To provide a systematic approach for troubleshooting issues in orthokeratology lens fitting.
Approach:
Connecting the Dots: Correlate patients’ subjective symptoms with axial and tangential difference maps to identify discrepancies.
Central Islands: Reduce sagittal depth to correct excessive vaulting causing poor vision.
Decentration Issues: Adjust sagittal depth to correct inferior or superior decentration.
Undertreatment and Overtreatment: Adjust the treatment target without rebuilding the lens.
When No Action Is the Best Action: Observe if the patient is comfortable and sees well, even with an imperfect map.
Key Findings:
Smaller back optic zone diameters can enhance myopia control outcomes.
Excessive sagittal depth can lead to central islands and poor vision.
Inferior decentration indicates a lens that is too steep, while superior decentration indicates a lens that is too flat.
Adjusting the treatment target can correct refractive errors without redesigning the lens.
Interpretation:
A systematic approach is essential for troubleshooting orthokeratology lens fitting issues, considering both subjective symptoms and objective measurements.
Limitations:
Not every lens fit issue requires immediate redesign; some cases may require observation.
Conclusion:
Effective troubleshooting in orthokeratology involves a careful analysis of both patient feedback and clinical data.
Susan Gromacki, OD, MS, FAAO, FSLS, Dipl AAO, and Clark Chang, OD, FAAO, FSLS, reviewed the latest developments in diagnosis, imaging, contact lenses, corneal cross-linking (CXL), and surgical management for KC.
