Orthokeratology (Ortho-k)

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What is Orthokeratology?

Orthokeratology or ortho-k are special contact lenses.

Unlike regular corrective lenses that focus light to the retina, these lenses temporarily reshape the cornea to improve vision.

Ortho-k lenses are a painless alternative to laser eye surgery.

They are also a good option for people who do not want to wear eyeglasses or contact lenses every day.

Orthokeratology does not offer permanent vision correction. But if you wear them as directed, they can improve your eyesight.

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Who is Ortho-K for?

Orthokeratology lenses are primarily used to treat myopia (nearsightedness).

However, they can also correct mild cases of astigmatism (blurred vision) and hyperopia (farsightedness).1

Doctors usually treat these refractive errors with glasses, contact lenses, and corneal refractive surgery such as LASIK and PRK.

Ortho-k lenses can be prescribed as an alternative if:

  • You prefer a non-surgical approach
  • You want to avoid wearing glasses or lenses all the time
  • Wearing contact lenses is not possible (e.g., you play contact sports)
  • LASIK surgery is not an option

The U.S. Food and Drug Administration (FDA) does not approve LASIK for people below 18 years.2

A person's eyes continue to develop until they reach adulthood. If LASIK is performed at an early age, the eyes will continue to change shape and lead to unexpected results.

This makes ortho-k lenses a safer option for children and adolescents.

How Does Ortho-K Work?

The cornea is a transparent eye structure. It helps you see by focusing light to the retina.

When the cornea is not the right shape, it causes refractive errors such as myopia, hyperopia, and astigmatism.

A refractive error makes it difficult to see clearly at certain distances. Ortho-k lenses correct them by flattening the center of the cornea.1

Corneal reshaping changes the way that light enters your eye. In turn, it temporarily improves your eye's ability to focus on objects.

Is Ortho-K Safe & Effective?

Yes, ortho-k lenses are safe and effective for people of all ages.

A systematic review of 170 ortho-k studies shows it can safely treat and delay the progression of myopia.3

People who start overnight orthokeratology between the ages of 7 and 16 years can slow the progression of their myopia.4

Researchers followed their progress over 12 years. They found ortho-k lenses to be clinically safe.4

Ortho-k lenses for astigmatism and hyperopia

Most orthokeratology lenses are spherical.

Spherical ortho-k lenses can treat near-sightedness caused by myopia. But they are not as effective for high astigmatism.4

According to studies, toric ortho-k lenses provide better vision correction than spherical lenses.7 They can:

  • Improve visual acuity in people with combined myopia and astigmatism.5
  • Correct myopia and astigmatism in children aged 6 to 12 with moderate to high astigmatism.6

Toric orthokeratology uses specially-designed ortho-k lenses that better stay in place. Research shows they can treat low to moderate myopia with moderate to high astigmatism.7

Special ortho-k lenses have been developed for people with hyperopia. These include Ocular Surface and External Integrated Remodeling Therapy (OSEIRT) and Alexa H lenses.

Both show promising results. But research is still limited.8,9

Ortho-k risks

According to the American Academy of Ophthalmology (AAO), ortho-k lenses put you at risk for bacterial keratitis.1 Poor hand hygiene and contact lens maintenance further increase your risk.

However, studies show that the risks associated with ortho-k are no higher than other contact lenses.3

You can lower your risk by cleaning lenses with a contact lens solution. Wash your hands before handling lenses to avoid contaminating them.

What Can You Expect from Ortho-K?

Here is what you can expect from wearing ortho-k lenses:

Lens fittings

The treatment involves wearing a series of specially designed contact lenses, which are made to fit the surface of your eye.

To ensure good fitting lenses, a doctor will use a corneal topographer. The imaging device measures and maps out your cornea and helps determine the shape of your lenses.

Optometrists and ophthalmologists perform most ortho-k fittings. However, a contact lens technician may also do lens fittings with their supervision.

Comfort and wearability

Orthokeratology uses rigid gas permeable (RGP) lenses. They are not as flexible as regular contact lenses. So you might feel them when you wear them.

There are two types:

  • Overnight ortho-k lenses. Worn for 8 hours at night and removed during the day.
  • Daytime ortho-k lenses. Worn during the day and for longer hours.

Doctors usually recommend wearing overnight lenses to help with the discomfort. Either way, most people feel more comfortable as they get used to wearing them.

Note: Consult your eye doctor if ortho-k lenses cause difficulty sleeping, prolonged eye discomfort, and eye irritation.

They may replace your pair with better-fitting lenses or suggest alternative treatment options.

Treatment time

Ortho-k lenses gently reshape the cornea. Your doctor may prescribe up to three pairs, which are worn one after another.

Treatment time can take two weeks or longer until you get the desired vision correction. However, you may start to see improvements within days of wearing them.

Your doctor will prescribe retainer lenses once you attain the ideal corneal shape.

Ortho-k provides temporary vision correction. If you stop wearing them, your cornea will return to its original shape.

The treatment requires that you wear lenses as prescribed to maintain the effects.

You can use ortho-k lenses for as long as you like. As long as they feel comfortable and your eyes stay healthy, there is no limit on how long you can wear them.1

How long does ortho-k last?

Ortho-k lenses should last you a few years. However, you may need to replace them if your:

  • Vision changes
  • Lenses get damaged

Regular eye exams ensure that your lenses are still right for you.

How Much Do Orthokeratology Lenses Cost?

Ortho-k lenses cost an average of $1,000 to $4,000. Ongoing treatment will cost you $300 to $500 per year.1

These additional treatment costs will cover your lens replacement, lens care solutions, and follow-up visits with your eye doctor.

Is ortho-k covered by insurance?

It depends. Most insurance companies do not cover orthokeratology since it is an elective procedure.

However, there are some cases where an insurance company pays for a portion of the total costs.1

Alternative Treatment Options

Orthokeratology uses temporary lenses. Like glasses and regular contact lenses, they can temporarily improve:

  • Nearsightedness (myopia)
  • Farsightedness (hyperopia)
  • Blurred vision (astigmatism)

If you prefer a more permanent solution, you can opt for LASIK eye surgery. It uses a laser to reshape your cornea and correct the way your eye refracts light.10

LASIK surgery can treat hyperopia and other refractive errors. Studies show it has a 90 percent success rate.

Another option is photorefractive keratectomy (PRK). It is a refractive eye surgery that uses laser to reshape the cornea and correct your eyesight permanently.11

You may opt for PRK over LASIK if you have particularly dry eyes or thin corneas, as these may disqualify you as a good LASIK candidate.Both LASIK and PRK surgeries are quick and easy.

But if you want to improve your vision with the least risks possible, you can use eyeglasses.

Many people with myopia use single-vision lenses. These glasses can correct various focusing issues.12

Alternatively, you can wear a regular pair of contact lens which focus light to your retina.

There are two types of contact lenses:

Your vision can change over time. So you need to get regular eye exams to ensure that your glasses and contact lenses are still the right prescription.

Various factors can affect your choice for vision correction. These include your eye health, general health status, and budget.

Before you decide which treatment is best for you, consult your eye doctor. Be aware of possible risks like corneal ectasia.

Can I have LASIK after ortho-k?

Yes, if you initially opted for orthokeratology, you can eventually get LASIK surgery for permanent vision correction.

The effects of ortho-k are reversible, so you can always switch eye treatments if you change your mind.

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12 Cited Research Articles
  1. What Is Orthokeratology?American Academy of Ophthalmology, 24 Oct. 2018.
  2. "When is LASIK not for me?" U.S. Food & Drug Administration.
  3. "The Safety of Orthokeratology—A Systematic Review." National Center of Biotechnology Information.
  4. "Effect of Orthokeratology on myopia progression: twelve-year results of a retrospective cohort study." National Center of Biotechnology Information.
  5. "Effectiveness of Toric Orthokeratology in the Treatment of Patients with Combined Myopia and Astigmatism." National Center of Biotechnology Information.
  6. "Toric orthokeratology for highly astigmatic children." PubMed.
  7. "Comparison of Toric and Spherical Orthokeratology Lenses in Patients with Astigmatism." Hindawi Journals.
  8. "OSEIRT/Ortho–K Indication for the Hyperopia Patients." Investigative Ophthalmology & Visual Science.
  9. "Orthokeratology With a New Contact Lens Design in Hyperopia: A Pilot Study." Lippincott Williams & Wilkins.
  10. LASIK - Laser Eye Surgery.” American Academy of Ophthalmology.
  11. What Is Photorefractive Keratectomy (PRK)?American Academy of Ophthalmology.
  12. How to Choose Eyeglasses for Vision Correction.” American Academy of Ophthalmology.
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