Are you worried about your child's shortsightedness getting worse? Or is your child active in sports and would rather not wear spectacles while playing games? If so, the Corneal Refractive Therapy (also known as Orthokeratology or Ortho-K) might be an option to consider.
Darren Toh, consultant optometrist at Optika Optometrist, informs that there are three methods to control shortsightedness:
* Ortho-K;
* Myopia control lenses – using customised spectacle lenses; and
* Drugs – there is an eyedrop that paralyses the muscles. This method is quite invasive.
“Based on academic results, Ortho-K is one of the most effective non-invasive methods to slow down the progression of shortsightedness in children,” says Toh.
What it is
A child opting for Ortho-K would wear customised hard contact lenses to sleep. When the child is sleeping, the eyelid would apply pressure on the lens and the lens would reshape the eye surface. When the child removes the lens the next morning, the eye surface would have been reshaped to the corrected form, thereby helping the child see clearly without the use of spectacles or any lenses in the daytime.
Initially, it would take a few days before the child would be able to see clearly the next morning without his spectacles.
The child would need to keep wearing the Ortho-K lenses every night to continue benefiting from the treatment.
If the child stops wearing the Ortho-K lenses a few nights, the corneal surface shape would revert to its original shape and the child would need to wear his spectacles to see clearly again.
“Usually, we expect the effects to last for a day. That's why children need to continue wearing the lenses every night. You have to wear it every night to maintain the corrected shape and form,” says Toh.
He explains that the Ortho-K lenses need to be hard lenses to be able to apply pressure on the cornea and they need to allow high oxygen transmission because they are worn to sleep and the eyes need oxygen. Without sufficient oxygen, there would be discharge and redness the next morning.
When Ortho-K first emerged, its purpose was not to control shortsightedness. It was to be an alternative to lasik. As lasik is invasive, a lot of people were scared to go for it and that's why Ortho-K was offered as an alternative.
The criteria
There is no age limit for using Ortho-K, although Toh recommends children only opt for it if they are able to take responsibility for the lenses.
However, not everyone who is shortsighted can qualify for Ortho-K. It is only for those who have a power of up to 600. Those with higher power can try it, but Toh informs that the result will not be as good.
“We've tried it on some kids with higher power because some parents are very keen on the therapy but we've found that the effect is not as good.
“So, it's best for those who are shortsighted with a power of 600 and less and for astigmatism with a power of less than 150.
“For Ortho-K, there is no real age limit. I would say it depends on the child's discipline level. As long as the child can co-operate and they are disciplined and can manage the lenses themselves, then it's fine. The youngest we've fitted was five years old. But there are also children who are eight or nine and refuse to let us fit them with the lenses, so it couldn't be done. It really depends on the children's discipline and compliance,” informs Toh.
Besides that, the shape of the corneal surface is also important – if it is too flat or too curved, the child won't be able to use the Ortho-K lenses.
The process
Parents would need to bring the child in for a thorough eye check. This includes tests to determine the condition of the cornea to find out if the child is a suitable candidate.
The first thing that is done is to check the child's power for both eyes. Then, using a slit lamp, the optometrist would check the external health of the eye and the corneal health. Then, a corneal topographer is used to map the corneal surface. This would give the optometrist a clearer picture of the child's corneal curvature – if it's too flat or too curved – and whether the child can wear the Ortho-K lenses.
If found suitable, the optometrist would loan the child trial lenses (which are new and unused), which come from the supplier in Singapore.
The child would also be prescribed temporary contact lenses with a partial power to wear while waiting for Ortho-K to take full effect.
That means, if a child's current eye prescription is 300, it might be reduced to 150 after the first night of wearing the lenses. In such a case, the child won't be able to wear his spectacles the next morning, and neither will he be able to see clearly.
This is where the temporary contact lenses with the partial prescription comes in. He would wear those for a day or two, until his eye power is reduced further and he can see clearly without the use of any spectacles or contact lenses.
Initially when the child first starts wearing the Ortho-K lenses, there will be discomfort but generally children adapt quite fast, informs Toh. After three or four nights, the child should be comfortable sleeping with the lenses on.
Parents shouldn't worry if their child wants to wear the Ortho-K lenses for a few hours prior to going to bed. Children are able to see with the Ortho-K lens. It doesn't have power but the curvature will compress the eye and allow the child to see.
Parents will need to bring the child in for a checkup after a week. If everything is okay, the trial lenses would be returned to the optometrist, who would send them back to the supplier. And, the optometrist would prescribe the Ortho-K lenses.
More checkups would follow in two weeks, one month, three months and six months because the optometrist would need to monitor how the lenses sit on the eyes, if there is any progression after the child starts wearing the Ortho-K lenses, and the physiology of the eye.
The child would wear the Ortho-K lenses daily up till the age of 18 or 19. This is when the power of the human eye is said to stabilise.
At 18 or 19, they would then be given a few options on how to proceed: Wear spectacles or contact lenses, go for lasik or to continue with Ortho-K.
Toh informs that he does have clients who wear the Ortho-K lenses up to the age of 40+.
Best outcome
Toh recommends parents bring their children in during the school holidays if they are keen to try out Ortho-K.
“For the lens to take effect initially, it takes about three to five days. So, if they come in during schooldays, it would be disruptive to school as they might only have partially corrected vision for a few days. That's why most parents bring their kids in during the school holidays,” says Toh.
During the school holidays, Optika typically sees four or five children opting for Ortho-K. On other months, there might be one or two cases.
According to Toh, out of five children coming in to see him, about two or three would qualify for Ortho-K.
He explains that although the parents are eager for their child to try it out, sometimes the child is adamant about not wanting to wear any lenses.
“Generally, the best age would be below 10. Once the power is over 500, it's a bit hard for us to fit the lenses on them. That's why we would like to catch them within that age window – once they can be disciplined and responsible enough to wear the lenses to sleep and before the age of 10.
“A lot of parents ask if Ortho-K lenses can cure or reverse shortsightedness. What I need to stress is that the Ortho-K method is only to slow down the progression and control the power. In fact, there's no method in this world that could reverse or cure shortsightedness. All we can do is slow down the progression and control the power,” he stresses.
Risks
As with all contact lenses, there are risks to wearing Ortho-K lenses. Hygiene should always be a priority. Without cleanliness, hygiene and discipline, there might be lens contamination or bacterial infection.
“I always stress that if the children are not capable of being responsible, or are not disciplined enough to go through the daily regimen, the parents will have to do it for them. Parents are responsible for them because we need to cut down the risk of any infection or contamination.
“That's actually one of the reasons why we need to see the children more frequently. We want to monitor and see if the child is disciplined enough,” says Toh.
According to him, the Ortho-K lenses are approved for one-year usage by the US FDA (Food And Drug Administration) but because of the high cost, the lenses can actually be worn up to three years. However, the optometrist needs to keep checking on the condition of the lenses to ensure they are still in good condition.
Conclusion
Toh has a few tips for parents considering Ortho-K for their children.
“Firstly, parents need to know there are considerations. This is not a one-time therapy where you come in, get treated and go home. The parents would need to bring their child in for checkups a few times over a few months.
“Secondly, the success rate is high, but we cannot guarantee 100% success. It depends on the individual's eye condition.
“Thirdly, continual wear is important. If you keep neglecting to wear it at night, then the effect would not be as good.
“Fourthly, hygiene, cleanliness and discipline are important,” he says.
Ortho-K is available in not more than 20 optometrists in the Klang Valley, and in Malaysia in about 40 optometrists. The package for Ortho-K including lenses, checkups and after-care service is from RM3,600.
Shortsightedness is caused by a few factors:
* Genetics – People in Asia, especially those of Chinese and Japanese ethnicity, tend to be more prone.
* Inherited from family members – Shortsightedness tends to run in families. If the parents are shortsighted, the children are likely to be shortsighted, too.
* Long hours and excessive amount of work from a close distance.
* Bad reading habits (under poor lighting conditions).
When children are exposed to excessive near work (from looking at books or gadgets from a close range), their eye muscles tend to be under stress. When they are under stress, they will send a wrong signal to the brain which causes the eyeball to elongate. When this happens, eventually it leads to shortsightedness.
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