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Review of Myopia Management’s Editor-in-Chief John Sailer interviewed Monica Jong, BOptom, PhD, Global Director of Professional Education, Myopia, Johnson & Johnson Vision, and Glenda Aleman, OD, Director of OK Love, to learn about the ins and outs of orthokeratology. In this first part of a two-part series, Dr. Jong and Dr. Aleman discuss why OrthoK is beneficial for your practice in managing patients’ myopia, including communicating with parents, instructions for safety wear, and the importance of follow-up visits.
Below is a transcript of the interview. Click here to watch the video interview.
John Sailer: Hello, and welcome to the Review of Myopia Management video series. I am John Sailer, Editor-in-Chief of Review of Myopia Management, and we are here today with Dr. Monica Jong, Global Director of Professional Education, Myopia, at Johnson & Johnson Vision, which has recently introduced the ACUVUE Abiliti Overnight Therapeutic Lenses for Myopia Management. Also, we have Dr. Glenda Aleman, optometrist and founder of OKLove Myopia Control Experts. In this first of a two-part series, Dr. Jong and Dr. Aleman will discuss “Why OrthoK?” Why is orthokeratology appropriate for your practice to manage your patients’ myopia? We would like to thank Dr. Jong and Dr. Aleman for sharing their insights into OrthoK today, and we would also like to thank Johnson & Johnson Vision for sponsoring this video. So, Dr. Jong and Dr. Aleman, please let us know, “Why OrthoK?”
Monica Jong: Thanks, John. It’s a pleasure to be here today and interview Dr. Aleman, who is the director of OKLove in Miami, Florida. It’s a real pleasure to be here today to speak to you. Do you want to talk a little bit about yourself and your experience with OrthoK, Dr. Aleman?
Glenda Aleman: Yes. And first of all, thank you, Dr. Jong for the introduction. It’s a true honor to be here with you guys today. My background — before I went to optometry school, I was a licensed optician and a vision center manager for 15 years. I basically started in the field when I was 18 years old. This was my first job in an optical as a sales consultant. Since then, I’ve just loved the field and I just kept learning. And every time I achieved my certificate or a milestone, I loved it so much that I just wanted to keep on going. So, after being an optician, I decided that I really enjoyed the patient care aspect of this field and decided to go back to school to become an optometrist. So, I graduated from Nova Southeastern University in 2017, and I have been very fortunate that I’ve had the opportunity to practice myopia management since my first day of being an optometrist.
Dr. Jong: That’s really interesting. So, how long have you been providing OrthoK management to your patients? We know OrthoK has been around for over 20 years, and there are some FDA-approved OrthoK treatments.
Dr. Aleman: I have been providing OrthoK services since my first day of work after I graduated optometry school. My first job was in New York City in 2017, and I’ve been doing OrthoK since then.
Dr. Jong: So, can you explain to our Review of Myopia Management readers out there — what is OrthoK, and how does it work to correct vision?
Dr. Aleman: So, OrthoK is a special procedure where we use a specially designed contact lens. It’s an RGP or gas permeable material. These new materials that we are using currently are highly permeable in oxygen.1 So, we know that they’re safe for our patients, and the way that the treatment works is by allowing the hydraulic forces to push on the cornea.
Dr. Jong: So, patients end up wearing these lenses overnight, and then when they wake up, they can see really clearly without the need for any contact lenses at all in their eyes.2*
Dr. Aleman: Correct. So OrthoK is really special because the patients just need to wear the lenses while they sleep. They put them in before they go to sleep. They remove them in the morning, and after just a few nights, they can see clearly without glasses or contacts during the day.2*
Dr. Jong: Excellent. So, what made you initially decide that OrthoK is the area that you really want to focus on? What do you find most rewarding?
Dr. Aleman: Yes. So, I just found the science behind the way the OrthoK lenses correct vision fascinating. It is pure physics. So, the science was very interesting, and that was the reason why I got curious and motivated to start, but that was just the beginning. After actually practicing with OrthoK and prescribing it for my patients, just to see how amazing the treatment worked for them and to see their self-esteem improve and how happy they were to just be free of correction during the day, that’s what kept me going. That was the motivation to get more and more involved with OrthoK, and I became really passionate about it.
Dr. Jong: That’s absolutely amazing. Which patients benefit from OrthoK, how do you decide, and what is the age range of your patients?
Dr. Aleman: I really cannot think of a patient that wouldn’t benefit from OrthoK. I have children, and my kids go to Kung Fu after school. So, if my kid’s going to Kung Fu, they don’t have to wear glasses during the day. That is a benefit. So, if we have to select a group of patients that we would say these are the patients that would benefit the most, I could say that the patients that are more active, that are involved in any type of sport after school, would see the benefits of OrthoK better because they would be able to perform those activities without having to worry about losing their glasses. So, there’s really so many benefits, but patients that do not practice any sports can also benefit from OrthoK as well.
Dr. Jong: We’ve always heard from other practitioners that it is quite challenging to communicate all these benefits. And then how do you communicate this in a positive way, as well as the number of visits and the chair time, for example.
Dr. Aleman: Absolutely. So, besides communicating the good parts of OrthoK, which are all the great benefits, we do have to also be able to communicate clearly with the patient and the parents as to what to expect from the process of being treated with OrthoK. One of the important points is that they need to understand that in order for their child to be successful and have a great treatment with OrthoK, it’s imperative that they bring their children back for their follow-up. The follow-up schedule is really important to make sure that we have a successful treatment. So, before we dispense the OrthoK lenses, I do have an informed consent that goes over instructions for safe wearing of OrthoK lenses. It also includes a detailed schedule of their follow-up visits. A lot of our parents have been myopic themselves, and they have had LASIK surgery. So, that is something that they can relate to. Similar to how we present OrthoK, I tell them it’s similar to braces for the eye. So, I try to use language that patients and parents are familiar with to make it easier for them to understand the treatment.
Dr. Jong: So, Johnson & Johnson Vision recently unveiled the Healthcaring Conversations, and the first Healthcaring Conversations webinar was introduced about a month ago, and you were part of that. Can you tell us a bit about what Healthcaring Conversations is about and how it will support practitioners who want to do myopia management?
Dr. Aleman: It is very important that we understand the behavior part of our patients, because there is a component of psychology that goes along when we’re treating our patients. So we need to have that understanding, and one of the greatest things that we learned when we communicate with parents, we have found that they are more receptive to changes that are happening to the immediate reward. They are more motivated by learning that their children will be free of correction. So, for practitioners, this is a key ingredient or key factor to understand because that way that will allow the practitioner to communicate with the parents more effectively, and to get those parents motivated to start OrthoK with their child.
Dr. Jong: Now, going back to your practice itself, you offer a specialty lens practice. Has OrthoK changed the way you practice, and has it built up your practice?
Dr. Aleman: Absolutely. So, I have two clinics. In one of the clinics I do primary care, and I had such a great demand and such very good success with OrthoK that I started to get more referrals from other practitioners in the area that want to help their patients, but they might not have the setup or are not interested in doing OrthoK themselves. So, these practitioners send me the patients. So, because I started doing OrthoK in my primary practice, that gave me the opportunity to expand and to open a new business opportunity. I was able to open OKLove, which is a clinic that I have that is dedicated strictly to myopia management and specialty contact lenses. So, the difference is that at OKLove, because I do specialty contacts, that is a specialty myopia management practice, my workflow there is a lot more relaxed.
I don’t have to see 20, 30 patients a day to be profitable. I can see two, three patients a day that are doing OrthoK. And at the end, that brings me more profitability than seeing 20 patients in my primary care practice. And I think that that’s very important to understand. We’re not only doctors, but at the end, a lot of us do own our own practices, and it’s inevitable that we are all in this to also create revenues — besides our primary reason, which is to help our patients. So, this is a great, great option for practitioners that are looking to implement or bring something to their practice that is not only going to help their patient in a way that is unimaginable.
Dr. Jong: That is wonderful to see that you started your practice only in 2017, and it’s grown to this level. You are an inspiration to other practitioners, and it’s really important that practitioners are going to be able to provide this kind of myopia management service — because of the work that we did previously that reported that by 2050, 50% of the world will have myopia.3 So it’s a wonderful service you’re providing to your patients. Now, a lot of practitioners are still sitting on the fence and wondering if they should do OrthoK, because they might hear that it’s challenging. Now, what would you suggest practitioners do if they want to invest in instrumentation to get started in OrthoK?
Dr. Aleman: Yes. That is a great question. So when started I had to go myself and look for webinars online, and there were not that many. Even just within five years ago, the resources that I had when I became interested in this field were a lot more limited than they are today. Now, we have great companies like Johnson & Johnson paying attention to this topic and getting involved to try to help more patients. So, practitioners that want to implement myopia management and more specifically OrthoK right now, I would tell them that this is the best time. It’s never been better to start your practice with OrthoK because of Johnson & Johnson with their new OrthoK lens, the ACUVUE Abiliti Overnight Therapeutic Lenses for Myopia Management and their FitAbiliti software.
It really makes it very easy to implement into the practice with their FitAbiliti software taking away a lot of the questions that doctors had. When I started, we had trial sets, and that meant spending a lot more chair time going through different lenses until we found the right lens to fit the patient. So, FitAbiliti really takes a lot of the questions, a lot of the myth, out of the equation, where the physicians now can just concentrate on treating their patients and spending more time, quality time, with their patients, rather than spending two, three hours trying to choose a lens that was appropriate to dispense for that patient. I can say that because when I started, I had two or three different trial sets in my office, and it would take me anywhere from 45 minutes to even two to three hours sometimes to get the proper lens for that patient. So, empirical fitting1* has changed the way that we work with OrthoK. So, I would say don’t be afraid. Johnson & Johnson has made it really easy for practitioners to implement OrthoK into their offices.
Dr. Jong: FitAbiliti software really has changed the way everyone can get into OrthoK, I think. The really exciting thing is that all a practitioner has to do is do the full eye examination of a patient and then capture really high-quality corneal topography and then upload that into the software along with the refraction data and the horizontal vertical iris diameter, and then the software maps the cornea and orders a lens that fits perfectly the first time. So, the quote is that it’s a fitting success rate of at least 90% or more first time.1† So, it makes it really exciting because like you said, by using this technology and harnessing it, it means that practitioners then can focus their quality time on the patient, on building their practice rather than sterilizing multiple different trial lenses and keeping the trial sets in order, which itself takes a lot of time. So, it’s very exciting all this new technology that’s available.
So, if you would like to give advice to new practitioners out there who want to do OrthoK, are there any staff training or support staff or any updates to the workflow you might suggest?
Dr. Aleman: Okay. So, that is a great question. I definitely recommend new practitioners that are thinking to start doing OrthoK that they designate one staff member to become their myopia management liaison or their myopia management champion. You need to have one person that you can rely on that you trust that they’re going to take high quality topographies. They’re going to be able to capture axial length for you. And also when you need to, you have that one person that you can delegate insertion and removal, and also that person can go through the informed consent with the patient. So, by having someone, you don’t need to have the whole office staff, but one person that is your to go to makes it a lot easier for the doctor. So, that would be my advice as far as staff education. And I am very happy to say that the AAOMC has recently launched an educational program to help doctors train their staff as well.
And companies like OKLove and other companies that are doing consulting can also help with that. As far as the workflow in the office when implementing OrthoK, I started in a commercial practice, so that’s a little bit more challenging. But in every office and every modality of optometry you will find that you have dead times in your schedule. There are times where it just always historically is going to be slow. My advice to the practitioners would be to really sit down and study their schedule. Go back six months to a year and figure out what is your slowest time, and I would designate those times specifically for first time myopia management consultations and first time OrthoK fits. So that way you’re really not taking anything away from your practice, but now you’re changing the game and making those spots that were not productive, and you’re turning it into a more profitable slot in your exam schedule. Once you start practicing OrthoK, you will develop your own workflow. You will find a schedule that works best for you, and you will figure out when is the time that you prefer to bring in your patients for first-time fittings. That is just a short guide as to how to get started. I want to add that Johnson & Johnson has really done an incredible job. They have developed an educational program introducing OrthoK little by little in dinner programs.
Then, after that, doctors that become more interested in doing OrthoK can attend one of the symposiums, which is a really great workshop where Johnson & Johnson brings not just myself, but other great, great OrthoK experts — Dr. Cary Herzberg, Dr. Kevin Chan, Dr. Brianna Rhue — the team is just amazing — Susan Resnick. Everybody’s passionate, and all we want to do is help other doctors is get involved with myopia management and get started with OrthoK. So, I just wanted to say thank you to Johnson & Johnson for providing such amazing resources to doctors so that more and more of us can get involved in helping our patients.
Dr. Jong: That’s really, really excellent practical advice to build your practice. So, you mentioned a bit about the associations. So, if people do want to get started, they should consider joining the American Academy of Orthokeratology and Myopia Control because they do run conferences such as Vision By Design. They also have a whole range of boot camps. They also partner with your group OrthoKLove to deliver OrthoK education. And then we have the support offered by Johnson & Johnson across the whole myopia management education portfolio. So, we have the FitAbiliti experiential guided software for OrthoK fitting, there’s the concierge support, and we partner with also OrthoKLove, Dr. Aleman, as well as other doctors to help educate practitioners about myopia and OrthoK fitting. So, please feel free to reach out to your Johnson & Johnson clinical sales consultants for more information, and thank you Dr. Aleman for your time.
John Sailer: Okay, and thank you both, Dr. Jong and Dr. Aleman, for your insights into “Why OrthoK.” Thank you for watching, and thank you Johnson & Johnson Vision for sponsoring this video.
References
*Reducing refractive error up to 4.000 of myopia and up to 1500 of astigmatism
† Final lens fit is determined by the ECP — software is for decision support only.
1 JJV Data on File 2022. ACUVUE Abiliti Overnight Therapeutic Lenses for Myopia Management — Consolidated, Approved Claims List (United States Only Claims).
2 PMA. P990018/S006
3 Holden BA, Fricke TR, Wilson DA et al. Global Prevalence of Myopia and High Myopia and Temporal Trends from 2000 through 2050. Ophthalmology. 2016;123(5):1036-1042.
PP2022ABL4093
