INTRODUCTION
Does your kid wear glasses?
As a parent, you always want the best for your child. You know your child’s vision is important, and you want to do everything possible to help them see as clearly as possible.
However, you are not sure if glasses are the right solution, and you want to explore all your options before deciding.
This is particularly true because wearing glasses can be a hassle, and they can sometimes get in the way. Also, they can be easily broken, misplaced, or easily scratched.
Then, you heard about orthokeratology, aka OrthoK, from your friend who posted a picture of her nearsighted kid on Instagram, swimming or playing sports without glasses, and you wondered if it could help your child as well.
In this article, I will share with you my thoughts on OrthoK from the perspective of an eye doctor, myopia management specialist and orthokeratologist.
I will break down the multiple benefits of OrthoK which can help improve eyesight without glasses during the day, tapping the break on myopia progression, protect children’s eyes from further deterioration, and improving their self-image.
WHAT IS ORTHO-K?
Orthokeratology, or “ortho-k” for short, is a special type of night-time retainer lens that gently reshapes the cornea while your child sleep. This helps correct nearsightedness (also known as myopia), and astigmatism.
Like dental retainer, the OrthoK retainer lenses are worn on the eyes by the child right before bedtime, and they are removed in the morning upon awakening.
In the morning, the child’s nearsightedness, aka myopia, would be corrected allowing them to see clearly throughout the day without the need for glasses or daytime contact lenses. They can swim or play sports without worrying about glasses getting in the way or getting damaged.
Currently, there are no eye exercises for kids that can help improving their eyesight once they develop myopia, but advance myopia treatment techniques such as orthokeratology can reverse their symptoms of weak eyesight as long as they keep wearing the lenses.
What is myopia?
Myopia is the condition that causes the eyes to become longer than they should be. An eyeball that is longer than it should be is at a higher risk of developing serious eye diseases such as cataract, glaucoma, and macular degeneration. If your kid’s glasses keeping thicker and thicker year by year, myopia may be the culprit.
Benefits of OrthoK Nighttime Lenses
1. OrthoK lenses correct your kid’s myopia while they sleep.
Ortho-k is a non-surgical, non-invasive treatment that uses specially designed rigid gas permeable contact lenses to gently correct myopia throughout the night.
The best way to think about Ortho-k is like an eye retainer. This is a good analogy because ortho-k works for the eyes in a comparable way that dental retainer works for teeth.
Right before they go to bed, OrthoK kids would put the custom lenses onto their eyes and then go to bed as normal. Like a new pair of shoes, new rigid OrthoK lenses would go through a period of “breaking in” for the first few nights.
Some level of lens awareness and slight discomfort are expected when the eyes are open, but not when they are closed. Most kids have no problem falling asleep with the lenses on.
When they wake up, the child would take out the contact lenses, clean them, and store them in an approved rigid contact lenses solution. Then they go about their day seeing clearly for the first time without any glasses.
This vision correction is possible because OrthoK lenses are designed to reshape your cornea to correct most, if not all, of the prescription naturally and without surgery.
The process of gently reshaping the cornea is called corneal molding system, or Vision Shaping Treatment (VST), or cornea refractive therapy (CRT). Studies have shown that OrthoK is more effective in slowing myopia progression than single vision glasses or contact lenses.
2. OrthoK is a safe and effective treatment that has been used for years
The FDA-approved OrthoK method has been used for many years to reduce myopia in patients, but the fitting process needs the expertise of an experienced orthokeratologist doctor.
The first orthokeratology lenses were invented sometime in the seventies for daytime wear, and constant tweaking and improvements were made throughout the decades.
In June 2022, the FDA approved the first overnight orthokeratology lenses made by Paragon, Inc (now a subdivision of CooperVision). As of 2018, Paragon has distributed over 1.5 million OrthoK contact lenses in more than 50 countries worldwide.
There are many more millions of OrthoK wearers around the world, with a higher concentration of wearers in Southeast Asia due to a higher number of myopia patients there versus US.
According to the Orthokeratology Market research report published on Marketwatch.com in March 2022, the global orthokeratology market size is estimated to be approximately $1.5 billion 2022 and is forecast to grow to a readjusted size of $4.1 billion in 2028. Asian Pacific has ~70% market share and North America has a ~15% market share.
OrthoK lenses are manufactured by many manufacturers worldwide, including some of the biggest name in the contact lenses industry such as Euclid System, Paragon CRT, Johnson & Johnson (Abiliti™), and Cooper Vision Isee and Ortho-Tool. I
The above OrthoK lenses are suitable for simple, entry-level fitting of OrthoK lenses. With more complicate fits, i.e., astigmatism higher than .50D and myopia higher than -6.00D, a doctor-designed 360° platform like the Nightlens platform we use in our myopia treatment clinic.
Like other types of contact lenses, good hygiene is essential when using OrthoK lenses, as they need to be cleaned and stored properly with the correct solutions to prevent complications.
With proper care and hygiene, OrthoK is a safe and effective way to treat myopia, and it has been used successfully by many people for many years.
3. OrthoK keeps your kid’s glasses thin and light instead
of thick and heavy
So, you can see how a higher prescription will result in heavier and thicker glasses for the child. And, let’s be honest, thinner glasses are always more attractive than thicker ones.
Plus, by using overnight lenses such as Ortho-K to control their prescription numbers means the kid can wear prescription sunglasses to protect their eye health without having to worry about their vision getting worse.
Also, if they ever decide they want to try out vision corrective surgery such as LASIK or PRK later in life, they’ll be a much better candidate because their eyes will be in a healthier place.
4. OrthoK improves kids’ eyesight and academic performance
As any parent or teacher knows, children develop at different rates. Some children learn to read early, while others take longer to master this essential skill.However, research has shown that there is a correlation between early reading proficiency and future success in school and life. Therefore, it is crucial to identify and provide support for children who are struggling to keep up with their peers.Unfortunately, vision problems are often overlooked as a potential cause of the achievement gap.According to two well-known studies funded by the NIH (National Institutes of Health), one in four school-aged children has a vision problem that can impact their ability to read and learn.“The researchers gave eye exams to 9,970 children aged 6 months to 6 years. About 4% of the preschoolers had nearsightedness (myopia). Another 21% had farsightedness, also known as hyperopia.
Ten percent of the children had a flaw in the curvature of the eye‘s cornea, which caused astigmatism. Astigmatism is a problem with focusing that leads to blurred vision.”
Source: Vision Problems in Preschoolers
Researchers also found that two percent of preschoolers had cross eyes (strabismus), and 5% were diagnosed with lazy eye (amblyopia). These conditions can lead to permanent blindness if left untreated during early childhood years!
Children with amblyopia (‘lazy eye’) read more slowly (Kelly et al. 2015) and take significantly longer to complete a multiple-choice form despite being provided with the correct answers when compared to a control group (Kelly et al. 2018).
This is important to know because vision problems, if detected early, can be easily corrected with eyeglasses or orthokeratology.
However, kids do not like to wear glasses sometime. Or sometimes they break them.
5. OrthoK improves your child’s self-esteem and quality of life
Many children who wear glasses feel self-conscious about their appearance and worry that they will be seen as different from their peers.
Children who don’t wear glasses often have a more positive self-image. They are more outgoing and sociable, and they tend to perform better in school.
For some children, glasses may be a necessary part of their daily routine. However, for others, they may be a source of anxiety and insecurity.
If your child is struggling with their self-image, it may be worth considering whether glasses are really the best option.
On the flip side, a recent study has shown that orthokeratology lenses have a positive effect on children’s quality of life, behaviors, and psychology.
The children who wore Ortho-K lenses were more self-confident, more willing to try new things, and more active in participating in sports and entertainment, resulting in an increasing trend of the total time spent on outdoor activities.
This is a very important finding, as it shows that not only can orthokeratology lenses improve vision, but they can also have a lasting positive impact on a child’s psychological development.
6. OrthoK allows freedom to play sports without glasses getting in the way
There are many reasons why kids might not like to wear glasses. They can feel bulky and uncomfortable, and sometimes they break or get lost.
But perhaps the most important reason to be glasses-free is to be able to participate in sports and other activities without worrying about breaking glasses or having glasses get in the way.
You have to admit, keeping glasses on the face is tough especially when you’re sweating, or sliding, or swimming, or rock climbing, etc. Whatever sports your kid chooses to participate in, chances are glasses will get in the way.
Well, maybe except for chess, which is a great sport by the way.
With Ortho-K, they can have clear vision and do not have to wear glasses during the day. It is an easy and convenient way to correct their nearsightedness and provide better vision for children.
And it is also an excellent way to improve their vision for sports.
Another benefit is that they won’t have to worry about their glasses getting dirty or damaged while competing. Damaged glasses could become annoying and costly over the long term.
7. OrthoK reduce risks of serious eye diseases such as glaucoma and cataracts
Myopia and astigmatism are all refractive errors that can be treated with corrective eyeglasses and daytime contact lenses.
However, these options only provide visual relief and do not address the underlying cause of the condition, which is the fact that myopia gets worse over time.
Cornea molding or vision shaping system such as orthokeratology manage myopia from increasing rapidly. High myopia, defined at -5.00D or more, occurs in about 5% of the population, and places the eyes at higher risk of glaucoma, myopic macular degeneration and retinal detachment.
8. OrthoK keep vision better and sharper in the long run
Even when no eye diseases are developed, myopic eyes still suffer reduced vision quality as measured by contrast sensitivity loss. Studies had shown that patients with high myopia, typically classified as at anything more than -5.00D, showed reduced contrast sensitivity vs. patients with low myopia.
It can be argued that orthokeratology can provide and maintain better vision in the long run. This is due to the nature of OrthoK lenses keeping the level of myopia low and controlled.
HIGH MYOPIA EQUALS POORER VISION QUALITY (AKA REDUCED CONSTRAST SENSITIVITY)
Have you ever heard of 20/20 vision?
20/20 is a common term used to describe how good or capable your eyes are at achieving certain levels of vision. When you have 20/20 vision, you have normal vision. When you have 20/200 (6/60) vision while wearing glasses, you’re legally blind.
But did you know that the 20/20 vision of highly myopic patients is NOT the same as the 20/20 vision of patients with no myopia or low myopia?
Fully corrected vision of high myopia patients is softer, less distinct, or sharp, and less focused compared to others, even with the best glasses or contact lenses.
In other words, if you have two kids, one with low myopia prescriptions and one with high myopia prescriptions, (-5.00D or more), and you put glasses on them and have them next to each other to take vision tests, the one with the higher prescription number will be unable to see as sharp and as distinct as the one with low number.
This is because as their eyes grow more myopic – by stretching and growing longer – they suffer a loss of contrast sensitivity vision. Contrast sensitivity is the ability to detect subtle differences in shades and patterns. Person with contrast sensitivity loss may have more difficulties discriminating between different types or styles of similar objects such as similar patterns, shading, or texture.
Loss of contrast sensitivity might be interpreted as evidence for early retinal function disruption before retinal pathological events occur in severe myopes (Liou et al. 2001).
HIGHER MYOPIA EQUALS MORE FLOATERS, SPECS, AND SWIGGLY LINES
I know this side-effect of high myopia all too well being a -7.50D myope. Higher numbers come from larger, more stretched eyeballs.
Have you ever heard the term “myopic stretch?” Unless you’re an eye doctor or work in the field, chances are you have not. Yes, it is a real medical term describing exactly what it sounds like.
When the eyes grow longer permanently, it not only makes your vision worse (higher prescription, thicker glasses), it also triggers a cascade of physiological changes within the eyes. Among those, it causes more floaters, black specs, and squiggly lines to appear in your line of sight.
Note: if you have these floaters or specs, it is important to understand that it could be an early warning sign of retinal detachment, which is a serious eye condition that can cause blindness if not taken care of immediately. So, if you’re experiencing any floaters or specs, it is important that you get an eye exam immediately and cleared by the eye doctor.
CONCLUSIONS
OrthoK nighttime retainer lenses, aka Orthokeratology, can help ensure healthier eyes overall, reducing the risks of the eyeballs being elongated, resulting in higher risk of developing sight-threatening diseases like glaucoma, macular degeneration, and cataract.
OrthoK can also improve eyesight without glasses during the day, allowing the kid to play sport unencumbered, achieving their full potential, increase self-confidence and improving their self-image.
REFERENCES
Walline, Jeffrey J.; Jones, Lisa A.; Sinnott, Loraine; Chitkara, Monica; Coffey, Bradley∥; Jackson, John Mark; Manny, Ruth E.; Rah, Marjorie J.; Prinstein, Mitchell J. PhD. The ACHIEVE Study Group Randomized Trial of the Effect of Contact Lens Wear on Self-Perception in Children, Optometry and Vision Science: March 2009 – Volume 86 – Issue 3 – p 222-232 doi: 10.1097/OPX.0b013e3181971985
Francine C. Jellesma (2013) Do glasses change children’s perceptions? Effects of eyeglasses on peer- and self-perception, European Journal of Developmental Psychology, 10:4, 449-460, DOI: 10.1080/17405629.2012.700199
Zhao F, Zhao G, Zhao Z. Investigation of the Effect of Orthokeratology Lenses on Quality of Life and Behaviors of Children. Eye Contact Lens. 2018 Sep;44(5):335-338. doi: 10.1097/ICL.0000000000000529. PMID: 29944504.
Basch CE. Vision and the achievement gap among urban minority youth. J Sch Health. 2011 Oct;81(10):599-605. doi: 10.1111/j.1746-1561.2011.00633.x. PMID: 21923871.
Holden, B. A., Fricke T. R., Wilson D. A., Jong M., Naidoo K. S., Sankaridurg P., Wong T. Y., Naduvilath T. J. and Resnikoff S. Global Prevalence of Myopia and High Myopia and Temporal Trends from 2000 through 2050. Ophthalmology 2016; 123: 1036-1042.
Borchert MS, Varma R, Cotter SA, Tarczy-Hornoch K, McKean-Cowdin R, Lin JH, Wen G, Azen SP, Torres M, Tielsch JM, Friedman DS, Repka MX, Katz J, Ibironke J, Giordano L; Multi-Ethnic Pediatric Eye Disease Study and the Baltimore Pediatric Eye Disease Study Groups. Risk factors for hyperopia and myopia in preschool children the multi-ethnic pediatric eye disease and Baltimore pediatric eye disease studies. Ophthalmology. 2011 Oct;118(10):1966-73. doi: 10.1016/j.ophtha.2011.06.030. Epub 2011 Aug 19. PMID: 21856013; PMCID: PMC3186878.
KULP, MARJEAN TAYLOR O.D., M.S.*; SCHMIDT, PAULETTE P. O.D., M.S.† Visual Predictors of Reading Performance in Kindergarten and First Grade Children, Optometry and Vision Science: April 1996 – Volume 73 – Issue 4 – p 255-262
Kelly, K., R. Jost, A. De La Cruz, and E. Birch. 2015. “Amblyopic Children Read More Slowly Than Controls Under Natural, Binocular Reading Conditions.” Journal of American Association for Pediatric Ophthalmology and Strabismus 19 (6): 515–520. doi:10.1016/j. jaapos.2015.09.002.
Kelly, K., R. Jost, A. De La Cruz, and E. Birch. 2018. “Multiple-Choice Answer Form Completion Time in Children With Amblyopia and Strabismus.” JAMA Ophthalmology 136 (8): 938. doi:10.1001/jamaophthalmol.2018.2295.
Carlton, J., and E. Kaltenthaler. 2011. “Amblyopia and Quality of Life: A Systematic Review.” Eye 25 (4): 403–413. doi:10.1038/eye.2011.4.
Gallo, P., M. Panza, P. Lantieri, D. Risso, G. Conforti, P. Lagonia, A. Piro, G. Tagarelli, and A. Tagarelli. 2003. “Some Psychological Aspects of Colour Blindness at School: A Field Study in Calabria and Basilicata (Southern Italy).” Color Research and Application 28 (3): 216–220. doi:10.1002/col.10148.
Siofra Harrington, Peter A. Davison & Veronica O’Dwyer (2021) School performance and undetected and untreated visual problems in schoolchildren in Ireland; a population-based cross-sectional study, Irish Educational Studies, DOI: 10.1080/03323315.2021.1899024
Bullimore MA, Brennan NA. Myopia Control: Why Each Diopter Matters. Optom Vis Sci. 2019 Jun;96(6):463-465. doi: 10.1097/OPX.0000000000001367. PMID: 31116165.\
Liou SW, Chiu CJ. Myopia and contrast sensitivity function. Curr Eye Res. 2001 Feb;22(2):81-4. doi: 10.1076/ceyr.22.2.81.5530. PMID: 11402383.
https://ecp.paragonvision.com/products/crt