When asked how to implement a successful and robust OrthoK program in an optometric practice, I advise colleagues that a timeline is the place to start. I suggest a three-month timeline. A deadline of 90 days may feel like a long time to get your OrthoK specialty practice started, but it will fly by during your normal day-to-day clinical practice.
Once you have created a timeline, formulate a list of potential candidates for OrthoK in your office.
Patient Selection is Critical
Good patient selection is paramount. I often am asked at this stage, “How do I pick patients who are going to be successful, and whose treatment is straightforward?”
The answer: Candidate selection is a group project involving key staff, and you start by asking them to identify the market for OrthoK among your patient base:
- What families are predisposed to myopia?
- What parents are highly nearsighted?
- What children stand out as being potentially interested in a new technology or an exciting new procedure?
- Which sports-oriented families have kids who either wear glasses or complain about the contact lenses they wear?
- Which adults might want to be rid of glasses but are afraid of surgery?
Once you have a list of about 20-30 names, winnow that down to the best 10-15 candidates for OrthoK.
Now, select “slam dunk” cases from your list and begin treatments. You want to achieve success in 10-20 cases, then expand your list of good candidates.
The following criteria are helpful in the selection process.
Most Successful Candidates
myopia -1.00D to -4.00D
myopia > astigmatism
cylinder <0.75 central and WTR
Ks 41.00-45.00
no lid disease
no corneal pathology
Most Difficult Candidates
hyperopia
myopia > -4.50D
astigmatism > myopia
cylinder > -1.50DC
ATR
limbal-to-limbal cylinder
steep or flat Ks (previous LVC)
At this point, you should be one to two months into your plan of action. In our case, we had about 15 names that we felt would make excellent candidates, patients who would be approachable for this exciting procedure. Usually, this short list can be expanded quickly once you have enthusiasm and success on your side.
Now, think about your schedule. In our office, we leave OrthoK assessments for the end of the day. Sometimes these visits even straddle our closing time at the office. My staff typically is present for a half hour following closing, so late-in-the-day scheduling works well.
We schedule accordingly for two reasons. First, it gives uninterrupted doctor/patient time, allowing for a thorough explanation of the process, risks/benefits, and fees associated with OrthoK. Second, it does not take away exam time that generates revenue with comprehensive exams, glasses, and contacts lenses, etc.
Troubleshooting Difficult Cases
As you work yourself down your list of good candidates and expand to more patients, more difficult cases will arise. This is when having a good relationship with a lab such as GP Specialists comes in handy.
Sometimes you are just unsure of a particular corneal topography or a particular relationship between the cornea and the parameters of the patient’s prescription. Simply calling for a second opinion, or better yet, sending email communication, can be invaluable. It also can save you large amounts of money, time, and stress.
Here is a perfect example of this from when we first started with OrthoK. I had fit a new patient successfully, with good results and solid 20/20 vision day and night. Her satisfaction level was low despite what I perceived as good results. To me, the topography looked excellent, and the fit and power of the OrthoK lens also looked great.
I was at a loss. It was time to phone a friend. I sent the topographies for consultation with GP Specialists, and they were kind enough to review the case with me over the phone. After discussing the information and reviewing the results, they asked one simple question: “How much sleep is this young lady getting?” I said truthfully, “I don’t know.”
The next day, the patient was in my office, and I posed this same question. The mom immediately said eight to ten hours, but after some discussion the daughter revealed she was only sleeping three to four hours per night.
Sometimes it helps to have another person to bounce ideas off, and tapping into the experience from your lab consultant can save you lots of heartache.
Implementing OrthoK in our practice has been the most fun and rewarding thing that we have done professionally in a long time. By choosing your first OrthoK patients wisely — and by following your timeline — you are setting yourself up for success!
