Orthokeratology: How It Works, Benefits, and Cost

What is Orthokeratology?

Orthokeratology, or ortho-k, is a non-surgical method to correct vision problems like near-sightedness (myopia). It involves wearing special contact lenses that reshape the cornea, the clear front part of your eye, while you sleep. This reshaping helps you see clearly during the day without the need for glasses or regular contact lenses.

Think of ortho-k as braces for your eyes. Just as braces slowly move teeth into the correct position, ortho-k lenses gently mold the cornea to improve vision. The changes are temporary but can be maintained by wearing the lenses every night.

Ortho-k is suitable for people of all ages, especially those who don’t want surgery. It’s often recommended for children and teenagers whose vision is still changing. This method may also help slow down the progression of myopia in children.

How Does Orthokeratology Work?

Orthokeratology works by using specially designed contact lenses to temporarily reshape the cornea, the clear front part of your eye. 

Ortho-k lenses are rigid and gas-permeable, meaning they are sturdy enough to gently reshape the cornea but still allow oxygen to reach your eye, keeping it healthy. By flattening the center of the cornea, the lenses change how light is bent when it enters the eye, correcting your vision. 

When you wake up and remove the lenses, your cornea retains its new shape for a while, giving you clear vision throughout the day.

Here’s a simple breakdown of how it works:

Initial Assessment and Fitting

• Comprehensive Eye Exam: The process begins with a thorough eye examination by an eye care professional. This includes checking your vision, measuring your eye's health, and determining the degree of refractive error (nearsightedness, farsightedness, or astigmatism).
• Corneal Topography: The eye doctor uses a device called a corneal topographer to map the surface curvature of your cornea. This map provides detailed information about the shape and features of your cornea, essential for designing the custom Ortho-K lenses.

Designing and Customizing Lenses

• Lens Design: Based on the corneal topography data, custom Ortho-K lenses are designed to precisely match the contours of your cornea. These lenses are rigid gas-permeable (RGP) lenses, allowing oxygen to pass through to keep the eye healthy.
• Lens Fitting: The initial fitting of the lenses involves placing the custom-designed lenses on your eyes to ensure they fit correctly and comfortably. Adjustments are made as needed to achieve the perfect fit.

Nightly Wear and Corneal Reshaping

• Wearing the Lenses: You wear the Ortho-K lenses while you sleep. The lenses gently reshape the cornea through hydraulic forces created by the tear film between the lens and the cornea. This reshaping corrects refractive errors by flattening or steepening certain areas of the cornea.
• Hydraulic Forces: The lenses create a pressure differential across the cornea, where the central part of the cornea is flattened to correct myopia (nearsightedness), and peripheral areas may be steepened to ensure proper focus.
• Duration of Wear: Typically, the lenses need to be worn every night to maintain the corneal reshaping effect. The time required for noticeable vision improvement can vary but usually ranges from a few days to a couple of weeks.

Daily Vision and Maintenance

• Removing the Lenses: In the morning, you remove the lenses. The cornea retains its reshaped form for the day, allowing you to see clearly without needing glasses or daytime contact lenses.
• Visual Clarity: After removing the lenses, your vision should be clear throughout the day. The reshaping effect is temporary, lasting usually about a day or two, hence the necessity of wearing the lenses nightly.
• Regular Check-ups: Regular follow-up visits with your eye doctor are essential to monitor the health of your eyes, ensure the lenses are functioning correctly, and make any necessary adjustments.

Long-Term Use and Benefits

• Long-Term Benefits: Continuous use of Ortho-K lenses can provide significant vision improvement. For children, Ortho-K can also slow the progression of myopia.
• Non-Surgical and Reversible: Unlike surgical procedures like LASIK, Ortho-K is non-invasive and reversible. If you stop wearing the lenses, your cornea will gradually return to its original shape, and your vision will revert to its pre-treatment state.

Who Can Benefit from Ortho-K?

Ideal Candidates

Ortho-k is ideal for people who want to correct their vision without surgery. It’s especially beneficial for:

• Individuals with near-sightedness (myopia): Ortho-k lenses can reshape the cornea to correct this common vision problem, allowing clear vision without glasses or daytime contact lenses.
• Those with farsightedness (hyperopia): Ortho-k can also help correct this by flattening the cornea and improving how light focuses on the retina.
• People suffering from astigmatism: Astigmatism is caused by an irregularly shaped cornea, leading to blurred vision at all distances. Ortho-k lenses can correct the cornea’s shape, improving vision clarity.
• Adults dealing with presbyopia (blurred near vision): Presbyopia, a condition that affects near vision as people age, can also be managed with ortho-k lenses. These lenses can be designed to help with near vision tasks, reducing the need for reading glasses.

Benefits for Children and Adults

Ortho-k is safe for both children and adults. It is particularly recommended for children whose vision is still developing. Since surgical options like LASIK and PRK are not suitable for children, ortho-k offers a non-invasive way to manage their vision. 

A study published in the Eye & Contact Lens: Science Journal found that children who wore ortho-k lenses experienced significant improvements in quality of life and behavior. They were more confident, willing to try new activities, and participated more in sports and outdoor activities.

For adults, ortho-k provides an alternative to glasses, contact lenses, and surgery, offering flexibility and convenience.

Comparison with LASIK and PRK

Unlike LASIK and PRK, which involve surgical procedures to permanently alter the cornea, ortho-k is non-surgical and reversible. This makes ortho-k a preferred choice for those who are not ready for surgery or who want a reversible solution. It’s also a great option for those who have conditions that make them unsuitable candidates for laser surgery.

What to Expect During Treatment

Undergoing orthokeratology treatment involves a few steps and requires some adjustments to achieve the best results. Here’s what you can expect during the treatment process:

Timeline for Vision Improvement

Most patients begin to notice vision improvement within a few days to a couple of weeks. The full effect can take up to two weeks or more, depending on the individual’s initial prescription and the rigidity of their cornea. Some people experience significant improvement in just a few days.

Adjustments and Modifications to Lenses

During the initial phase of treatment, you may need several follow-up visits to adjust the fit and effectiveness of the ortho-k lenses. These visits are crucial to ensure the lenses are reshaping your cornea correctly and comfortably. Your eye specialist may modify the lenses based on how your cornea responds.

Factors Affecting Treatment Speed

Several factors can influence how quickly you see results with ortho-k:

• Initial Prescription: Higher prescriptions may take longer to correct.
• Corneal Rigidity: Stiffer corneas may require more time to reshape.
• Tear Quality and Quantity: Good tear production helps with lens comfort and effectiveness.
• Your Expectations: Realistic expectations help in understanding the timeline and adjustments needed.

By following this routine, you can maintain clear vision throughout the day without the need for glasses or daytime contact lenses. Regular follow-up visits are essential to ensure the treatment continues to work effectively and safely.

Is Orthokeratology Safe?

Orthokeratology, or ortho-k, is generally considered a safe and effective way to correct vision. However, like any contact lens treatment, it comes with some risks that you should be aware of.

Infection Risks and Prevention

One of the primary risks associated with ortho-k is eye infection. Just like with regular contact lenses, improper handling, and poor hygiene can lead to infections. This risk is particularly concerning for children, who might not always follow the best hygiene practices. To minimize the risk:

• Always wash your hands thoroughly before handling the lenses.
• Clean and disinfect the lenses as instructed by your eye specialist.
• Avoid sleeping in lenses not designed for overnight wear.
• Replace lenses as recommended to avoid the build-up of deposits.

According to Live Science publication, nearly a million Americans visit their doctor each year due to eye infections caused by contact lenses. Infections can range from mild irritations to more serious conditions that could lead to vision impairment.

Importance of Regular Check-Ups

Regular check-ups with your eye specialist are essential when using ortho-k lenses. These visits help monitor the health of your eyes and ensure that the lenses are fitting correctly and effectively reshaping your cornea. During these check-ups, your doctor can:

• Check for signs of infection or complications.
• Ensure the lenses are still effective in correcting your vision.
• Make any necessary adjustments to the lenses or your treatment plan.

Ortho-k Lenses Cost

The cost of ortho-k treatment can vary widely based on several factors, including the practitioner’s expertise, geographic location, and the specific needs of the patient. 

Generally, the initial fitting and first set of lenses in the US can cost between $1,000 and $4,000. This fee typically includes:

• Initial consultation and eye examination.
• Corneal topography and mapping.
• Custom ortho-k lenses.
• Follow-up visits for adjustments and monitoring.

In addition to the initial costs, there are ongoing expenses for maintaining the lenses, including:

• Replacement lenses (usually needed every 1-2 years).
• Cleaning and disinfecting solutions.
• Regular follow-up visits.