Getting parents onboard with orthokeratology

Orthokeratology (OK) has been shown to be one of the most effective forms of myopia control. As proactive commencement of myopia management often involves younger children, suggesting contact lenses can be surprising to parents, especially if they have no vision correction themselves. Common questions can be "is OK safe for children? Is my child too young for contact lenses?" How do you address these questions to get parents onboard with orthokeratology?

Here, CK has shared such a case whereby the patient's mother understands and concurs with the suggestion of orthokeratology, but the father remains skeptical.

Firstly, it is good to highlight the benefits of orthokeratology (OK) lens wear. OK lenses are one of the most effective interventions to slow myopia progression and axial elongation.¹ Another plus point is that they are good for children who are active in contact and water sports as they will not require optical aids during waking hours to see clearly. Children wearing OK lenses rate their overall vision, distance vision, appearance, academic performance, ability to participate in activities, peer perceptions and overall satisfaction as significantly better than children wearing spectacles, with only handling rated as more difficult, and near vision, daytime symptoms and academic performance rated as similar^.2

Secondly, communicate the safety profile of OK lens wear - though there is a risk of infection, that risk becomes very low with good contact lens hygiene protocol.³ It has been shown that that the rate of soft contact lens complications is lower in children compared to teens and adults. When it comes to OK specifically, one case study analysis has shown that children and teens have a slightly higher risk of infection than adults when both are wearing OK, but overall this risk is around 1 per 1,000 patient wearing years, which is similar to the risk of wearing a reusable silicone hydrogel contact lens. Read more about this in Contact Lens Safety in Kids.

Thirdly, communicate that children are very capable at handling contact lenses, as indicated in many OK lens studies. Research has shown that children only take an extra 10-15 minutes to learn how to handle contact lenses, and then follow up appointments in the fitting process take no longer than for teens or adults.⁴

Read more about explaining the general benefits and safety of contact lenses for kids in Keys to Communication in Myopia Management.

It would be most productive to investigate the specific reasons for a parent’s reservations and address them one by one. Face to face parent discussions can help them understand orthokeratology better and improve the intention to fit OK lenses.⁵ Participatory discussion with parents can also improve compliance.⁶

Some parents may request scientific evidence or additional sources to support your recommendations. To grow your own myopia management knowledge and confidence, the links mentioned above on Contact Lens Safety in Kids and Keys to Communication in Myopia Management are important for this scenario - the latter which takes you through the Managing Myopia Guidelines Infographics which are a pictorial, easy to communicate guide to in-room clinical communication. It also provides a chairside reference for ongoing management.

Further reading for parents is available on the My Kids Vision public awareness website, which includes a myopia blog with explanations of orthokeratology and other contact lens options; and the How-To Video Guides which offer short, shareable videos on the Benefits of contact lenses for kids and even how to apply, remove and clean orthokeratology lenses. These resources can be viewed together in the consultation room, and/or emailed to parents afterwards for further reading and support of your discussion.

This child is -3.00D at age 12, so is likely still progressing.⁷ Since only half of myopes stop progressing by 15 years of age,⁸ and her mother is a high myope,⁹ she is at risk of progression into high myopia herself. Being high myope increases lifelong risk of ocular diseases tremendously.¹⁰ Explaining the reality of these risks may help a parent understand why attempts at prevention are better than cure.

A parent, though, may not understand what they're looking at when viewing an image of a compromised retina. In this case, the increased risks can be explained numerically. The Managing Myopia Guidelines Infographics provide a panel which shows how the lifelong risk of cataract, retinal detachment and myopic maculopathy increases with increasing levels of myopia. Read more about how to explain this to parents appropriately, avoiding too much alarmism, in Keys to Communication in Myopia Management.

When attempting to get a parent onboard with orthokeratology, or indeed any contact lens option you have suggested, the approach includes:

1. Understand the parent’s specific concerns and address them directly.
2. Back up your recommendations with the latest evidence. Use external sources of information to support and validate your clinical communication.
3. Visual guides can help support you in explaining the benefits of contact lenses as well as the lifelong risks of higher myopia.

• Is orthokeratology useful for myopia control in low myopia?

• Clinical case: Fitting orthokeratology successfully for a patient with astigmatism

• Clinical case: Which is best? Myopia management for an astigmatic myope

If you'd like to get started fitting orthokeratology yourself, check out our Myopia Profile Academy online course Orthokeratology Fundamentals, which is structured to step you through your first handful of fits with safety and success.