What is Myopia?
Myopia, or nearsightedness, is caused by an elongated eye, causing light to be out of focus when it enters the eye. The eye typically elongates as children grow, causing nearsightedness to worsen each year. It causes blurry distance vision but clear near vision.
Why is Myopia Bad?
Increased levels of myopia increases your risk of blinding eye diseases later in life. These inlude glaucoma, premature cataracts, retinal tears, retinal detachments, and myopic maculopathy, among others.
Why Does Myopia Progress?
Myopia worsens when the axial length of the eye increases. This is common in growing children, but certain behaviors, such as increased near point and screen time and reduced outdoor time are thought to promote axial length growth.
What Can Be Done To Slow Myopia?
Myopia control is continually improving and new advances in contact lenses allow us to slow myopia progression significantly. To learn more about Myopia control and determine which is best for your child, view the Treatment Options table below.
Types of Myopia Control
Ortho-K are custom contact lenses that are worn only at night. They gently and temporarily reshape the front surface of the eye. When they are removed in the morning, patients can see clearly with no correction. Studies show that Ortho-K lenses significantly slow Myopia progression in children and teens.
Soft Multifocal Contact Lenses
Soft multifocal contact lenses are identical in feel and wear to normal soft contact lenses. They are worn during the daytime and removed at night. The difference is the varying power of the lens from center to periphery. These varying powers allow light to focus appropriately on all areas of the retina, greatly slowing the progression of myopia.
Atropine is medication used in some dilating drops. When diluted to lower doses, like .01% or .05%, it has been shown to significantly slow the rate of myopia progression. Although Atropine is a dilating agent, when used in low doses the dilating effects are minimal and any side effects noticed by the patient are easily managed.
Learn more about Orthokeratology (Ortho-K) Below
Orthokeratology (Ortho-K) uses a corneal retainer mold (similar in appearance to a contact lens) that is custom-designed for your eye by Dr. Montgomery to gently and temporarily reshape the front surface of your eye, called the cornea. The retainers are worn while you sleep and removed in the morning. By making these microscopic changes to the shape of the cornea, light entering the eye will be in focus on the retina and you will see clearly without the need for glasses or contacts!
So How Does it Work?
First, a machine called a corneal topographer is used to measure over 10,000 data points on the surface of your eye. With this information, Dr. Montgomery designs a custom reverse geometry lens for your eye.
These retainer lenses put light pressure on some parts of your cornea and no pressure on other parts. The area of the cornea that we wish to reshape is under slightly more pressure from the retainer, causing the fluids within the cornea to redistribute, which changes its overall shape. The cornea, being very elastic, easily changes shape when this lens is placed on the eye! There are three important things to note about Ortho-K:
- It’s not permanent! The moment you take your lens out, your cornea will slowly start returning to its original shape. It doesn’t matter if you’ve been doing Ortho-K for 10 weeks or 10 years, all corneas will always return to their original shape. That’s the beauty of Ortho-K!
- No Irritation! Although the retainer puts pressure on the central part of your cornea, it never actually touches the central cornea! A small 20 micron thick layer of tears always lies between the retainer and your eye. This prevents the retainer from irritating your central cornea.
- Microscopic Changes! The change in the thickness of your central cornea is between 20-30 microns. That’s less than the thickness of a single sheet of paper! Very small changes to the shape of the cornea result in large changes in vision correction!
Ortho-K is FDA approved to treat up to -6.00 Diopters of myopia in children and adults. There is no age restriction! In fact, children as young as age 6 may be candidates for Ortho-K It’s also a great alternative to LASIK, as it is cheaper, non-permanent, and involves no cutting on the eye! There are many reasons for someone to choose Ortho-K for their vision correction:
- Any nearsighted adult or child may be a candidate!
- Patients wanting freedom from daytime contact lenses and glasses
- Those with myopia up to -6.00 Diopters with mild astigmatism
- Athletes who are unable to perform with the burden of glasses or contacts
- Those who suffer from dryness with traditional soft contacts
- Children who are not candidates for LASIK due to age restrictions
- Patients wanting a non-surgical, non-permanent alternative to LASIK
- Children who become progressively more nearsighted each year (see the “Myopia Control” section for Ortho-K’s unique benefit to nearsighted kids!)
Myopia Progression Since 1971, myopia prevalence in the US has increased by 66%! Children diagnosed with myopia typically become progressively more nearsighted every year until they reach a plateau sometime in their early to mid-twenties. This often starts with children having a low prescription, such as -1.00 and ending up with a large prescription, ranging from -3.00 to -20.00! Ask any eye doctor and you’ll hear: “Nearsighted kids get more nearsighted each year!”
What Can We Do To Limit Myopia? We know that, in addition to genetic factors, extended near work plays a significant role in myopia progression. Limiting near work, holding reading material at least 14″ from the face, and spending time outdoors can help to minimize the effect of near work on myopia progression. Ortho-K offers an alternative to myopia control. By properly focusing light on the central and peripheral retina-something that regular glasses and contact lenses can’t do- we eliminate the stimulus for the eye to elongate, which causes myopia. Numerous studies have found that children in Ortho-K programs have reduced progression of their myopia compared to their peers who wear glasses or contacts!
Orthokeratology, sometimes called Ortho-K or Corneal Refractive Therapy (CRT) uses a custom-designed corneal retainer mold to gently reshape the front surface of the eye, called the cornea, while you sleep. In the morning, the retainer mold is removed and you can enjoy clear, crisp vision all day without the need for glasses or contact lenses!
What is a Corneal Retainer Mold?
The Corneal Retainer Mold looks similar to a contact lens, although it is smaller than standard soft contact lens. It is a rigid, oxygen-permeable lens that is completely custom-designed by Dr. Montgomery to fit your eye and provide the correct amount of treatment.
Are the Corneal Retainer Molds easy to insert? Are they comfortable?
The retainers are very easy to insert and remove with a little practice. It is very similar to inserting a contact lens. You will receive complete training on how to handle these retainers in our office. Since the retainers are worn while sleeping, there is no discomfort when the eye is closed. When the retainer is worn while awake, you may be more aware of it than a soft contact lens, but should not experience any pain.
How does Ortho-K work?
Ortho-K retainers are custom-designed to apply gentle pressure on certain parts of the cornea, causing it to change its shape by redistributing water within the cornea. Although it sounds dramatic, the change in central corneal thickness with Ortho-K is around 20-30 microns—that’s less than the thickness of a single sheet of paper! By changing the shape of the cornea, light is appropriately focused on the retina for clear vision without the need for glasses.
How long does the reshaping effect last?
This largely depends on your initial prescription. Virtually all Ortho-K wearers are able to go at least a full day before their cornea begins to return to its original shape. Many patients actually experience 20/20 vision for 2-3 days after removing the lens and only wear their retainers every other night!
What happens if I stop wearing the retainers?
If you stop wearing the retainers, your cornea will return to its original shape, as will your vision, within a period of several days, even if you have been wearing retainers for years. Ortho-K is NOT permanent—that’s what’s so great about it!
Is Ortho-K safe?
Ortho-K is a safe and reversible procedure. It was FDA approved in 2002, although corneal reshaping has been practiced since the 1980’s. As with wearing standard contact lenses, there is a small risk of eye irritation or infection, which can be treated with eye drops. Virtually all complications arising from Ortho-K can be minimized by adopting a meticulous hygiene and cleaning regimen for your retainers. There is no evidence of side effects from long-term Ortho-K wear. Many patients have been wearing Ortho-K for decades with no physiological changes to their corneas.
How does Ortho-K differ from LASIK?
LASIK (Laser-assisted in situ keratomileusis) is a refractive surgery with the same goal as Ortho-K: to get you seeing 20/20 without glasses or contacts. While Ortho-K gently and temporarily reshapes your cornea, LASIK uses a laser to permanently remove corneal tissue to reshape your cornea. LASIK is not reversible, but often provides excellent vision to many patients. Although LASIK is an excellent option for many older patients, it is not an option for most people under the age of 20.
Who is a candidate for Ortho-K?
Many factors go into determining if you are a good candidate for Ortho-K. Ortho-K works best on patients who have less than 6.00 Diopters of myopia (also called nearsightedness) and less than 1.50 Diopters of astigmatism. Other factors, including the shape of your cornea and eye health are also considered by Dr. Montgomery.
What is Myopia?
Myopia is the medical term for an eye that focuses light in front of the retina rather than directly on the retina. Essentially, the eye’s power is too strong. We have to use Ortho-K, glasses, or contacts to reduce the effective power of the eye, bringing the image into clear focus on the retina.
I have Myopia (near-sightedness) and my prescription gets higher every year! Can Ortho-K help?
YES! Ortho-K has been proven effective in many studies to slow the progression of myopia significantly. Some patients even have their myopia stop progressing entirely. Higher amounts of myopia are a problem because high myopia is associated with increased risk of retinal tears and detachments as well as other eye health concerns, not to mention, glasses and contact lenses become thicker and more difficult to wear.
Can children wear Ortho-K retainers?
Absolutely! In fact, many of our Ortho-K patients are children. Because of its ability to slow or stop myopia progression, children who are becoming nearsighted are especially good candidates for Ortho-K.
I’ve never heard of Ortho-K. Do most doctors offer Ortho-K?
While most optometrists are trained in contact lens fitting, few go on to obtain the necessary level of additional training needed to design and manage Orthokeratology programs. Additionally, specialized equipment like a corneal topographer and proficiency in Ortho-K designing software are needed to accurately manage Orthokeratology patients. Many optometrists simply do not have the time or resources to offer Ortho-K. At West End Eye Care, Dr. Montgomery has chosen to devote more time to each patient so that he can offer a comprehensive Orthokeratology program.
How long does it take to reshape my cornea?
In most cases, the target shape of Ortho-K is reached in 7-10 days. Larger prescriptions take longer to reach the maximum effect, while smaller prescriptions may be fully corrected after just one night of wear.
If it takes a week to reach the full effect, how will I see in the meantime?
If it is anticipated that full correction will take a week or longer, Dr. Montgomery will prescribe you low-powered soft contact lenses to wear during the day for the first week. This will only be a temporary solution until the cornea has reached its intended shape.
Can I see while wearing my Ortho-K retainers?
Yes. No matter what time of day, you will always have perfect vision with your retainer. This will allow you to see if you wake up during the night.
How often do I need to replace my retainer molds?
Retainers are replaced every 12 months.
What is the cost for Ortho-K?
For new Ortho-K patients, we charge a global fee that includes all prescribed Ortho-K visits during the first year as well as the retainer molds, Ortho-K guidebook, and insertion and removal training. There are no hidden fees! The total cost varies, depending on many factors, and can be discussed after the consultation.
What are the yearly fees for established Ortho-K patients?
After the first year of Ortho-K, an annual fee will be established that includes the assessment of retainer fit, topography, any changes that need to be made, and a new set of retainer molds.
Does my insurance cover Ortho-K?
Neither vision nor medical insurance covers Ortho-K.
My driver’s license states I must wear glasses or contacts while driving. What do I do?
You will be given a card stating that you are undergoing vision-correcting therapy.
Are there financing options available to pay for Ortho-K?
We offer Care Credit®, which offers many financing options to help divide your cost into smaller, manageable payments.
We also offer Care Credit® as a financing option for our Ortho-K patients. Care Credit® allows you to finance part or all of your Ortho-K costs and pay it off in small monthly payments. Some plans even have interest free financing, if paid within a specific time period. Ask our front desk about your payment options with Care Credit®!
Insertion and Removal Help:
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