Contact Lens Business
Orthokeratology: Here to Stay?
Contact lens manufacturers are now putting their money on this procedure as an alternative to refractive surgery.
BY WARREN MCDONALD, PH.D.

Recently, several RGP contact lens manufacturers have been revisiting an old idea that ophthalmologists have often scoffed at: orthokeratology.

As you know, this procedure (Paragon Vision Sciences now calls it Corneal Refraction Therapy) involves a patient wearing specially designed contact lenses while sleeping at night. The lenses gently redistribute epithelial cells, and the patient wakes up able to see without correction.

The effect isn't permanent, but in most instances it lasts all day. In some cases, the effect lasts several days. (At this writing, no nighttime-wear lens for this purpose has been approved by the FDA, but this is expected to change in the near future.)

A NEW ERA

Orthokeratology's poor reputation among M.D.s is understandable: Until recently this procedure was largely unproven and showed a wide range of results. However, the corneal reshaping lenses now being designed appear to be more safe and effective than those that were available in the past.

More to the point, regardless of how you feel about it, this method of treating refractive error isn't going to go away. It's now receiving attention (and funding) from some significant manufacturers. In fact, it could end up holding significant value for your practice as an alternative to refractive surgery.

I used to have a less than favorable attitude toward these lens designs, but I've now seen enough evidence to convince me that they work. As a result, I recently began working as a consultant for Paragon Vision Sciences.

I believe this procedure has value, and I won't be surprised if many ophthalmologists eventually come to the same conclusion.

WHY SHOULD YOU CARE?

My intention is not to debate the evidence about orthokeratology, but to ask an important question: Why should an ophthalmologist able to perform refractive surgery be the least bit interested in using a lens to reshape the cornea? After all, we can permanently reshape the cornea by ablating tissue.

Here are a few reasons you might find this procedure worth looking into:

Lots of patients turn down LASIK. Many surgeons have reported that only 20% of the patients who walk into a refractive surgery center actually have the procedure done. That number varies, I'm sure, but it's clear that many interested patients don't follow through with the procedure. If you own a center, wouldn't it be good to offer those patients a nonsurgical alternative?

The procedure is reversible. Research has shown that these lens designs don't cause permanent corneal disturbances. If patients aren't happy, or if they become presbyopic, they can simply stop using the lenses, and their eyes will return to their normal shape in a relatively short time. If something goes wrong with a surgical procedure, you can't glue that tissue back on.

It's an opportunity for nonrefractive surgeons to offer a refractive service. Approximately 20% of the M.D.s in this country perform the vast majority of the refractive surgery. If you're one of the doctors who chooses not to offer refractive surgery, corneal reshaping would allow you to offer some help to patients who don't want to wear glasses or contact lenses full-time.

Profitability. If you do only one of these procedures a week, your practice can realize a sizeable profit.

LIKE IT OR NOT, HERE IT COMES

Whether or not you're a skeptic, corneal reshaping may soon impact your practice. I'm not saying that this procedure is for everyone, but I believe that it represents a useful alternative to refractive surgery and a potential practice resource in difficult economic times.

Take a look at the new designs. I think you'll be as impressed with their potential as I am.

Dr. McDonald is director of contact lens services at the Jacksonville Eye Clinic in Jacksonville, N.C. He also serves as an adjunct professor at Webster University.