Ortho K

[Ediddy]

I've been learning about ortho k contact lenses a bit at school and I am wondering how many of you ODs out in practice use them or recommend them for patients? Those of you that have, how do your patients respond? Have you found it to be a money maker for your practice or is it too time consuming? Do patients ever ask you about ortho K lenses before you bring them up?
It is my understanding that OrthoK is much more popular in other countries and has never really caught on here in the USA- I am just trying to get a feeling as to why this is the case. Any thoughts?

Thanks

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[scvcstar]

I've been learning about ortho k contact lenses a bit at school and I am wondering how many of you ODs out in practice use them or recommend them for patients? Those of you that have, how do your patients respond? Have you found it to be a money maker for your practice or is it too time consuming? Do patients ever ask you about ortho K lenses before you bring them up?
It is my understanding that OrthoK is much more popular in other countries and has never really caught on here in the USA- I am just trying to get a feeling as to why this is the case. Any thoughts?

Thanks

I personally wore Ortho-K lenses from 6th grade until my 1st year of optometry school. My primary reason for dropping out after 11 years of wear is somewhat petty...as an optometry student that was getting refracted practically every day during 1st year, I realized I wasn't consistently seeing 20/20 or 20/15 everyday due to some induced astigmatism (I'm on the higher end of the limits for treatment with Ortho-K). Something that had never bothered me before suddenly began to bother me. On top of that, we were getting nice discounts on frames and our student insurance plan covered lenses. Sometimes we even got free frames and lenses. I'm a sucker for freebies. If I remained in Ortho-K, I never would've been able to take advantage of these things. And we all know that wearing stylish frames helps sell frames, right? So all of these things added together made me switch back to regular daytime wear GPs, which I'm pretty happy with now. I consistently get 20/15 vision with my GPs and I can wear stylish glasses whenever I want. So vain, I know.

However, I do miss those Ortho-K days. It was awesome never seeing anything really blurry. I could go to the beach (I went to UCSD at the time) whenever I wanted to without worrying about sand or salt water getting underneath my contacts. I could go swimming and see clearly through non-prescription goggles (which are much cheaper than Rx goggles). People were always fascinated that I slept in contact lenses and took them out in the morning, and I think I made quite a few referrals when I told them how happy I was not wearing contacts during the day. I used to lose my contacts a lot during the day when I rubbed my eyes or my eyes got too dry and they popped out.

Ortho-K is a huge practice builder. It's a great alternative to LASIK and you gain patient loyalty (they have to come see you for regular followups, and you have their history of all the lenses you've designed for them), a LOT of patient referrals (parents are going to tell all their friends to put their kids into Ortho-K, especially for sports), and since it's a specialty contact lens, it earns more money than regular contact lenses (partially due to more chair time, of course, but it's worth it). At UC Berkeley, we fit a lot of Ortho-K contacts with great success. It is thought to slow down the progression of myopia, and in my experience, it worked (this was the reason I entered Ortho-K in the first place). I only increased by -0.25 DS from the time I started to the time I stopped, over a period of 11 years. A lot more research is still being done on this though.

I'd highly recommend offering Ortho-K in your practice. I definitely will, since I had such a positive experience with it. I think I owe my career in optometry to Ortho-K, because I started in 6th grade with an optometrist in a group practice that specializes in Ortho-K and has many satisfied patients...and I stuck with that same group practice up to today (I've even interned there and may join their practice after I graduate), and that experience was what inspired me to go into optometry. =)

 

[JMU07]

I've been doing it since I started optometry school and I LOVE it. My optometrist back home fits patients with ortho-k lenses every so often and he sees a lot of success with it. I have no idea how much a pair of lenses costs regularly but I know they're pretty expensive.

 

[lovelydisaster]

The doc I works for has ortho K patients and they are very pleased with his work. However, it does take several times before they find a right fit, and the lenses can get kind of pricey. Overall I think it's very advantageous to offer ortho k fittings in one's practice.

 

[KHE]

The doc I works for has ortho K patients and they are very pleased with his work. However, it does take several times before they find a right fit, and the lenses can get kind of pricey. Overall I think it's very advantageous to offer ortho k fittings in one's practice.

In my office, I have a number of patients, mostly children doing it and they LOOOOVE it.

I have not found that it takes very many tries to get the right fit. The modern fitting sets almost fit themselves. I've had excellent results with the CRT system from Paragon.

Many patients actually end up only having to wear the lenses every OTHER night. We have a few that wear them only every THIRD night. And while the lenses are expensive to replace if the patient loses them, they almost never do because they only wear them while they're sleeping and they don't fall out. If the patient takes care of them, they can last 3-4 years.

 

[Mewcakes]

I want ortho-K so bad...But Kaiser Permanente doesn't fit it. :-( I jumped -.50D in the last 6 months, I blame it on my iPhone. People in optometry school...did you get fitted/CLs for free?

When I was at my interview at UMSL, I asked Dr. DeKinder about the popularity of Ortho K. She said it's a wonderful thing but unfortunately there just hasn't been a huge market for it to justify further development (I was asking specifically about CL research). None of the doctors I've worked for thus far (about 4 offices now) fit ortho K. So if you offered it at your practice and got as many people as you could on the bandwagon, you might just have a real edge over your competitors and corporations.

 

[KHE]

I want ortho-K so bad...But Kaiser Permanente doesn't fit it. :-( I jumped -.50D in the last 6 months, I blame it on my iPhone. People in optometry school...did you get fitted/CLs for free?

.

What does Kaiser have to do with it? Are you locked into some kind of HMO that you have to see one of their docs? Why not find a different doc who does it?

How much would you be willing to pay for it?

 

[Mewcakes]

My dad works for Kaiser, so naturally I have their insurance. It's a really good insurance, $250/2 yrs on anything. But yeah, if you've ever had Kaiser for their Medical Insurance, you pretty much have to go to their doctors. It's the same for their vision. The only thing they don't do is dental/orthodontal. So yeah, if I want kaiser to pay for it, I have to see them.

I'm willing to pay...not an arm and a leg? Though I was told by someone who wore ortho K that when they started optometry school they had to go back to glasses/regular CLs because they were being dilated like everyday and it messed with the corneal shaping. So maybe this isn't a good time. :-\

 

[Meibomian SxN]

My dad works for Kaiser, so naturally I have their insurance. It's a really good insurance, $250/2 yrs on anything. But yeah, if you've ever had Kaiser for their Medical Insurance, you pretty much have to go to their doctors. It's the same for their vision. The only thing they don't do is dental/orthodontal. So yeah, if I want kaiser to pay for it, I have to see them.

I'm willing to pay...not an arm and a leg? Though I was told by someone who wore ortho K that when they started optometry school they had to go back to glasses/regular CLs because they were being dilated like everyday and it messed with the corneal shaping. So maybe this isn't a good time. :-\

Ortho-K is a self-pay procedure. Just like LASIK. And hopefully it is never covered by insurance!

My patients love it, although I have better success with children.

 

[JMU07]

I want ortho-K so bad...But Kaiser Permanente doesn't fit it. :-( I jumped -.50D in the last 6 months, I blame it on my iPhone. People in optometry school...did you get fitted/CLs for free?

When I was at my interview at UMSL, I asked Dr. DeKinder about the popularity of Ortho K. She said it's a wonderful thing but unfortunately there just hasn't been a huge market for it to justify further development (I was asking specifically about CL research). None of the doctors I've worked for thus far (about 4 offices now) fit ortho K. So if you offered it at your practice and got as many people as you could on the bandwagon, you might just have a real edge over your competitors and corporations.

The lenses used to be free at SCO but something changed at the first of the year (don't know what) and now it's $60/pair which is still a HUGE discount. Like I think KHE said, if you take care of your lenses they can last years. (edit: I wasn't sure if you were asking about soft lenses too but that depends on the brand... Ciba will give a year's supply (I think of just the dailies) free, some Acuvues give 3 months free, etc.)

PS, I was dilated two, three times a week all through this year and never had an issue with my lenses.

 

[Mewcakes]

Ortho-K is a self-pay procedure. Just like LASIK. And hopefully it is never covered by insurance!

My patients love it, although I have better success with children.

Oh I see. I wasn't sure. If I had opted to have RGPs at Kaiser, my insurance would have paid for it, I assumed ortho k, if offered, would have been covered under the same token. It doesn't seem to matter what I spend my $250 on. Though maybe that's why they don't fit ortho-k in the first place.

 

[Meibomian SxN]

Oh I see. I wasn't sure. If I had opted to have RGPs at Kaiser, my insurance would have paid for it, I assumed ortho k, if offered, would have been covered under the same token. It doesn't seem to matter what I spend my $250 on. Though maybe that's why they don't fit ortho-k in the first place.

We allow the patients with contact lens coverage to use it up before having to pay out of pocket, but other than that I can not see how any insurance can cover the total expenses of Ortho-K.

Or maybe they give you $250 towards the material, but the actual fitting they expect you to pay for?

 

[Mewcakes]

It seems that it's a material allowance, I can spend it on glasses or CLs. Though fittings...I only remember going in and paying my copay and that's it, but that's soft CL fit. And sure, it might not be able to cover the price of the lenses, but it would pay for $250 of it. But either way, it's not offered, so I'll have to get it somewhere else. It's ok, I'll spend my allowance on glasses. Not a problem.

 

[zyg0te]

People wearing soft CL or RGPs have the option of wearing glasses if they don't want to wear their CLs (due to seasonal allergies, infection, etc).

Ortho-K patients, say you had allergies and the lenses are just really scratch/uncomfortable. What are your options?

 

[Mewcakes]

Well you only wear them while you sleep, so you're not blinking, which for me is the source of most discomfort with CLs, and you don't have allergens coming at your face as you walk down the street. ...so shoot up on Zyrtec before going to bed and call it good?

 

[scvcstar]

Well you only wear them while you sleep, so you're not blinking, which for me is the source of most discomfort with CLs, and you don't have allergens coming at your face as you walk down the street. ...so shoot up on Zyrtec before going to bed and call it good?

I agree with the above...I have a problem with dry eyes and allergies too, but when I was doing Ortho-K it didn't really bother me since I only wear my CLs when I was sleeping.

As for minor abrasions you could just skip a day of wearing Ortho-K and see 20/30 or something instead, or you could pop on some low power soft CLs. If you have an infection though, you would need to get some low-powered glasses to help you through that period of time that you can't wear CLs at all. So you have to work with your OD closely...which is why Ortho-K is really good for patient retention and loyalty.

 

[Mewcakes]

When you stop wearing ortho-k, how long does it take for your eyes to go back to the way they were? To the point that you can wear your old glasses again?

 

[JMU07]

When you stop wearing ortho-k, how long does it take for your eyes to go back to the way they were? To the point that you can wear your old glasses again?

It depends on your rx. I'm a -1.00 but with the lenses end up a +1.50. Since I'm so over-corrected it takes me about a week to need to wear them. For someone with a higher rx it's not going to take as long. I think what I've read is that it takes two weeks for your cornea to completely go back to how it was but you'll notice your rx changing before that. I also don't mind being 20/25 or even 20/30, but someone who needs that sharp 20/15 is going to notice it more quickly, too.

 

[scvcstar]

When you stop wearing ortho-k, how long does it take for your eyes to go back to the way they were? To the point that you can wear your old glasses again?

Since I did Ortho-K for 11 years, I didn't have old glasses anymore...I rebounded almost all the way within 2 weeks using soft CLs but took a month or longer to completely stabilize on the topographer before my optometrist felt comfortable prescribing my refraction. It was about the same time we were practicing refractions in pre-clinic too, so it was neat watching the subtle changes.

 

[artsydentsy]

so why isn't ortho K more popular? the eye doctors in my area say they don't do alot of them.

 

[Meibomian SxN]

so why isn't ortho K more popular? the eye doctors in my area say they don't do alot of them.

Not many doctors are trained and comfortable prescribing ortho-k lenses. Also because it is not covered under insurance, so that coupled with the start up investment may be a hinderance for many doctors.

Its a shame because there are people who are not candidates for LASIK refractive procedures, and would benefit a lot from ortho-k.

 

[JMU07]

Not many doctors are trained and comfortable prescribing ortho-k lenses. Also because it is not covered under insurance, so that coupled with the start up investment may be a hinderance for many doctors.

Its a shame because there are people who are not candidates for LASIK refractive procedures, and would benefit a lot from ortho-k.

This is right. It's really expensive so most people don't want to do it. They'll pay for LASIK because they (generally) won't have to deal with contact lenses afterward, but they're not going to pay a few hundred bucks, or even over $1000 for a pair of contact lenses that they still have to wear every day (night). Plus, you have to know how to do it and a lot of practitioners probably aren't comfortable enough with this kind of specialty fit.

 

[artsydentsy]

Under what circumstances does the Ortho K lens not work for a patient? besides the patient not being a good candidate in the first place.

 

[JMU07]

Under what circumstances does the Ortho K lens not work for a patient? besides the patient not being a good candidate in the first place.

Too much myopia or astigmatism.

 

[Ediddy]

Under what circumstances does the Ortho K lens not work for a patient? besides the patient not being a good candidate in the first place.

From what I have read and learned, Ortho K lens are pretty successful on up to 6.00D of myopia, ~1.50D of astigmatism, and low amounts of hyperopia.

This site has some good basic information that I thought was helpful.
http://www.ortho-k.net/orthok.htm

 

[artsydentsy]

Regarding the length of time that you can go without wearing them during the night and still see clearly during the day, can this length of time increase after months of wearing ortho K?

 

[Meibomian SxN]

Regarding the length of time that you can go without wearing them during the night and still see clearly during the day, can this length of time increase after months of wearing ortho K?

Yes, but it is variable from patient to patient.

 

[JMU07]

It also depends on your starting rx. I'm a -1.00 and my lenses overcorrect me a lot, so I can wear mine every other night and by the end of the second night I'm probably 20/25, maybe 20/30. But I don't mind the slight blur. For people who demand 20/15 you're going to have to wear them every night. And if you're say, a -4.00, there's a good chance you're not going to be able to go two days and still be able to see well. But, it's different for everyone.