.50 with VST. Many doctors believe the best candidates are people who have low amounts of myopia, about four diopters or less.

The procedures can be performed on practically anyone of any age, as long as their eyes are healthy. Ortho-k holds particular appeal for people who participate in sports, or who work in dusty, dirty environments that can cause problems for regular contact lenses.

Because ortho-k offers similar benefits to LASIK, it’s also appealing to adolescents and teens, who are not eligible for LASIK However, there are some concerns about corneal infections in young people who have used ortho-k, so it’s wise to pursue this with an eye care practitioner who is experienced in treating this age group.

What Results Can You Expect from Ortho-k?

Dr. H. Walji usually aims for 20/ 20 vision, but 20/40 or 20/ 50 vision (the legal minimun for driving in Canada.) is typically considered acceptable. In the FDA (USA) clinical study for approval of CRT, 93% of patients achieved 20/ 32 vision or better, and 67% achieved 20/ 20 or better. In the clinical study for FDA approval of one VST design, about 95% achieved 20/40 or better, and 73% achieved 20/ 20 or better. Both studies followed patients over at least a nine month period.

What to Expect When You Begin

Dr. H. Walji will begin by measuring the curvatures of your corneas using an instrument called a keratometer and 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 Wltil you reach the desired prescription. Dr. Walji’s goal is one pair of lenses for each patient, but for the most part, I’m using two pairs of lenses. Dr. Walji fits CRT, VST as well as other ortho-k designs depending on what is best for your eyes.

How Long Does Ortho-k Take?

Ortho-k can reshape two to three diopters of myopia in two weeks or less. During the time your eyes are being reshaped, you can experience side effects. In the beginning, you’ll have glare and halos that will be reduced with time, but may never completely go away. As with LASIK, patients with large pupils are especially susceptible to this.

Once your eyes reach the desired prescription, you will need to wear lenses when you sleep or during part of the day to maintain your prescription. Discontinuing lens wear altogether allows your corneas to gradually regress to their original shape or close to it.

Is Ortho-k Comfortable?

Some people have comfort issues with daytime wear of GP contact lenses (also known as RGP or “oxygen permeable” lenses), which are used for ortho-k. With GPs, a sensation of lens awareness can result from interaction of the eyelid with the edge of the lens during blinking. (This doesn’t happen with soft lenses because they are larger and remain tucked under the eyelids.) But since ortho-k lenses are worn during sleep, blinking and lens awareness are generally not a problem.

Cost of Orthokeratology Treatment

Fitting ortho-k lenses takes much more of a doctor’s time than a regular contact lens fit. It requires a series of office visits and potentially multiple sets of lenses. Dr. Walji determines his fee for orthokeratology, which is based on both time and lens costs. These includes a spare pair of lenses, all vision and eye health assesment appointments, all teaching instructions, all ortho-k progress check-up appointments and unlimited consultation for a period of twelve months from the commencement of the treatment. Professional Fees start from $1500 and include the entire year of gentle vision shaping treatment care.

Should You Have Ortho-k Instead of LASIK?

Ortho-k works best for people who don’t want to wear glasses or contact lenses all day, every day – but don’t mind wearing contact lenses at night, or occasionally during the day. If your primary goal is to be glasses- and contacts-free during the day, then ortho-k might be a good alternative for you. Howeve if you want to eliminate contacts altogether, then ortho-k is not likely to satisfy you.

Ortho-k may be a good option if you suffer from dry eyes. It’s been found that this condition is sometimes worsened by LASIK.

Unlike LASIK, ortho-k is reversible. If you try reshaping lenses and later decide you want laser eye surgery instead, you can do that. But for a period of time before surgery (possibly several months), your surgeon would have you stop wearing your lenses so your corneas can revert to their natural shape.

As with all contact lenses, there are some side effects and possible complications. Ask your eye care practioner about the challenges you can expect.