sponsored content
November 15, 2024
By Kate McClure, OD, MS, FAAO & Eric Leung, OD
Dr. McClure is an employee of Johnson & Johnson. The following advice outlines personal approaches, and J&J does not necessarily advise these approaches to clinical management. This article is for educational purposes on how to fit a contact lens on the eye, and it is supplemental to but not a substitute for formal medical training. Individual results may vary.
Photo Credit: Getty Images
Myopia management is becoming increasingly critical, and the successful fitting of orthokeratology lenses can offer a transformative approach for both practitioners and patients. This article delves into the essential components of fitting OrthoK lenses, emphasizing the importance of education, communication, and patient selection. With insights from an experienced professional, it provides practical tips to enhance the fitting process, ultimately aiming to elevate the quality of life and vision for myopic patients.
Key Communication Points
During the initial prescribing conversation, it is critical to set expectations for the patient and parents. There are a few key expectations, which can often be neglected, but are necessary to communicate: OrthoK takes time to achieve the full effect and the importance of a back-up pair of lenses. Parents may have the unrealistic expectation that their child will see 20/20 after the first night of OrthoK lens wear. This may happen for some patients, depending on the prescription, but it is important to reiterate that OrthoK can take up to three weeks to achieve optimal vision.1 It is also important to set the expectation that having a back-up pair of OrthoK lenses is ideal. Accidents may happen — the child may lose or break a lens during treatment. Having a back-up pair of lenses prevents any lapse in treatment, helping maintain compliance, if these accidents occur. These two conversation tips are simply part of the larger patient and parent conversation and will help you excel in effective patient communication when fitting OrthoK.
Optimal Patient Selection
Appropriate patient selection is a key driver for success in fitting OrthoK. There are lifestyle considerations such as motivation and ability to handle contact lenses, also the child’s personal interests and activities. While considering the patient’s lifestyle, it is equally as important to determine if the patient is suitable for OrthoK based on their refractive status and corneal topographies. ACUVUE Abiliti Overnight is FDA approved for myopia management up to -6.00D and astigmatism up to 1.50D.2 The -1.00D to -4.50D prescription range is generally recommended when you are new to OrthoK, as this prescription range tends to be easier to fit.3
Photo Credit: Johnson & Johnson Vision
Other clinical considerations for good patient selection include the patient’s topography scans. The corneal toricity and refractive astigmatism should be similar, otherwise, the patient will have residual astigmatism. Although this is not a contraindication to fitting, vision may not be optimal and vision expectations should be communicated in advance. To achieve a high first fit success rate, it is recommended to obtain at least four quality topography scans per eye for the initial fitting. Johnson & Johnson has many resources available to help guide you through taking quality topography scans. ACUVUE Abiliti Overnight provides a lens to fit your patient’s unique corneal shape.4 And with good topography scans and the FitAbiliti software, you can achieve a first fit success rate of 90% for spherical prescriptions and 95% for astigmatic prescriptions.*5
*Final lens fit is determined by the ECP — software is for decision support only.
What Does Success Look Like in Clinical Practice?
To illustrate what success looks like in clinical practice, Dr. Eric Leung, was invited to provide his perspective on fitting OrthoK and ACUVUE Abiliti Overnight.
Q: Any tips you think would be beneficial to a colleague just getting started in OrthoK?
A: “If you’re not lucky enough to be in a group practice, have specialty contact lens training, or have a mentor, then build your own support system by finding like-minded colleagues in local societies, in-person continuing education, etc. Be especially picky when selecting your first few patients. Choose only what you think will be the best candidates with parameters limited to low prescriptions, typical K-values, and mild corneal toricity. This will sometimes mean that you will have to actively decide not to fit a willing patient because they may lack the maturity or ability to regularly practice proper lens hygiene. This selective process will give you a higher rate of success, which will in turn give your patients, your staff, and most of all, you the doctor, confidence and time to absorb a new skill. Let your confidence build and expand the parameters to steeper steep K’s, flatter flat K’s, and higher prescription ranges when you feel more comfortable. Recognize when you’ve reached a limit of either the lens or your skill and use the available consultation services to try to troubleshoot. Understand that despite your best efforts, sometimes you won’t achieve a satisfactory fit and you may need to transition to another modality. Be patient and determined but not foolhardy. Schedule regular frequent follow-ups as a standard of care. Early detection of complications can prevent larger problems. Success is when results exceed expectations. So clearly explain, communicate, and manage expectations. Find the balance that helps to give your patients an excellent quality of life with excellent quality vision. Most importantly, just get started, because every day you’re not managing myopia is another day your patient is getting worsening vision.”
Q: What have been the benefits of fitting ACUVUE Abiliti Overnight to you and your practice?
A: “Fitting OrthoK for the uninitiated can feel intimidating. There are many different fitting systems — doctors and staff alike can feel unprepared without proper training. With the limited exposure to OrthoK lens fitting in most optometry school curricula, new graduates understandably lack confidence to fit OrthoK without proper guidance.
“Johnson & Johnson provides a comprehensive support system to make starting to fit OrthoK easier than it has ever been. With the proper equipment (corneal topographer), initial ordering, subsequent follow-ups, and continual troubleshooting will help address issues if they arise. You can use resources to educate internal staff, and marketing materials to educate patients helps to start to fill in the knowledge gaps. The last remaining piece of the puzzle is for the doctor to start fitting and learn by doing. Consultants are available online to give detailed responses about each individual case so that you can focus on mastering the fitting process. The topography-guided system makes fitting more automated. As each patient’s eye is unique, every new case is a new learning opportunity. ACUVUE Abiliti has given me and my practice a new tool to help patients achieve improved vision while managing their myopia. Parents can rest soundly knowing that their child’s myopia is being managed. And I know that I’ve done my part to make a positive impact on my patient’s myopic journey for the rest of their lives. It’s a WIN-WIN-WIN!”
There are many considerations to successfully fitting OrthoK, and we’ve highlighted a few key tips to help elevate your OrthoK fitting success — good patient and parent communication and optimal patient selection. Dr. Eric Leung’s clinical testimony demonstrates that there is a clear path to manage myopia and help shape the future of myopia for your patients.
 |
Dr. Kate McClure completed her Doctor of Optometry degree at The Ohio State University College of Optometry. She continued her education at Ohio State earning a Master of Science degree in Vision Science while completing a two-year Advanced Practice Fellowship in Cornea and Contact Lens. Before joining J&J, Dr. McClure was a part owner of a multi-location private practice in Columbus, Ohio, where she was integral in instituting her practice’s successful myopia management clinic. Her clinical practice focused on specialty contact lenses and myopia management. Dr. McClure also served on faculty at The Ohio State University College of Optometry as an Assistant Clinical Professor. In August 2023, Dr. McClure started her role with Johnson & Johnson as the North American Professional Education Lead for the myopia team. Dr. McClure is excited to pursue her passion for helping other eye care practitioners excel in myopia management.
|
 |
Dr. Eric Leung earned his Doctor of Optometry degree from the Southern California College of Optometry at Marshall B. Ketchum University, graduating Cum Laude. He has worked at Golden Vision, a leading practice specializing in myopia control, since 2011. He is currently the Chief Myopia Control Optometrist in Southern California advancing new myopia control initiatives for Total Vision. Dr. Leung has extensive experience in various modalities of myopia management and is committed to advancing patient care within this critical specialty of optometry. |
References:
- Johnson & Johnson. Data on File 2023. Professional Fitting and Information Guide: ACUVUE Abiliti Overnight Therapeutic Lenses for Myopia Management
- Data on File 2023. Instruction For Use (FDA)
- Vincent SJ, Cho P, Chan KY, Fadel D, Ghorbani-Mojarrad N, González-Méijome JM, Johnson L, Kang P, Michaud L, Simard P, Jones L. CLEAR – Orthokeratology. Cont Lens Anterior Eye. 2021 Apr;44(2):240-269
- Data on File 2023. Menicon Design History file
- JJV Data on File 2022. ACUVUE Abiliti Overnight Therapeutic Lenses for Myopia Management – Consolidated, Approved Claims List; U.S. Only Claims
Important Safety Information: ACUVUE Abiliti Overnight Therapeutic (tisilfocon A) Contact Lenses are indicated for use in the management of myopia. They are indicated for overnight wear for the temporary reduction of myopia and should only be disinfected using a chemical disinfection system. As with any contact lens, eye problems, including corneal ulcers, can develop. Some wearers may experience mild irritation, itching or discomfort. These lenses should not be prescribed if patients have any eye infection, or experience eye discomfort, excessive tearing, vision changes, redness, other eye problems, or if patients have any allergy to any ingredient in a solution which is to be used to care for these lenses. Complete information is also available from Johnson & Johnson Vision Care, Inc. by calling 1‐877‐334‐3937, or by visiting www.seeyourabiliti.com.
2024PP17009
