How Do I...
Optometrist and independent practice owner, Jonathan Cohen, on offering ortho-k to patients of all ages
As the owner of an independent practice, in order to differentiate, we focus on niche specialist areas of eye care.
One of the ways we do this is through orthokeratology (ortho-k). I have been fitting ortho-k lenses for over 10 years and currently have around 200 of these patients.
I learnt about ortho-k partly because I saw it as an avenue for business growth and partly to make my clinical practice more varied and interesting. Fortunately, my predecessor had some expertise in the subject and was on hand to offer guidance whilst I gained confidence with my first few patients.
Where to start
Ortho-k is a great practice builder for independents who are interested in fitting RGP/ specialist contact lenses.
In the first instance, I would recommend attending a training course or two. Many suppliers of ortho-k lenses such as No 7, Menicon (David Thomas) and I-Go offer courses or accreditations that are specifically designed to teach practitioners the basics and help you get started.
To begin practising you will need a slit lamp and a corneal topographer, which needn’t cost a fortune. Build confidence initially by selecting ‘easy patients,’ low myopes, with regular corneas, who tick all of the required boxes and sit well within the recommended fitting criteria.
Most laboratories offer excellent support with everything from selecting your first lens using baseline data to trouble-shooting when things don’t go to plan. Much of this can be done through shared software platforms. Attending regular educational lectures on the topic, combined with hands-on experience, helped me as I began to fit more complex ortho-k cases.
"I begin by selling them the positive aspects of ortho-k, and then slowly talk about the drawbacks"
I fit patients of all ages with ortho-k lenses. It is widely accepted that ortho-k provides excellent myopia control for children, and for adults it also offers a great lifestyle choice.
When broaching the topic with patients, I begin by telling them the benefits of ortho-k, and then slowly talk about the drawbacks. A question such as ‘Would you like to be free of contact lenses and glasses?’ is an effective opener. If they show interest and the conversation progresses, it is important to explain what is achievable and what is involved.
I give my patients a leaflet fully explaining the advantages and disadvantages of ortho-k, along with details of the treatment pathway and payment plan. Ortho-k is not for everyone and it is vital to ensure the patient has reasonable expectations to give informed consent prior to commencing treatment.
As with any specialist treatment, the patient will need to attend the practice regularly and, of course, in the beginning this can be labour intensive.
Initially I will see the patient for the fitting and collection. I will not let them take the lenses away until they are competent with handling and had training on hygiene. Then, our standard procedure would be to see them for a morning after appointment, then one week on and at the end of the first month.
You may need to see new patients more frequently, especially children. Yet, however many times support is needed, you must ensure that the door is open, and they are able to contact you and come in if they need to.
With ortho-k, as many suppliers will explain, you have to front load your time and the rewards will come later down the line as many patients will, for example, sign up to a Direct Debit scheme. Plus, for most patients, once initial niggles have been ironed out and it becomes plain sailing, you will see them less frequently. Initially this may be once every three months, then once every six months, and then you may not see them for a year as everything is going well.