Treating Uncomfortable Contact Lens Wear With Orthokeratology

Abstract

Objectives: Many contact lens (CL) users permanently discontinue wear because of ocular dryness and discomfort. This study aimed to determine whether refitting symptomatic soft CL wearers in to orthokeratology could improve ocular symptoms and signs. Methods: This was a prospective, 3-month, open-label study of symptomatic (Contact Lens Dry Eye Questionnaire [CLDEQ-8] ≥12) soft CL wearers who were between the ages of 18 and 45 years. All subjects were refit into orthokeratology CLs (Emerald, Euclid Systems). The following tests were completed: CL history, Standardized Patient Evaluation of Eye Dryness (SPEED) questionnaire, CLDEQ-8, CLDEQ-4, logarithm of the minimum angle of resolution visual acuity, pupil size, refractive error, slit-lamp biomicroscopy, noninvasive tear break-up time, tear meniscus height, phenol red thread, conjunctival staining, corneal aesthesiometry, and corneal topography. Results: Twenty-nine of 40 qualifying subjects (age=24.43±4.62 years) completed the study. No significant differences were detected between completed and noncomplete subjects. Completed subjects had significantly better CLDEQ-8, CLDEQ-4, and SPEED scores at 3 months compared with baseline. Completed subjects had significantly better conjunctival staining scores and flatter keratometry values at 1 month compared with baseline. Conclusions: Although not all symptomatic soft CL wearers were able to be refit into orthokeratology, subjects who were wearing orthokeratology at 3 months had a significant and clinically meaningful improvement in ocular symptoms. Additional work is needed to determine the mechanism leading to improved comfort because few clinical signs were changed after switching to orthokeratology.

Established soft contact lens wearers’ awareness of and initial experiences with orthokeratology

“…This lack of eyelid movement while wearing the lenses during sleep is thought to reduce lens awareness dramatically. This is supported by previously published data from this project that found a large portion (72.5%) of adult subjects who were uncomfortable soft contact lens wearers could be treated successfully with orthokeratology 4 . These same subjects who completed this 3‐month study had dramatic improvements in contact lens discomfort as well as dry eye symptoms compared with when they were wearing soft contact lenses 8 .…”

“…This is supported by previously published data from this project that found a large portion (72.5%) of adult subjects who were uncomfortable soft contact lens wearers could be treated successfully with orthokeratology. 4 These same subjects who completed this 3-month study had dramatic improvements in contact lens discomfort as well as dry eye symptoms compared with when they were wearing soft contact lenses. 8 Despite these data and past related reports, there is a paucity of published data related to the initial experience of undergoing orthokeratology treatment (e.g., adaptation, initial perception of technology).…”

“…Since the mid-1990s, orthokeratology has been prescribed by eye care practitioners as a means of temporarily reducing refractive error, 1 and it has gained acceptance for the correction of myopic refractive errors in adults and children. [2][3][4] While the number of patients undergoing orthokeratology treatment in the United States has increased in recent years, this practice is still only a small overall portion of the contact lens market. 5 While the reasons for underutilisation of orthokeratology have not been fully investigated, orthokeratology prescribing may not be widespread because it requires extra technology to prescribe it effectively.…”

BCLA CLEAR - Orthokeratology

“…The characteristics of good potential candidates for ortho-k include [26]; myopia up to approximately 4.50 D, corneal or refractive astigmatism up to ~3.00 D, and a pupil diameter less than ~6.00 mm in dim illumination to minimise symptoms associated with post-treatment elevated higher order aberrations (HOAs). Soft lens wearers who suffer from lens related discomfort or dryness [27] may also benefit from ortho-k, and the typical requirements and contraindications for commencing contact lens wear apply (e.g. a healthy ocular surface, eyelids, tear film) (see CLEAR Evidence-based Practice Report) [28].…”

“…In adults, ortho-k is useful for temporary myopia reduction, especially for those who would like to be free from spectacle or contact lens correction during the day [200], or those who suffer from soft contact lens discomfort [27]. In children, ortho-k is predominantly prescribed for its myopia control efficacy [201], typically as an off-label treatment [24].…”