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Orthokeratology (Ortho-k) - Reshaping your eyes while you sleep

Orthokeratology Lenses What is orthokeratology?
Orthokeratology (also called ortho-k) is a technique that uses special rigid contact lenses to reshape your eyes while you sleep. This allows you to have better vision during the day while not wearing corrective lenses. The effects of orthokeratology are only temporary, so the lenses must be worn often to maintain good vision. For many, this will mean wearing lenses nightly, though it varies from person to person. Some patients will only need to wear the lenses 3 to 4 times per week, depending on the severity of their nearsightedness.

Ortho-k is only for people with mild-to-moderate myopia (nearsightedness) or astigmatism. People with up to six diopters of myopia can be treated, 1.75 diopters of astigmatism. The ideal candidates are those with 4 diopters of myopia or less, thought it can treat up to 6 diopters of myopia effectively.

How it works
Like refractive surgery, orthokeratology temporarily flattens the cornea of myopic patients by redistributing the corneal tissue peripherally, enabling light rays entering the eye to focus properly on the retina. The lenses are rigid gas-permeable (RGP), snug-fitting, and somewhat flattened in the center to put pressure on the cornea and change its shape. Ortho-k is generally a gradual process, and may require a series of different lenses, though that will depend on the specifics of the patient and the type of lenses being prescribed.

Two different brands of orthokeratology lenses have been approved by the FDA for overnight reshaping: Vision Shaping Treatment (VST) by Bausch & Lomb and Paragon Vision Sciences' Corneal Refractive Therapy (CRT). VST can be used for patients with up to 5 diopters of myopia, 1.50 of astigmatism while CRT is approved for patients with up to 6 diopters of myopia, 1.75 of astigmatism.

Reasons to consider orthokeratology
Orthokeratology may seem like a strange choice, given the popularity of procedures such as LASIK, which enable patients to be permanently without lenses. However, not everyone is eligible for refractive surgery. People under 20, those with dry eyes or thin corneas, and some other eye or health issues are not good candidates for surgery. Price can be a factor in the decision as well; orthokeratology costs significantly less than surgical options.

Ortho-k is also an ideal choice for those who can't (or don't want to) wear corrective lenses during the day, but don't mind wearing them at night, including people who work in dirty or dusty environments and those who are active in sports. And unlike refractive surgery, orthokeratology is reversible if you are unhappy with the results.

One major reason to consider orthokeratology is for children with rapidly progressing myopia. It is said to hold the cornea in place so that myopia does not increase as rapidly compared to not wearing the lens.

Who is not a candidate?
Not everyone is eligible for orthokeratology. If you have severe dry eye, reduced corneal sensitivity, allergies that are aggravated by contact lenses or contact solutions, or certain other eye or medical conditions, ortho-k may not be the right choice for you. Or if your prescription falls out of the range of correction.

Cost of treatment
Fitting a patient for orthokeratology lenses is a lot more involved than a standard lens fitting. Multiple office visits are required, and sometimes multiple sets of lenses as well. Ortho-k costs an average of $1400-1800 for both eyes, but fees can vary widely and may cost as much as $3000 for both eyes in special cases. When replacement lenses need to be purchased down the road, they will cost around $300-500 per pair. Typically, orthokeratology lenses last at least a year before needing to be replaced.

The treatment is rarely covered by insurance, because it is considered elective, but you may have partial coverage, especially if standard contact lenses are covered.

Side effects
The two most common side effects are corneal edema (swelling) and corneal staining, both of which are usually temporary as long as the lenses are removed immediately and treatment is sought. Other, less-common side effects include eye infection, corneal ulcer or abrasion, iritis, corneal scarring, neovascularization, and permanent decreased vision.

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