- Forge Orthokeratology lenses should be inspected and cleaned well before dispensing.
- Verify the engraving against the members.eyespace.com.au website.
- Place one drop of a preservative-free solution with NaFl in the back of the lens.
- With the patient in a face-down position, insert the lens directly onto the cornea. If bubbles are present under the lens, remove and reinsert.
- Allow the lens to settle and assess the lens fit. Please note new wearers may need longer settling time (30 mins) due to blepharospasm and epiphora.
- Assess the lens centration and movement.
- Hold the eyelids and manipulate the lens to a central position for best assessment of the lens alignment observing the NaFl pattern.
- If possible, it is good practice to photograph the NaFl pattern in a central position for use when sending to your distributor for troubleshooting.
- Note the position and stability of the lens markings for Forge toric designs.
- Perform an over-refraction over the lens on the eye.
- Review of the lens fit should be done at regular intervals: Lens delivery, day one, week one and two, one month, three months.
- With the completion of the orthokeratology fit, annual reviews should be performed.
- Communicate to the patient the warranty period for lens adjustments as provided by your distributor.
- Corneal topography.
- Monocular unaided vision at distance and near.
- If unaided vision reduced, record the residual refraction.
- Slit lamp assessment of the ocular surface with NaFl to check for corneal staining or opacity.
- Assessment of lens for defects, scratches, chips, depositing.
- Mixing daywear and overnight wear for this modality are NOT recommended. The constant moving of the lens due to lid movement and gravity during daywear will distort the treatment zones and cancel the overnight moulding effect.
- Corneal damage can occur due to abrasion and seal off which is typically seen from daywear of reverse geometry lenses.
- The overnight wearing schedule should be 8 to 10 hours per night for the first couple of days until the moulding effect has stabilised.
- Maintenance wear between 6 to 8 hours per night should be sufficient to keep the vision clear after the moulding process has stabilised.
- No modification of any curvature of the lens is permitted. Only the lens edge can be hand polished relieve any edge irritation.
- Ortho-K lens wearers should always place one drop of preservative-free solution in the back of the lens, and insert the lens in a face-down position, placing the lens directly onto the eye over the pupil.
- Insert the lens 10-15 minutes before going to bed to allow the lens to settle.
- The lens should be removed within 15 minutes of waking.
- The lens needs to be loosened before removal. To loosen the lens, insert a drop of lubricant into the eye. Free the lens by using the index finger to push up the bottom eyelid against the lower edge of the lens.
- The single most important factor in achieving a successful result in Orthokeratology is the reliability and repeatability of the corneal topography.
- The patient’s eyes must look good, feel good, and see good. If in doubt discontinue lens wear. Contact your distributor if you have any concerns or queries.
- During evaluation record the pupil size in both bright and dim lighting conditions.
- Overly large pupils will increase the risk of poor night vision, flares, and halos. The average orthokeratology treatment zone is about 5- to 6 mm.
- High prescriptions above -6.00D will give more peripheral pupil blur compared to lower Myopic prescriptions. High Myopic patients can experience more flare and halos at night and should be forwarned.
- Peripheral pupil blur can be a plus for younger patients as it will aid in myopia control.
- Slight decentration will be more noticeable with larger pupils compared to smaller pupils.
- Patients with larger pupils might notice more residual power and cylinder than smaller pupils (think pinhole effect.)
- Evaluating pupil size should be managed on a case by case basis to ensure your patient has realistic expectations that match their visual needs.
The most common reasons patients will experience corneal staining during their orthokeratology treatment are:
- Lack of apical clearance. Too little cTFT.
- Prolonged daytime lens wear.
- Allergy/reaction to cleaning solutions or lubricating drops.
- Poorly rinsed or dirty lens.
- Improper insertion or removal techniques.
- Scratched or damaged lenses.
Troubleshooting Corneal Staining
When troubleshooting corneal staining, pay attention to where the staining is located. A more localised corneal staining appearance is likely to be a mechanical issue where the lens is making contact with the cornea, such as lack of apical clearance.