Good clinical practice in orthokeratology
Introduction
Optometry is a primary care health profession, yet it has the unique dichotomy of providing a professional service as well as supplying the required optical aids at a profit. It would therefore be prudent to open this discussion with reference to the “rights” of “patients” compared to those of “customers”. In terms of the optometrist's professional relationship with the patient, this is governed to a large degree by whether the relationship is contractual or not. With respect to orthokeratology (ortho-k), legal responsibility is usually established under tort law, whereby the practitioner's duty of care, legal obligation, or standard of care is not necessarily dictated by a formal, written agreement between both parties, but is reflected by the common law system. Any sub-standard practice may result in a civil claim for compensation arising from professional negligence. However, some practitioners may prefer to establish a contractual relationship with their patients, in terms of services and goods provided, and this in turn would be governed by contract law [1]. In this case, the patient would appear more like a customer. Nevertheless, whatever the relationship, the legal responsibilities of the optometrist are set in law and cannot be ignored, as the law protects the patient/customer in both cases.
Overnight wear ortho-k is becoming increasingly popular for myopic reduction in many parts of the world [2]. Recent studies have shown the treatment to be effective for slowing the progress of myopia [3], [4] and this is likely to increase the use of ortho-k. Modern ortho-k involves the use of RGP lenses worn on an overnight wear basis. The advantages of this modality are less lens awareness, easier adaptation, lower risk of lens loss and a faster reduction in refractive error compared to daytime wear [5]. Also, the patient benefits from the freedom of having to wear optical correction during the day which may interfere with sports and recreational activities.
The major drawback of overnight wear ortho-k is the potentially higher risk of corneal ulceration [6], [7], [8], [9], [10]. In many Asian countries, where myopia has a high prevalence, ortho-k is mainly prescribed for slowing myopic progression in children, and in most cases, overnight therapy is used. The Internet is replete with unsubstantiated claims regarding the efficacy of the procedure and this, unfortunately, is the most common source of information for patients and parents interested in the treatment for their children. This can lead to unrealistic expectations and inappropriate or misleading information which can lead to unhappy patients and/or serious complications. A patient may claim compensation if the practitioner makes unsubstantiated statements which result in harm, as this may constitute negligence, or if the practitioner is unable to provide reasonable care and skill in diagnosis, advice and treatment resulting in injury to the patient [1].
Guidelines have been established for silicone hydrogel contact lenses for continuous wear [11]. In view of the increasing popularity of overnight ortho-k, where children may be involved, there is a need to develop guidelines for this specialized treatment for the ortho-k practitioners [1]. Therefore, this paper aims to provide guidance for practitioners on the standards required for competent clinical practice in ortho-k. The authors also see the paper as a means of initiating discussion between practitioners so that a universally acceptable code of practice can be adopted internationally.
Section snippets
Clinical setup
In the early days of revived interest in ortho-k in the late 20th century, there was little or no structured education available. Practitioners had to educate themselves via trial and error, or apprenticeship with a colleague experienced in the procedure. However, ortho-k practice has since evolved rapidly with improvements in the technique, including higher Dk lens materials, advanced lens designs and corneal topography for monitoring corneal shape changes. There has also been a concomitant
Clinical pearls in ortho-k practice
Some simple clinical pearls that can act as a guide to ‘best practice’ in ortho-k are listed below.
Conclusion
Overnight ortho-k is gaining popularity and the interested practitioners need to be well prepared. Practitioners need to equip themselves well to practice ortho-k and diligent and vigilant care is essential. There is still a lot we do not understand about ortho-k, and rightly a lot of research is still going on to seek further understanding and to increase the safety of ortho-k practice. It is therefore important that practitioners keep abreast of latest developments in ortho-k and continue to
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Cited by (43)
SWOT analysis of ortho-K practice in India
2024, Contact Lens and Anterior EyeA comparison of vision-related quality of life between Defocus Incorporated Soft Contact (DISC) lenses and single-vision spectacles in Chinese children
2023, Contact Lens and Anterior EyeCitation Excerpt :Pomeda et al. surprisingly found that the rated score of handling with CLs was higher than spectacles in children, and they assumed the reason was the strong desire to use contact lenses for vision correction and enjoy the perceived convenience they provided [21]. A different study found lower handling scores with OK CLs than for spectacles; [28] a result which, while children and adolescents are reported to be competent and capable of independently managing contact lenses of all types (soft, daily disposable, rigid gas permeable and OK) [15,21,33–36], might be attributed to the strict care procedures required to maintain safety and avoid complications during wear [37]. Certainly, in the present study, enrolled participants wore DISC for 6 months without significant issues and handling scores improved by about 6.7 points per year of age, so it may not be so surprising that performance was not different between the two groups.
Orthokeratology
2023, Contact Lens Practice, Fourth EditionCompliance with orthokeratology care among parents of young children in Taiwan
2021, Contact Lens and Anterior EyeCitation Excerpt :The use of temporary glasses when necessary, follow-up visits, and removing lens protein deposition were the three behaviours with the lowest compliance rates in this study. Clinical practice in Ortho-K suggests that some patients need to wear spectacles for correcting residual refractive error during the day [22]. However, the higher levels of uncorrected refractive error and lower uncorrected visual acuity are associated with higher levels of spectacle wear [30].
Antibiotic eye drops prescription patterns by orthokeratology practitioners in China and the development of antibiotic usage guidelines
2021, Contact Lens and Anterior EyeCitation Excerpt :They may perceive excessive discharge, foreign body sensation, and other irritating symptoms, which may merely be due to allergic reaction, insufficient lens cleaning, or a scratched or warped lens, as clinical signs of infection (‘emergency’). Therefore, instead of dispensing antibiotic eye drops to patients for emergency use, ECP should review ortho-k patients regularly to check for any complications and provide patients with an emergency contact number in case a real emergency does occur. [10] Another common inappropriate use of antibiotic eye drops reported by the respondents (48.5 %) is to wet fluorescein strips during ortho-k lens fitting, not only because antibiotic eye drops are relatively accessible in hospitals and clinics in Mainland China, but also because some ECP believe that the use of topical antibiotics during invasive diagnostic procedures, like contact lens trial fitting or gonioscopy, would prevent infection.
Vision-related quality of life of Chinese children undergoing orthokeratology treatment compared to single vision spectacles
2021, Contact Lens and Anterior Eye