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Orthokeratology: Safety, Compliance, Comfort, Communication and more

Orthokeratology has been well established as an effective way to not only temporarily correct myopia without the need for daytime contact lenses or glasses, but also control myopia progression. It is arguably the intervention with the most research evidence for myopia control, with multiple studies indicating a consistent effect in slowing axial elongation, even for patients with moderate astigmatism and high myopia.

The newest research in orthokeratology has investigated compliance, safety, comfort and combination treatment with atropine. Here, we'll bring you the latest knowledge with implications for clinical practice.

Clinical Article

The Latest Research On Orthokeratology: Compliance, Safety, Comfort And Combination With Atropine
Orthokeratology has been well established as a myopia control treatment. The newest research in orthokeratology has investigated compliance, safety, comfort and combination treatment with atropine. Here, we'll bring you the latest knowledge with implications for clinical practice.

Case Studies

Getting Parents Onboard With Orthokeratology
How do you get parents onboard with orthokeratology when they are unsure of childhood contact lens wear capability, benefits or safety? In this case, one parent was receptive to this recommendation but the other parent was not. Read more on the steps to take to support your clinical communication, including further reading and resources to help.
Which Is Best? Myopia Management For An Astigmatic Myope
Contact lens options are ideal for higher myopes. What about when they have moderate astigmatism as well? This case discusses the evidence base for myopia control options which correct for astigmatism, along with patient-specific considerations and whether a combination treatment with atropine is needed.

Science Snippets

Which works best - atropine 0.02% or orthokeratology?

This paper compared the efficacy of 0.02% atropine eye drops and orthokeratology (OK) in controlling axial length (AL) elongation in a group of 203 Chinese children aged 7-14. The 0.02% atropine drops were diluted from 1% and these children wore single vision spectacles, whilst the orthokeratology group was historical. Following 2 years of treatment, the atropine group demonstrated significantly faster axial length elongation (0.58±0.35mm) compared to the OK group (0.36±0.30mm). In both groups, younger age and shorter baseline axial length were associated with faster axial length elongation, as expected. Whilst the ages of the two groups matched, the OK group had a longer baseline AL, so this could account to some degree for the slower overall progression observed. Every 1mm shorter baseline axial length resulted in 0.11mm faster AL elongation in the OK group and 0.17mm in the 0.02% atropine group over two years. With overlapping 95% confidence intervals, the overall effect between the two groups could be similar; although when AL was controlled for, a stronger myopia control effect was found in higher myopes wearing OK, but not in the 0.02% atropine group. Clinically, this study indicates that OK may be more effective in controlling AL elongation in comparison to 0.02% atropine, particularly in children with higher baseline myopia, but further research is required as the two groups weren’t completely matched.

Lyu Y, Ji N, Fu AC, et al. Comparison of Administration of 0.02% Atropine and Orthokeratology for Myopia Control. Eye Contact Lens. 2021 Feb 1;47(2):81-85.
How common is Microbial Keratitis in Children wearing Orthokeratology?

This study estimated the incidence of microbial keratitis (MK) in children wearing overnight orthokeratology lenses in a group practice in Russia. The study observed a rate of MK of approximately 5 cases per 10,000 patient years, which is lower than previous reports from clinical data gathered over a decade ago, and similar to that associated with daily-wear soft contact lenses. This should give both practitioners and parents confidence in considering overnight orthokeratology as a means of myopia control. The mean age of MK was 15.2±1.1 versus the mean age of fitting 12 years, indicating children are more likely to experience MK years after being fitted, rather than in the first few months. This highlights the importance of remaining vigilant in educating patients on good hygiene and lens care for the duration of their treatment period. The finding of a higher safety profile compared to previous reports could be due to the data being gathered from a single group of practices with standardized training and care protocols, and/or reflecting a concerted effort to improve OK safety and compliance in the past decade or so.

Bullimore M, Mirsayafov D, Khurai A, et al. Pediatric Microbial Keratitis With Overnight Orthokeratology in Russia. Eye & Contact Lens. 2021;47(7):420-425.

Helpful links from Menicon

Menicon Lecture Movies. Menicon Academy presents a series of freely available lectures, with topics including understanding corneal topography & orthokeratology case studies (by Mr Sander Sterk); myopia management in the clinic (by Dr Kate Gifford); orthokeratology for myopia control research (by Professor Pauline Cho) and the Menicon perspective on the present and future of myopia management (by Mr Steve Newman and Dr Jacinto Santodomingo). Select lectures are also available in Chinese.
White paper on Menicon Bloom Myopia Control Management System. Menicon Bloom Night is the first orthokeratology lens system CE marked for myopia correction and control. CE approval is regulated by the European Medical Agency, and is recognized around the world. CE marking indicates that the highest safety, efficacy and quality standards have been met for a medical device, authorizing Menicon Bloom to be marketed for the specific indication of myopia control. This white paper describes Menicon Bloom Night and why CE approval matters.

Myopia Profile Academy new platform launched

With our new learning platform upgrade comes a special event. Our world leading, completely free Myopia Management in Practice online course has been updated with a brand new look in our engaging, interactive new text-based format. The content has also been updated to include the latest research on efficacy and outcomes of myopia management interventions.

More courses and benefits of our new platform will be revealed in the second half of 2021 - check out the new look and upgraded course here.

Our Resources to help you manage myopia

Courses Our world first, FREE Myopia Management in Practice course will get you started on your learning journey. Check out our newest courses on Binocular Vision Fundamentals, Orthokeratology Fundamentals and Contact Lenses for Kids.
Managing Myopia Guidelines Infographics Designed to support your clinical communication with parents and young patients, our hugely popular infographics are free to download and available in eight languages with various options based on your region and scope of practice. 
 
MyKidsVision.org Our public awareness website supports your in-room communications with fast facts, a risk survey, a detailed blog and 18 How-To videos to explain myopia to parents. All are freely available for you to link and share to your own website and social media accounts.
Instagram Follow MyopiaProfile for more links and learning experiences for eye care practitioners. Follow MyKidsVision for bite-sized, graphically appealing info on myopia and children's vision for parents which you can share to your own platforms.
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