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Daniel Press, OD, FCOVD, Discusses Orthokeratology at THE Myopia Meeting

June 15, 2023

Daniel PressROSEMONT, Ill. – At THE Myopia Meeting held here May 21, 2023, Daniel J. Press, OD, FCOVD, of Park Ridge Vision in Park Ridge, Ill., presented on behalf of Johnson & Johnson Vision, discussing orthokeratology in general and the ACUVUE ABILITI Overnight lens specifically. He shared his inside knowledge of using topography-based fitting to create a truly customized lens based on the patient’s corneal profile:

“I’m here with Johnson & Johnson Vision to talk about the ACUVUE ABILITI Overnight lens. Here is what Johnson & Johnson commits to:

  • Continue to lead with science by generating new research and evidence.
  • Demonstrate through leadership to shape the future of myopia and change the trajectory of this chronic, progressive disease.
  • Empower and activate ECPs through partnership, education, and advocacy.

“It’s nice to see that they’ve made this commitment within the myopia space. I decided to partner with Johnson & Johnson because I want to make sure they stay in this space. They are a global leader in health care, and what’s nice is that we have a direct conduit to many medical professionals, including pediatricians. 

Topography Fitting a Four-Curve OrthoK Design
“I got interested in OrthoK back in 2006, entering my fourth year of optometry school. I’ve been fitting OrthoK lenses since then. There are a lot of great lenses out there, and they all work really well. So, did I need the ACUVUE ABILITI Overnight lens in order to keep successfully fitting OrthoK lenses? The answer is, ‘No.’ But I’m always interested in new technology. I love the concept of topography-based fitting because we are truly customizing a lens based on that patient’s corneal profile. 

“The ACUVUE ABILITI Overnight lens is a four-curve traditional design. You’ve got your base curve, reverse curve, tangent, and the edge lift. These are the parameters within the ACUVUE ABILITI Overnight lens itself:

Diameter: 10.20mm, 10.60mm, 11.00mm

Center Thickness: 0.24mm

Base Curve: 7.20mm to 9.50mm (0.05mm steps)

Tangential Angle: Sphere — 50ᴼ to 65ᴼ (1ᴼ steps); Astigmatism — 46ᴼ to 63ᴼ (1ᴼ steps)

Sagittal Depth: 1.00mm to 1.80mm (0.01mm steps)

Vertex Power: 0.00D to +2.00D (0.25D steps)

Fenestration: three holes

Diameter of Hole: 0.25mm

“It has three different diameters. The real differentiator is the fenestration. There are three fenestration holes on the surface of the lens that allow for tear exchange while the lens is on the eye. It is FDA approved for up to -6.00D myopia with 1.50D of astigmatism. 

“The lens itself is manufactured in Menicon Z, which offers the highest DK at 182, and we know that Menicon Z is FDA approved for 30 days of continuous wear. So, if you’re new to OrthoK and you’re a little hesitant about hypoxia with overnight lens wear, I would not worry about it. Between the high DK and tear exchange with the fenestration this is as safe of a design as you can get in the OrthoK space.”

Fitabiliti Software ‘Holds Your Hand Through the Process”
“What sets ABILITI apart is the Fitabiliti lens software. If you’re new to OrthoK, this is a great platform to use. When I have associates who are just getting into this, this is where I’ll have them start because it holds your hand through the process. With good topography scans, and you can expect a 90% first fit success rate when you have a spherical prescription. 

“What about those astigmatic prescriptions? I was surprised to see from ABILITI that it’s even higher. It’s 95% first fit success in patients with an astigmatic prescription. It almost doesn’t make sense. We think those patients will be more challenging, but when you stay within the guidelines and fit within the 1.50D of cyl, the software will design a toric periphery. How many patients do we see who have a true spherical cornea? I don’t think I’ve ever seen a patient who has a purely spherical cornea. So, when you pass that threshold where it’s going to create that toric periphery, it provides a better outcome. That’s why we have an even higher first fit success rate with astigmatic patients. So, if you’re new, this is going to literally show you best practices all the way through fitting an OrthoK lens from start to finish.

“Put in your refractions, a little bit of history, your slit lamp findings, HVID, upload your topographies, and then it’s going to suggest a starting lens. There’s a nice fluorescein simulation pattern of what to expect when you put the lens on the eye. Again, for new practitioners, this is where I would start. 

Quick Fitting for More Experienced Fitters
“Before the latest software update, everybody using the lens had to go through this process, but within the last few weeks, J&J Vision released a quick fitting mode intended for more experienced fitters. You can skip a lot of these history steps, just put in your data, and it will suggest a lens design. 

“The software guides you through the different visits — the initial examination, lens collection, and then it recommends the first night and one week for your initial monitoring. You probably aren’t going to make many changes unless there’s a serious issue with corneal health or outcomes before about three weeks, which is when you should perform an efficacy assessment. Beyond that visit, in our practice we see the patient for assessments at three, six, nine, and 12 months. 

“If you’re new to orthokeratology it is best to select good candidates to start, don’t select a high myope. Select a child who is a minus three or less. For the Ks, stick between 42 and 45 flat K as a guideline of where to get started. Select the patient who has one or less diopters of stigmatism. HVID is critical. The lens diameter is probably going to be the biggest determination of success.

“You’ll be surprised how many of these kids have corneas that are closer to 12mm. An 11mm lens gives you around 92% corneal coverage on a 12mm-diameter cornea. You need to know that before you get started. Capturing quality topography scans is critical to practice OrthoK, especially with any topography-based designs. 

Consultants and Technology Make You ‘An Expert Over Time’
“Partnering with Johnson & Johnson over the last few months has helped my practice because their amazing local OD consultant comes to the practice. They have taken my staff’s ability to capture a quality topography to the next level. This obviously helps with fitting the ACUVUE ABILITI Overnight lens, but it helps with fitting any contact lens, whether it’s OrthoK or not.

“If you are relatively new to fitting OrthoK lenses, don’t be worried if you don’t consider yourself a contact lens expert. I am not a contact lens expert, but if you’re heavily involved with pediatrics, you cannot ignore myopia progression anymore and the dangers associated with it. So, don’t be worried if you don’t have a command of specialty contact lenses. Between the different consultants and the technology that’s out there, you really don’t need it. You learn a lot as you go through the process, and you’ll consider yourself an expert over time. But don’t be afraid to jump in. 

“To get started with ACUVUE ABILITI Overnight lenses, the Fitabiliti platform takes about an hour to complete the certification process. If you haven’t started yet, Johnson & Johnson can help integrate it into your practice. They’ll empower you to treat more patients. The concierge support we’ve received for the ACUVUE ABILITI Overnight lens is second to none.

“This is just the beginning of Johnson & Johnson’s growing portfolio of solutions. We can look forward to more resources that they’re going to allocate toward the myopia management space. Within those resources, there will be campaigns for public awareness and to help you within your practice and your community.”

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