"OrthoK: Initial Fitting Challenges and

Michael J. Lipson, OD, FAAO

This newsletter will feature highlights from a very informative and contemporary webinar from GPLI Advisory Board member, Dr. Michael Lipson, entitled: “OrthoK: Initial Fitting Challenges and Problem-Solving”. It was presented Tuesday evening, March 16th, attended by almost 200 eye care professionals, and is now available online under the “Webinars” tab at We will also feature our webinar-based resources. Finally, GPLI Advisory Board member, Dr. Alan Glazier, who introduced – among other innovations – the very popular “ODs on FaceBook”, has recently introduced the first-ever optometry television show, entitled: “FluoreSCENE”. He highlighted the GPLI in a recent segment which will be discussed in the newsletter.  

Education Spotlight:

“OrthoK: Initial Fitting Challenges and Problem-Solving”

Dr. Lipson highlighted the following areas:

1)   Why Prescribe OrthoK?
=====a.    Patients love great unaided vision
=====b.    Slow axial elongation in myopic kids
=====c.     Grow your practice (new service and GREAT referral ==========source)

2)   What we know about OrthoK
=====a.    It corrects myopia and provides good unaided visual ==========acuity
=====b.    It is reversible and temporary
=====c.     Patients report better Vision-Related Quality of Life
=====d.    It is an attractive alternative to glasses or daytime CL’s
=====e.    It slows myopia progression
=====f.      It is safe

3)   What we don’t know about OrthoK
=====a.    How long good unaided vision remains after lens ==========removal
=====b.    Why patients have a variable response
                                                             i.     Individual differences
                                                           ii.     Eccentricity
                                                         iii.     Corneal rigidity
                                                        iv.     Corneal thickness
                                                          v.     Eyelids
                                                        vi.     Tear quality
                                                      vii.     Efficacy of slowing axial elongation

4)   Candidacy for OrthoK
=====a.    Progressing myopes
=====b.    Motivated not to wear glasses
=====c.     Expressed interest in myopia management

5)   Be careful about . . .
=====a.    Parent motivated; child is not
=====b.    Questionable compliance (wear, lens care, follow-up)
=====c.     High refractive astigmatism (> 1.75D)
=====d.    Vertical/Horizontal elevation differences (> 35 microns)
=====e.    High Myopia (> -4.50D)
=====f.      Tight eyelids
=====g.    Small aperture

6)   Importance of corneal diameter
=====a.    Critical for optimal fit, centration & fluid forces
=====b.    Should be 92 – 95% of HVID; average HVID = 11.8; ==========OAD often between 10.8 – 11.4mm

7)   Modes of Fitting OrthoK
=====a.    Empirical
=====b.    Diagnostic lenses
=====c.     Topography-based software: good method because it is ==========difficult to truly determine the tear layer with ==========fluorescein if there is less than 20 microns of ==========clearance whereas topography is vital and allows you ==========to evaluate a number of important fitting factors ==========including corneal change.
=====d.    One-night wear of diagnostic lens

8)   Case Presentations
=====a.    A series of three different case presentations, all young ==========people with different refractive data (among other ==========factors) were presented.
=====b.    The decision-making process in managing these patients ==========is presented and discussed

9)   Problem-Solving: Included but not limited to the following:
=====a.    Centration (very important)
                                                             i.     Can be improved:
===============1.    Optimize lens diameters (larger is usually ====================better)
===============2.    Use toric reverse or alignment curves
===============3.    Increase overall sag
=====b.    Difference Maps
                                                             i.     Very important to obtain high quality difference ===============maps
                                                           ii.     The map should illustrate:
===============1.    Well centered central flattening
===============2.    Uniform/smooth area of central flattening
===============3.    4 – 5mm diameter of central flattening
===============4.    Uniform ring of paracentral steepening
=====c.     Corneal Staining
                                                             i.     Common at 1 – 2 days of wear; should be gone ===============within 1 week
                                                           ii.     It could also be non-fit related (i.e., application ===============technique, removal technique, dryness)
                                                         iii.     If fit-related, likely mechanical and sag can be ===============slightly increased (i.e., steepen fit)
=====d.    Safety/Complications
                                                             i.     Serious complications are rare but compliance ===============with lens wear and care is important
=====e.    Over/Under-correction
                                                             i.     If present recheck initial calculations
                                                           ii.     You can change base curve radius without ===============affecting fit
                                                         iii.     Slight over-correction (up to +1.25D upon ===============removal) is typically acceptable with kids
=====f.      Decreased VA at End of Day
                                                             i.     Refit with a higher myopia target
                                                           ii.     Prescribe longer wearing time
                                                         iii.     Prescribe small spectacle correction (i.e., -0.50 ===============to -1.00D)
=====g.    Dryness
                                                             i.     Lubrication is important
===============1.    Pre-application
===============2.    Just before sleeping
===============3.    Pre-removal
===============4.    During the day (without lens wear)
=====h.    Night Glare
                                                             i.     Typical in the first 1 – 2 weeks but not a ===============common long-term problem with kids
                                                           ii.     Ensure good centration
                                                         iii.     May need to increase the optical zone
                                                        iv.     Can also prescribe Brimonidine

10)       Bottom Line
=====a.    Problem-Solving varies with fitting technique
=====b.    Know your topographer
=====c.     Know your lens design
=====d.    Know your laboratory consultants and use them



2021 GPLI Monthly Webinar Series

April 20, 2021

Scleral Lens
Practice Management

Presented by
Edward Boshnick OD, FAAO
8:00 PM Central

Student Webinar April 27, 2021

Topography-guided Troubleshooting for Orthokeratology

Anita Gulmiri, OD, FAAO


May 18: Karen G. Carrasquillo OD, PhD, FAAO, FSLS, FBCLA: 
Management of the Scleral Lens Ocular Surface Disease Patient Beyond the Fit

June 15: Heidi Miller OD, FAAO, FSLS:
Pediatric Specialty Contact Lens Applications

July 20: Jeff Walline OD, PhD, FAAO: 
Myopia Management Update

July 27: STUDENT WEBINAR: Dawn Lam, MS, OD, FAAO and Erin Rueff, OD, PhD, FAAO
Troubleshooting Corneal GP Lenses

August 17: Stephanie L. Woo OD, FAAO, FSLS:
Contact Lens Management of Keratoconus

September 21: Renee Reeder OD, FAAO, FSLS: Custom Soft Lens Update for Healthy and Irregular Cornea Patients

October 19: Jason Jedlicka OD, FAAO, FSLS:
Software Applications for Specialty Lens Designs

November 16: Greg DeNaeyer OD, FAAO, FSLS: Beyond the Basics: Advanced scleral lens design

December 21: Maria K. Walker OD, MS, FAAO, FSLS: GP Material Update


GPLI Resources Spotlight:

GPLI Webinars and Lectures

The GPLI has hosted – with the assistance of WINK Productions – a monthly webinar series for the past 10 years. The over 110 webinars encompass every conceivable topic pertaining to GP and custom soft lenses ranging from scleral, orthokeratology, multifocal, toric, spherical, and keratoconus management with GPs, to custom soft lenses as well as building a specialty lens private practice. We also have almost 50 webinars under the “Residents & Students” tab that are more fundamental in nature but would be beneficial to any eye care professional desiring to adopt another lens modality into their contact lens practice. In addition, under the “Resources” tab is a lecture series that includes four lectures on all components of keratoconus and a pediatric aphakia presentation – all from Dr. Christine Sindt – and an optimizing initial comfort presentation with spherical lenses that I presented. All of them are archived such that you can customize our library to your area(s) of interest.

GPLI Advisory Board Spotlight:

Dr. Alan Glazier and FluoreSCENE
Dr. Alan Glazier – who originated “ODs on Facebook” recently introduced optometry’s first television show, entitled “FluoreSCENE”. The GPLI was highlighted in an interview he performed with me on Episode 8. You will love his initial segment about funny comments made by patients to doctors. It can be  Viewed Here


Orders shipped to the USA only - complimentary

1)   GP Lens Management Guide (download only)

2)   Fluorescein Pattern Identification Card

3)   Correcting Presbyopia Tips Card

4)   Contact Lens Clinical Pocket Guide

5)   In-Office Disinfection of Multi-Patient Use Diagnostic Contact Lenses

6)   See with Your Contacts Even When You’re Not Wearing Them (Orthokeratology Patient Brochure which can be downloaded as well)

7)   Look as Young as You Feel (Multifocal Patient Brochure which can be downloaded as well)

8)   Scleral Lenses are Big News (Scleral Consumer Brochure which can be downloaded as well)

9)   Caring for Your GP Lenses (Care and Handling Patient Brochure which can be downloaded as well)

10)   Myopia Management (Myopia Patient Brochure for which the references can be downloaded from this site)

11)  Reading Verification Card (features both passages on one size of varying acuity and different types of print – newspaper, etc. – on the other side)

12) Scleral Lens Care Tips, Application and Removal Card

Edward S. Bennett, OD, MSEd, FAAO, FSLS
Professor Emeritus, University of Missouri St Louis College of Optometry
President and Executive Director
Our contact lens industry is growing thanks to each of us connecting with each other, hoping for the best and believing in what we do!!

Stay safe, enjoy life and respect each other.

GP Lens Institute

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