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March 2, 2026
By Dr. Gabriela Olivares
Photo generated by Gemini
Myopia continues to rise at an alarming rate worldwide, with projections estimating that nearly 50% of the global population will be myopic by 2050.¹ This growing prevalence has increased the demand for effective, evidence-based, and non-surgical myopia management solutions.
Orthokeratology (OrthoK) has been well established as an effective modality for both temporary refractive correction and myopia control, yet many practices hesitate to integrate OrthoK due to perceived complexity, chair time demands and workflow disruption.
Topography-based orthokeratology addresses these concerns by transforming OrthoK into a predictable, efficient and scalable service. By leveraging corneal topography and data-driven lens design, clinicians can streamline chair time, improve first-fit success and enhance patient outcomes. When integrated with a well-trained team and standardized workflow, topography-driven OrthoK becomes not only feasible in a busy practice, but a valuable clinical and business asset.
Why Topography-Based Fitting Works in a Busy Practice
Precision From the Start
Corneal topography provides detailed, objective data regarding corneal curvature, shape and symmetry. This information is essential for modern OrthoK fitting, as reverse-geometry lenses rely on precise alignment with the corneal surface to achieve optimal treatment zone centration and refractive outcomes.2
By beginning with an accurate understanding of corneal anatomy, clinicians can achieve faster success and greater predictability from the initial dispense. Topography-based fitting allows practitioners to select initial lens parameters using full-surface corneal data rather than the traditional keratometry-based method. Studies have demonstrated that data-driven lens selection significantly improves first-fit success and reduces the need for lens remakes.3
Reduced Chair Time
Chair time is a critical consideration in busy clinical settings. Topography-based OrthoK can reduce chair time by enabling optimized first fits and minimizing follow-up visits. Clear, repeatable corneal maps allow clinicians to quickly assess treatment effectiveness and identify issues such as lens decentration, inadequate treatment zones, or poor compliance.
Higher first-fit success rates translate into fewer adjustments, fewer unplanned visits and more efficient follow-up schedules. This efficiency benefits not only the doctor but also staff and patients, allowing practices to expand myopia management services without extending clinic hours.
Predictable Outcomes
Predictability is a key factor in long-term success with OrthoK. Objective corneal maps provide visual assessment of treatment progress, making troubleshooting faster and more precise. When treatment outcomes are predictable, patient satisfaction improves and clinician confidence increases.
Research has shown that OrthoK can slow axial elongation in children by approximately 32–55%, depending on patient compliance.4 Predictable outcomes, supported by objective topography data, reinforce parental confidence and strengthen long-term treatment adherence.
Workflow Integration: A Step-by-Step Approach
Pre-Work and Team Training
Successful implementation begins with staff education. Technicians should be trained to consistently capture high-quality and repeatable topography maps, by ensuring proper fixation and blinks in the patient. Establishing a standardized protocol for topography as part of comprehensive exams ensures reliable data collection without disrupting patient flow.
Integrating topography into routine exams allows practices to identify potential OrthoK candidates early, creating organic opportunities for education and discussion without adding additional appointments.
A Streamlined Patient Journey
Screening
Potential candidates are identified during routine exams based on factors such as age, refractive error, myopia progression and lifestyle.
Education
While capturing topography, trained staff explain OrthoK benefits, expectations and the role of corneal reshaping in myopia control. Using visual maps enhances understanding and engagement.
Topography-Driven Design
Software-based platforms (such as FitAbiliti or comparable systems) allow clinicians to design lenses quickly using corneal data, eliminating guesswork and reducing chair time.
Dispense Visit
Due to optimized initial lens design, dispensing visits require minimal chair time. Care instructions and lens application and removal training can be delegated to trained technicians.
Follow-Up Protocol
Standardized follow-ups (typically at day one, one week and one month) use corneal topography to track treatment response and ensure stability.
Delegation and Efficiency
Delegation is essential to maintaining efficiency. Technicians can perform topography acquisition, patient education, insertion and removal training and data gathering. The doctor’s role is focused on interpretation, clinical decision-making and treatment modification when necessary.
This team-based approach improves productivity, enhances staff engagement and allows doctors to manage OrthoK efficiently alongside a full clinical schedule.
Clinical and Business Benefits
Enhanced Clinical Confidence
Objective corneal data simplifies troubleshooting and reduces uncertainty. Topography-guided designs have helped me achieve fewer complications, improved centration, and higher patient satisfaction.5
Practice Growth and Differentiation
Offering orthokeratology positions a practice as a leader in myopia management and specialty contact lenses. As awareness of myopia control continues to grow, families are increasingly proactive in seeking providers who offer advanced, evidence-based solutions rather than traditional spectacle correction alone.
In my own practice, I have experienced a growing number of families who seek out our office specifically because they have heard that we provide orthokeratology. These patients often present as new patients whose initial motivation is myopia management; however, once in the practice, they are exposed to the full scope of our technology-driven, patient-centered care model. This frequently opens the door to additional comprehensive eye examinations for siblings and parents, as well as long-term relationships with families who value advanced clinical care.
Orthokeratology not only differentiates the practice clinically but also serves as an entry point for new patient acquisition. When families see the level of technology, education and customization involved in OrthoK, it reinforces the perception that the practice offers the highest standard of care. This differentiation can strengthen patient trust, increase retention and position the practice as a destination for myopia management rather than a transactional vision care provider.
Revenue Impact and Long-Term Loyalty
OrthoK is a premium service with strong return on investment in my experience. Topography-based efficiency has increased patient capacity without extending our clinic hours. Additionally, pediatric myopia management fosters long-term patient loyalty, often extending into adolescence and adulthood. Satisfied families generate referrals, further supporting practice growth.
Real-World Tips From a Busy Practice
- Capture multiple topography images for each eye and select the most consistent, high-quality map for analysis.
- When ocular surface dryness is present, instilling a non-preserved artificial tear prior to image capture can significantly improve tear film quality and enhance topography accuracy.
- Eyelashes may occasionally obstruct the measurement area and create shadow artifacts on topography maps. Using a cotton-tipped applicator to gently lift lashes out of the optical path can help achieve clearer, more reliable images.
- Obtaining high-quality topography images in pediatric patients can be challenging. Rather than training all staff, designate one or two technicians who consistently achieve reliable results and allow them to become specialists in pediatric topography capture.
- Aim for corneal coverage of 80% or greater to ensure accurate data for orthokeratology lens design and follow-up assessment.
- Pre-assign follow-up appointment slots to maintain clinical flow and reduce scheduling disruptions.
- Use standardized scripts for staff-led education to minimize doctor chair time while maintaining consistent messaging.
- Track treatment progress using serial topography maps to visually demonstrate success and reinforce value to parents and caregivers.
Conclusion
Topography-based orthokeratology is often perceived as complex or intimidating, particularly for clinicians who did not receive extensive contact lens or specialty lens training during optometry school. This hesitation is understandable. I am not residency-trained in contact lenses, and like many practitioners, I felt that my exposure to orthokeratology during optometric education was limited. Initially, OrthoK felt overwhelming and outside my comfort zone.
However, with encouragement, guidance, and support from industry partners, along with hands-on experience and repetition, orthokeratology became not only manageable but intuitive.
Topography-based systems simplify the process, removing much of the guesswork and allowing clinicians to rely on objective data rather than trial-and-error. With consistent use, the learning curve shortens quickly, and confidence grows.
What once seemed intimidating is now a streamlined, efficient and highly rewarding part of daily clinical practice. Topography-based OrthoK is easy to integrate, easy to monitor and easy to scale within a busy practice. I strongly encourage clinicians who may be hesitant to take the first step. With the right tools, workflow and support, orthokeratology is not only achievable—it is one of the most impactful services we can offer our patients and their families.
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Dr. Olivares brings to The Eye Center extensive knowledge and passion for the diagnosis and treatment of ocular disease, as well as myopia management and control. Dr. Olivares was born and raised in South Florida. She earned her degree in Optometry at Nova Southeastern University, while on the Chancellor’s Scholarship, and graduated in the top ten percent of her class. Her undergraduate schooling was completed at the University of Central Florida, where she received a bachelor’s degree in Molecular Biology and Microbiology. |
References
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- Holden BA, et al. Global prevalence of myopia and high myopia and temporal trends from 2000 through 2050. Ophthalmology. 2016;123(5):1036–1042.
- Mountford J, Ruston D, Dave T. Orthokeratology: Principles and Practice. Butterworth-Heinemann; 2004.
- Caroline PJ, André MP. Contemporary Orthokeratology. Contact Lens Spectrum. 2012.
- Cho P, Cheung SW. Retardation of myopia in Orthokeratology (ROMIO) study: a 2-year randomized clinical trial. Investigative Ophthalmology & Visual Science. 2012;53(11):7077–7085.
- Santodomingo-Rubido J, et al. Long-term efficacy of orthokeratology in myopia control. Contact Lens & Anterior Eye. 2017;40(4):259–267.
Read more about orthokeratology contact lenses here
2026PP04813
