Ortho K: why do it and is it risky?

Myopia, or near-sightedness, is a big problem in the world today (see my other article on myopia). There are three approaches to treat myopia:

1) wear optical correction, for example, glasses, contact lenses. These allow patients to see clearly, but once you take off the glasses or contact lenses, it’s still burry, and your eyes are still myopic.

2) surgery to optically correct myopia, examples include LASIK and PRK. These allow you to see clearly without wearing glasses or contact lenses. But your eyes are still myopic, or in other words, the risks of a myopic eye still hold, including retinal detachment.

3) There are a number of methods tested to slow myopia progression, with two things working the best, ortho K and atropine eyedrops. Both can slow myopia development at least 0.25 D per year, meaning if a kid is treated from ages 8 to 18 when most of the myopia develops, they will be 2.50 D less myopic than what they would be with just wearing glasses. Unfortunately once myopia develops, it cannot be reversed, so the only way that can help is to slow it down. Problem with atropine eye drops is that even though it slows myopia development, it does not reverse it, so kids still need to wear glasses or contact lenses to see clearly. On the other hand, ortho K allows clear vision during the day without needing to wear any glasses or contact lenses, advantageous for sports and cosmesis. One advantage of ortho K over LASIK is that ortho K is reversible, your cornea goes back to normal after discontinuation of lens wear; also you can wear ortho K at any age but LASIK is only done after age 18.

Here is how ortho K works.

It is a hard contact lens called gas permeable lens that you wear while you sleep. It temporarily flattens your cornea (the transparent surface of the eye) so that when you take out the lens in the morning, your vision is clear (Figure 1). Throughout the day, your cornea gradually goes back to its original shape, but by the time your vision is blurry, you put in lenses again and go to sleep, the cycle goes on. What’s magical is not that you don’t need to wear anything during day to see clearly, but that by doing so your myopia development actually slows down. Ortho K essentially hits two birds with one stone: it’s an optical correction just like other contact lenses (difference being wearing at night instead of during the day), but it also slows myopia progression. Compared to atropine eye drops, you don’t need additional glasses to see clearly while still having the same benefit of slowing down myopia.

I would do it if I were a kid and just stated to develop myopia. During the day I am glass free to do sports or whatever activities I like, and I know that I would be less myopic than my peers down the road who just wear glasses.

So what are the risks?

Biggest one is infection. Infection goes with any contact lens, especially the type that you wear at night. The reason is that when our eyes are closed, there is less oxygen going to the cornea, and an additional lens in the eye is not going to help. This is less ideal for the health of the cornea. But infection itself comes from mis-handling of contact lenses or inappropriate lens care. Research has shown that infection risk of wearing ortho K is comparable to that of regular contact lens that is worn at night, which is higher than wearing contact lens during the day. Given that many ortho K patients are young adults or kids, it is important that the patient is a responsible person, or that they have a responsible parent. Overall incidence of infection from ortho K is 7.7 per 10,000 patients per year, so less than 1 person out of every 1000 people treated.

Thus far, ortho K is not covered by insurance. And it costs $2-3,000. So the expense is also something to consider.

Would you do it? Would you do it for your kids? Do let me know.


Figure 1.