February 1, 2022
By Thomas Weshefsky, OD
Instead of standard OrthoK designs, we can customize lenses to the nth degree. We truly fit the eye — we are not taking a standard fit and putting it on the eye.
As a practitioner who has been offering orthokeratology to my patients for more than 25 years, I have had countless instruments in my office to help make this process smoother. However, since I started using the OCULUS Pentacam AXL for tomography earlier this year, it has been a significant change in treating patients.
Tomography is a new enhancement that has allowed me to design some of the best fitting orthokeratology molds I have ever done. It has also allowed me to take on cases that I might have shied away from in the past, and I have gotten excellent results. As successful as I was with just using topography over the years, I would not want to go back to just relying on those measurements. The Pentacam allows me to get micron-level precision with each reading, and that data is more dependable. The camera spins around and catches the cornea from several angles, eliminating many errors that we might typically see with topography readings. This device makes it easier for my technicians to capture better, more accurate data.
Advanced Technology Produces Better Patient Outcomes
Though I had been using topography on my OrthoK fits for years, the technology and the quality of the measurements do not compare to what I can accomplish with tomography readings. A topography reading is quite accurate when treating a patient with a symmetrical, normal cornea. However, suppose the patient has an irregular tear film, an asymmetrical cornea, or the camera picks up on shadows from the eyelashes or nose. In that case, all of those factors can throw off a topography reading. It is also important to note that a topographer will only catch the central 6mm of the cornea; once you go beyond those 6mm, the machine is extrapolating data — it is just a computerized guess. Again, when you are dealing with a healthy, symmetrical eye, it will do a beautiful job. On the flip side, when a patient has a lot of asymmetry in the cornea or any level of keratoconus, that extrapolation data is far less reliable.
That is where tomography comes in. It is a newer way to measure corneal elevation, with actual data — not a proxy for the corneal surface. The reading is much more precise, producing a more accurate OrthoK design. We want to slow myopic progression, and the more accurate our measurements are, the more precise our designs will be, which improves our patients’ outcomes.
Customizing Lens Designs Helps Us Reach More Patients
In addition to tomography, utilizing the WAVE Nightlens system to design OrthoK lenses has broadened the scope of what I can offer my patients and the types of cases I can now tackle. I have been using WAVE for about 15 years, and what I used to think was impossible when fitting OrthoK has become part of my everyday reality.
Instead of standard OrthoK designs, we can customize lenses to the nth degree. I explain to patients that this computer-aided design (CAD) allows me to create a mold that’s as customized and individual to that eye as the patient’s thumbprint. We truly fit the eye — we are not taking a standard fit and putting it on the eye. For OrthoK patients, customization comes with several benefits: decentration is far less of an issue, first lens fit success is far greater, and we can be more precise and get the best fit possible.
It makes a difference when treating my patients because I can do things I never thought were possible. I used WAVE to create lenses for one of my most successful (and now happiest) patients, but it was a case I would have avoided in the past. I waited an entire year to make sure I knew what to do and what to design for her, but she went from intermittent 20/60 vision with soft toric lenses that were rotating significantly to a crisp 20/20. She is my all-time happiest OrthoK patient, and I would never have thought it was possible to put her in lenses such as this before WAVE.
Once you start fitting advanced cases, you develop a reputation in the community. It has been my experience that many practitioners are happy to refer patients that may be more complicated than just a traditional contact lens patient. When it comes to GP lenses, you need to fit the patient and design the lens properly. I get so many referrals from my colleagues, and it also helps to be able to market these services on my website. It opens the door for many struggling patients who have bounced between eye doctors for years. Customizing a design specifically for a patient benefits your practice and the patient’s long-term eye health.
WAVE Can Be Simple and Valuable for All ECPs
One of the best parts of using the WAVE software is that it can be straightforward or complex, depending on the practitioner. Once you capture a patient’s topography or tomography reading, you plug in the patient’s spectacle Rx, and the software will instantly design a standard corneal GP lens. You can stop there, and the fit will be effective for the patient. However, there are also opportunities to continue customizing the lens; you can choose between a scleral, corneal scleral, or an OrthoK mold. Then, the software will design that type of lens for you given the patient’s information.
When working with highly asymmetrical corneas, there are several design choices — a spherical lens, a geometrically symmetrical lens, or a freeform design, which allows you to contour the cornea. For these patients, you can design a highly symmetrical lens on the posterior surface and correct the optics on the anterior surface. From there, you can adjust everything to suit the patients’ needs — the diameter, the edge design, the reverse edge curve.
There is a learning curve to WAVE if you want to get into the weeds and learn all the intricacies of the different customizations, but the software also has its own version of the easy button. The typical design process can be done in as few as three clicks once you input the patient’s data. This process will also work for patients who need to be corrected for astigmatism or need other accommodations. It all depends on how involved the practitioner wants to be in the lens design and what adjustments they want to make for their patients.
The process does not have to be difficult for practitioners. WAVE also recently introduced a concierge lens design service, which allows ECPs to submit their Pentacam data into WAVE, and the software will create custom lenses for them. It does not have to be time consuming or difficult; once you grasp the concept and see the limitless choices, it starts to sink in, and you realize you can do anything.
Improving Conversations with Parents
The technology from the OCULUS Pentacam AXL and the WAVE Nightlens software has genuinely been game-changing for my practice. Still, it also helps me when it comes time to discuss different myopia management options with parents. When trying to explain myopia control and how OrthoK works, most parents have never seen anything like this. Having the technology in the office makes a dramatic difference when having these kinds of conversations. It changes patient perceptions when measuring the axial length and explaining its importance.
The Pentacam has made all of that possible in my practice. I do not know that I realized just how beneficial it was until I had one in the office. I thought it would be nice to have, but it was unnecessary to run my practice. Now, after having it, I could not be without it. We use it for more than just fitting lenses, and it has significantly changed the way I treat my patients and what I can offer them.
|Dr. Thomas J. Weshefsky graduated from the Pennsylvania College of Optometry in 1987. In 1997, he was among a handful of optometrists from New Jersey who studied with Dr. Jim Day, the developer of one of the early orthokeratology lens designs. In 2009, he completed his credentialing and earned his Fellowship in the International Academy of Orthokeratology and Myopia Control, one of fewer than 50 doctors in the world to have earned this distinction. Dr. Weshefsky began his private practice in New Jersey in 1987 and practiced there until relocating to Myrtle Beach, S.C., where he opened Carolina Forest Family Eyecare in 2006.|