Orthokeratology F.A.Q.!

Transcription

1 Orthokeratology F.A.Q. Why orthokeratology? There are many reasons why people choose to correct their vision with orthokeratology. The main reason is the freedom from glasses and contact lenses. Orthokeratology is a lifestyle choice lets people engage in normal activities like swimming, driving, reading, computers, and sport without having to worry about their eyes. Some people find glasses inconvenient or impractical for their day to day activities, like chefs whose glasses are prone to fogging up in the kitchen, or tradespeople who get their glasses dirty and their lenses scratched on the job. Others find soft contact lenses dry their eyes out or don t correct their vision as well as they d like. A medical reason for using orthokeratology is that it has been shown to stop or slow down the rate of progressing short sightedness in children and teenagers. This prevents their eyes from getting worse and reduces their chances of eye diseases like glaucoma and macular disease when they are older. Many people are not keen on eye surgery due to the expense, the risks, their age, or other reasons why they may not be a good candidate. Orthokeratology is, unlike laser refractive surgery, completely reversible. Orthokeratology also costs significantly less than surgery. Laser eye surgery is also not a permanent solution, and for a given individual it cannot be accurately predicted how long the patient will benefit from clear vision. While many patients can get years of good vision after laser surgery, some will have less than a year before their eyes become blurry again. Orthokeratology is a great option for ages 8 years and up How does orthokeratology work? Orthokeratology works by reshaping the front surface of the eye overnight, so the eye vision becomes in focus again. This allows you to see all day without glasses or contact lenses. In effect, the eye becomes its own contact lens Who is suitable for orthokeratology? Almost everyone The latest technology allows orthokeratology to work for a wide range of prescriptions. This can include short-sightedness (myopia), high myopia (up to D), farsightedness (to to +4.00), astigmatism (up to -3.00), and presbyopia (trouble reading at close distances). The only way to determine if an individual is suitable is to have an eye examination and an orthokeratology assessment by an optometrist specialising in orthokeratology. 1 of 3

2 How much does orthokeratology cost? Orthokeratology costs a fraction of laser eye surgery and is quite economical over the long term. ONE EYE BOTH EYES PRICE $800 $1,500 Each lens should last at least a year, but often they last two, three, four, and occasionally up to five years Par for the course is 2 years. How quickly do I experience a change in my vision? Orthokeratology starts working immediately. Approximately 50 to 70% of the change in vision happens in the first night s wear, with the remainder happening within the first two weeks. Lower prescriptions may get the full effect within a few days, whereas the full treatment effect may take up to 1 month for higher prescriptions or more difficult eyes. Are the results permanent? Orthokeratology is a reversible change to the cornea, so to maintain the effect you need to keep wearing the lenses. Are orthokeratology lenses comfortable? Orthokeratology lenses are worn while you sleep and are quite comfortable under these conditions. There can be an adaptation period of a week or so where the lenses become more comfortable. Is orthokeratology safe? With proper care and fitting, orthokeratology is a safe way to correct your vision. However, all contact lenses come with risks. Can I still have LASIK after using orthokeratology lenses? Since orthokeratology is a reversible change to the shape of the cornea you can still have laser eye surgery even if you have worn the lenses for many years. In fact, if you ve had LASIK and it has worn off (as it does) then you may still be able to have orthokeratology after that. 2 of 3

3 What happens if my prescription changes? One of the great things about orthokeratology is that your prescription is less likely to change. However, if it does, a new lens will need to be ordered. Subsequent pairs (re-orders) of lenses are offered at a discount to the initial purchase price. If I already wear contact lenses, why should I change to orthokeratology? Daytime dryness and discomfort is an issue with soft contact lens wear but much less so with orthokeratology, since the lenses are worn only during sleep. The ability to engage in swimming and other sports without the risk of losing your lenses or getting an eye infection from watercontamination is another advantage. Orthokeratology is also capable of slowing the rate of change of your short-sightedness and lowering your risk of associated eye diseases like macular degeneration and glaucoma. What if I have dry eyes? Dry eyes may be more suitable for orthokeratology than soft contact lenses because orthokeratology lenses are worn while you sleep, reducing the chance of experiencing daytime lens-related dryness. Can I see with my orthokeratology lenses in my eyes? Yes. Your personalised lenses are specially made so that you can see with them in and with them out. So, if you wake during the night and need to get up, you can still see. How long do orthokeratology lenses last? Each lens should last at least a year, but often they last two, three, four, and occasionally up to five years How long they last depends on several factors including how well you take care of them. Do orthokeratology lenses need cleaning? Like any lens worn on the eye, orthokeratology lenses require proper cleaning. This is a simple and quick process. We will teach you how to do it. 3 of 3

4 Orthokeratology Consultation Schedule There will be several consultations in the initial phase of orthokeratology wear. Typically, the patient will have a comprehensive eye examination that is bulk billed for Medicare and DVA card holders. A free orthokeratology assessment consultation can then be organised to see if the patient is a suitable candidate for the treatment. After that, customised orthokeratology lenses are ordered and take about 2 weeks to be manufactured. The new lenses arrive and the patient is taught how to insert, remove, and care for their lenses, as well as a trial of the lenses on eye for typically 20 minutes. The next morning, after the first night s wear, the patient is reviewed to see if the eye shape is changing as predicted and that the eyes are responding well to the treatment. Follow up appointments are scheduled for one week and then one month of treatment and after the initial phase, regular orthokeratology examinations are recommended for every 6 months. Patients should bring their lenses to every consultation. A detailed consultation schedule is given below. Initial Eye Examination - (30 minutes) 30 minutes in duration. Bulk Billed to Medicare or DVA where possible. Includes full ocular health assessment and spectacle prescription. Assessment & Fitting - (30 to 60 minutes) Shape of the corneas are measured (corneal topography). Evaluation of suitability for orthokeratology. (If not suitable, no fees will be charged) Calculations of the type of orthokeratology lenses needed. Customised fitting of orthokeratology lenses. Discussion of the risks or overnight orthokeratology lens wear. Orthokeratology Agreement discussed and signed. Payment plans discussed and initiated, and personalised orthokeratology lenses are ordered. The personalised orthokeratology lenses usually take 1 to 3 weeks to arrive. Lens Collection & Instruction - (30 to 60 minutes) Instruction and practical tutorial on insertion and removal of orthokeratology lenses. Instruction and practical tutorial on care and maintenance of orthokeratology lenses. Take home your personalised orthokeratology lenses and wear them tonight (The lenses come with a starter pack, which includes a bottle of BioTrue multipurpose cleaning solution, a lens case, a box of Menicon Progent intensive cleaning solution, a Menicon Progent case, a bottle of 1 of 2

5 Ocupure saline solution, a bottle of Hylo-Forte or equivalent lubricating drops, a DMV Sucker lens remover, and a USB stick with PDF information sheets and images of recommended products.) Review After The First Night Of Wear Assessment of the treatment effect after the first night of wear. Assessment of the eye s physiological response to overnight wear. Review of insertion and removal if necessary. Consultation is the earliest possible time in the morning. Please sleep in as late as possible before coming to the practice. You do not need to wear your lenses in to the consultation but please bring them with you. Continue with another 6 nights of wear. Review After 7 Nights Wear Assessment of the treatment effect after the first 7 nights of wear. Consultation is in the morning. You do not need to wear your lenses in to the consultation but please bring them with you. 1 Month Review Assessment of the treatment effect after the first 30 consecutive nights of wear. Consultation is in the morning. You do not need to wear your lenses in to the consultation but please bring them with you. 3 Month Review Consultation is any time of the day. Please bring your lenses and case to the appointment. 6 Month Reviews (Ongoing) Consultation is any time of the day. Please bring your lenses and case to the appointment. 2 of 2

6 Inserting An Orthok Lens Wash and dry your hands. Before handling your lenses you must wash your hands with antibacterial soap. Use a soap without moisturisers like lanolin as it can contaminate your lenses. Dry your hands thoroughly so that there is no tap water remaining on them. Use a lint-free paper towel or a well laundered clean towel. Remove a lens from its case and rinse it with solution. Rinsing your lens before you insert them is important so that any foreign material that may have accidentally found its way into the lens case solution is removed from the lens. Rinsing the lens with contact lens storing solutions (Menicare Plus, BioTrue, Boston Conditioner) is acceptable but LensPlus OcuPure Saline is the recommended solution because is it as close to non-preserved and chemical-free as possible. Place the lens on your dry index fingertip and fill it completely with non-preserved artificial tears? The lens needs to be completely filled with liquid before insertion. It is this liquid that produces the corneal re-shaping effects on the eye overnight. No liquid = no effect This liquid is going to be under the lens all night and so it is important to use a non-preserved product. The recommended products are Hylo-Forte or Theratears. These are non-preserved and non-toxic to the corneal surface. Add 2-4 drops to the bowl of the lens so that it is full of liquid and ready for insertion. Insert the lens(es) directly on to the cornea. Inserting these lenses properly and directly onto the cornea is so critical for getting a good treatment effect. Place a mirror on the bench-top. Tuck your chin into your chest as far as possible. Bend over as much as you need to so that your face is pointing directly downward. Your head should be completely parallel to the floor / mirror. Use one hand to hold open your upper lid. Grab the lashes rather than the lid itself. Use the middle finger of the hand carrying the lens to pull open the lower lid. You should now see the whole iris (coloured part of your eye) without the lids being in the way. Keep both eyes open as wide as possible. Use the index finger with the lens on it to insert the lens directly on the cornea. DO NOT put it on the white of the eye and slide it onto the cornea. If the lens is on the white of the eye, remove it and re-insert properly. Check that the lens settles and is fairly comfortable. Repeat the process with the other eye. 1 of 2

7 Empty your case, clean it, and leave it to air-dry. Tip out all of the BioTrue solution from the lens case. This should never be re-used. Rinse the case with some BioTrue solution and dry it with a clean facial tissue. Leave the case to air dry on a clean tissue, open and upside down. Throw out your case every time you purchase new solution and use the fresh case that comes with the solution. Let the lenses settle in for 10 to 15 minutes with your eyes open. The lenses need between 10 and 15 minutes to settle before you close your eyes to sleep. During this time, do not read, watch TV reclined in bed, or do other activities that require consistent downward looking. Just use your eyes otherwise normally. This is a good time to perform your normal pre-sleep routine of brushing your teeth etc. Close your eyes and go to sleep. 2 of 2

8 Removing An Orthok Lens Wash and dry your hands. Before handling your lenses you must wash your hands with antibacterial soap. Use a soap without moisturisers like lanolin as it can contaminate your lenses. Dry your hands thoroughly so that there is no tap water remaining on them. Use a lint-free paper towel or a well laundered clean towel. Fill your lens case with fresh solution. Prepare your lens case for the lenses to be stored in by filling it up with your habitual solution. Recommended products are Menicare Plus, BioTrue, or Boston Conditioner. Check that it is safe to remove the lenses. When you blink you should feel the lens move a little each time. If you can feel the lens move when you blink then it is safe to remove the lens. Moisten the tip of the lens remover (suction cup). Open your upper and lower eyelids as per insertion technique. You can be upright for removal, unlike insertion where your head needs to be face down. Looking in the mirror, place the remover directly on the centre of the lens. Gentle pressure is enough. Pull the remover back out and the lens should come with it. Slide the lens off the suction cup, don t pull it directly off the suction cup or you risk warping or breaking the lens. If you can t feel the lens move when you blink, and it feels like it isn t there, then it is likely that the lens has bound to your cornea overnight. The lens must be freed from binding before removal. Place a drop of artificial tears in your eye. Pull the lower lid down with your fingers so that you can see the white of your eye below the iris. With gentle pressure push up and in at the edge of the iris. This should break the surface tension and free the lens. Repeat if necessary. You should then feel the lens move when you blink and it is now safe to remove as above. Clean the lens and store it in solution in the lens case. Please see Cleaning and Caring for Orthok Lenses for this process. 1 of 1

9 Cleaning and Caring for Orthok Lenses Fill your lens case with fresh solution. Prepare your lens case for the lenses to be stored in by filling it up with your habitual solution. Recommended products is BioTrue (Substitutions: Menicare Plus, or Boston Conditioner). Rub, Rinse, & Soak. After you remove the lenses from your eyes, you need to clean the lenses. This needs to be done every day. It s just like doing the dishes, in that some mechanical friction is needed to get the dirt off your lenses before they are rinsed off and stored. RUB. Place the lens in the palm of your hand, bowl side up. Add a small amount of BioTrue solution. With your index finger in the bowl of the lens rub it gently against the palm. This cleans the outside of the lens. Next, hold the lens between your thumb and index finger of one hand and rub the inside of the bowl of the lens with the other index finger. Rub from the centre to the edge whilst rotating the lens. This cleans the inside of the lens. RINSE. Rinse the lens with a generous amount of BioTrue solution on either side. Shake off any excess. SOAK. Put the lens in the case with the BioTrue solution and replace the lens cap. Tips Try not to apply too much pressure on both sides of the lens at once, as you ll risk warping or breaking the lens. If you drop the lens on a bench or the sink, pick it up vertically and don t scrape it along the surface. This may scratch it. Use the lens remover sucker to pick the lens up if it is face down. If you have long nails or large fingers you may need to use a cotton tip wet with BioTrue to clean the bowl of the lens. Monthly intensive clean (Protein Removal). Menicon Progent is an excellent protein removal system and is highly recommended to be used once a month. In the morning, clean your lenses as per usual but place them in the Progent case. Pour one vial of Solution A followed by one vial of Solution B into the Progent case and close the lid. Soak the lenses for 30 minutes. It is helpful to set a time as over-soaking in Progent may cause lens discolouration. After the 30 minutes has passed, clean the lenses again with your habitual rub, rinse, and soak method. 1 of 1

10 Safe Use of Contact Lenses Check your eyes Wash your hands with anti-bacterial soap Avoid moisturisers Check your lenses Rub and rinse Replace your lenses as advised Clean your case daily Replace your case monthly Use only the solutions recommended Keep your glasses up to date Don t wear your lenses if you are unwell Avoid swimming in your lenses Avoid rubbing your eyes Stick to the wearing schedule you ve been prescribed Stop Wearing Your Lenses and Contact Us Immediately If You Experience EYE PAIN SIGNIFICANTLY RED EYE SENSITIVITY TO LIGHT SUDDENLY REDUCED VISION PUS OR COPIOUS DISCHARGE FROM THE EYE.

11 Risks and Complications of Contact Lenses Microbial Keratitis Microbial keratitis (MK) is usually a bacterial or, less commonly, a fungal infection of the cornea. It is also referred to as a corneal ulcer. This is the most serious of contact lens related complications. It affects between 1 and 20 in 10,000 contact lens wearers per year of wear, depending on the type of contact lens, frequency of wear, and whether or not the patient is sleeping in their contact lenses. MK is an emergency and if left untreated, or treatment is delayed too much, it may result in permanent scarring of the cornea, permanent vision loss, and even blindness. Severe cases require hospitalisation and intensive antibiotic treatment. Some patients require a corneal transplant if there is too much scarring from MK. Rarely, the eye may need to be removed. The best ways to reduce the risk of MK are good hand, case and lens hygiene; adherence to your prescribed lens care regime and replacement schedule; and common sense. Please read the PDF document Safe Use Of Contact Lenses for a list of dos and don ts and the symptoms of MK. CLPU This is microbial keratitis little brother. CLPU stands for Contact Lens Peripheral Ulcer and is a misnomer as it is not, technically, an ulcer. It is an inflammatory response to bacteria in the eye and on the contact lens. Having a CLPU event means you re not caring for your contact lenses properly and you are running the risk of microbial keratitis in the future. Treatment requires discontinuing lens wear, antibiotic drops, and sometimes corticosteroid eye drops. CLARE CLARE, or Contact Lens-related Acute Red Eye, is another inflammatory response to improper contact lens use. It commonly occurs in patients wearing their lenses continuously, meaning both during the day and during sleep, for up to 30 days in a row. Treatment requires temporarily discontinuing lens wear and lubricating the eye frequently. GPC Giant Papillary Conjunctivitis (GPC), also known as Contact Lens-related Papillary Conjunctivitis (CLPC) is an allergic type of response to the mechanical interaction between contact lens and upper eyelid. The underside of the upper lid becomes bumpy, the eye produces mucus, and the lens may feel unclear and like it is moving a lot when blinking. It occurs in a few percent of soft lens wearers. Treatment may or may not require temporary discontinuation of lens wear, coupled with anti-allergy or corticosteroid eye drops.

12 Corneal Neovascularisation Blood vessels from the edge of the cornea may grow into the cornea due to mechanical interaction of the lens on the eye or, most commonly, if the contact lens is not allowing enough oxygen to permeate through the lens and get to the cornea. Treatment usually requires changing the type of lens worn to a highly breathable lens and/or to a softer one. Solution Toxicity Some people react to the chemicals or the preservatives in their contact lens care solutions. Identifying the product at fault and changing to another product may remedy the situation. Alternatively, Ocupure saline can be used to rinse the lens before insertion. Corneal Staining The think protective layer of the cornea can become damaged and weakened during contact lens wear. We assess this by instilling a fluorescent dye in the eye and observing where it pools on the cornea. This is called corneal staining. Safe contact lens wear should induce little or no corneal staining. Significant staining will require treatment and the actual treatment will depend on its cause. Corneal Abrasion Removing or inserting a contact lens improperly can abrade the cornea. This can be very painful and leaves the eye open to infection such as microbial keratitis. Temporary cessation of lens wear along with intensive lubrication of the eye is usually enough to resolve a superficial abrasion within a few days. Dry Eye Contact lenses can exacerbate dry eye symptoms as a lens is in essence a foreign body that disrupts the delicate tear film. Symptoms of contact lens related dry eye include sandy, gritty, burning, stinging, red, watery eyes, and intermittent blurred vision. This is usually worse towards the end of the day. Often it is best to treat the underlying reason for the dry eye, rather than simply lubricating the eye more. Treating the dry eye disease before starting contact lens wear may be necessary for successful contact lens wear. Scarring A scar in the cornea is just like that in the skin. The tissue is tougher and different in colour. The problem with corneal scars is that they are not transparent like the rest of the cornea and can cause permanent visual distortion and/or blurred vision. Scarring can be from improperly fitted hard lenses in keratoconus, chronic dryness at the edge of a hard contact lens, microbial keratitis, contact lens peripheral ulcers, among other things. The best treatment for corneal scarring is to avoid it in the first place.

13 CLIP With daytime RGP (hard) lens wear there is a possibility of developing a droopy upper eyelid. This is called Contact Lens Induced Ptosis (pronounced toe-sis). Ceasing lens wear or changing to a soft contact lens are the two options to remedy this.

14 Rub, Rinse, And Store Your Lenses In BioTrue This is a multipurpose solution for rubbing, rinsing, and storing hard and soft contact lenses. It is not as good a cleaner as the Menicare Plus and the Boston Advance but it lubricates the lenses Substitutions: Boston Advance Conditioning Solution, Menicare Plus. Before Insertion, Rinse With AMO OcuPure Saline This is only for rinsing your lenses with. It s a good idea to rinse your lenses with this saline before insertion so that there is a minimal amount of cleaning chemicals and/or preservatives on the lenses before insertion. You can even use this solution to fill the back of the lens before insertion instead of nonpreserves artificial tears. However, you should not store your lenses in this saline as it has no disinfectant or antimicrobial properties. Fill Lens Before Inserting It With Hylo-Forte These are excellent lubricant eye drops in a contamination-resistant dispensing bottle. The solution in the bottle is completely preservative free, making it perfect for filling the lens with before insertion. The shelf life is 6 months from opening. Substitutions: Threatears, OcuPure Saline

15 Once a month give your lenses an intensive clean with Menicon Progent Progent is an intensive cleaning system for all types of rigid gas permeable contact lenses. It will keep your lenses beautifully clean, remove protein build up, and extend the life of the lenses. It is highly recommended to use Progent once per month. Remove Your Lenses With Straight DMV Ultra Lens Remover This is the preferred lens remover because it s the easiest to use and has the most suction on the tip. Substitutions: DMV 45 Lens Remover (angled)