Orthokeratology, also known as overnight Ortho-K, is a treatment in which an individual wears special contact lenses while he sleeps at night. The lenses correct the shape of the cornea, so when the patient wakes up his vision is good for the day.

The way it works is that the central part of the contact lens puts gentle pressure on cornea and actually changes it shape, so the cornea curvature is decreased by putting gentle pressure on the lens, thus reducing the myopia.

Approved by the Food and Drug Administration in 2002, Ortho-K, also referred to as corneal refractive therapy, and vision and corneal shaping treatment, can cost from under $1,000 up to $3,000. However, the end cost can be similar to laser eye surgery, about $7,000.

It's a nonsurgical procedure in which an individual wears of a series of specially designed, rigid contact lenses to progressively reshape the curvature of the cornea over time, according to the American Optometric Association.

"The results of the painless procedure are not permanent; thus, retainer contact lenses must be worn periodically to maintain improvements made in vision. Ortho-K is used to treat low to moderate nearsightedness and low degrees of astigmatism," AOA experts note. e_SClBChildren and teenagers are not ideal candidates for reflective surgery, such as laser eye surgery, so if they or their parents want a contact lens solution that doesn't involve much care, Ortho-K is an option, explains Dr. Joseph Barr, the vice president of global clinical and medical affairs and professional services for vision care at Bausch + Lomb.


Nearsightedness on the rise

The rate of nearsightedness among the young is increasing quite significantly, notes Dr. S. Barry Eiden, the immediate past chair of the contact lens and cornea section of The American Optometric Association, who also specializes in complex contact lenses care.

"Young people who become nearsighted get worse as they age, and each year they need stronger glasses. Through a variety of studies, corneal reshaping treatment has shown to potentially slow down the rate of myopia in the young," explains Eiden.

It's also an option for people who are very active and those who have dry eyes, thus making it difficult to wear traditional lenses. By not wearing lenses during the day, Ortho-K users avoid those symptoms and don't have to worry about the lenses being dislodged or accidentally falling out.

In addition, the procedure might appeal to employees who live or work in an environment with a great deal of dust and pollen.

"We are starting to see a little more interest in Ortho-K. In the U.S., of all the contact lenses fitted, about 1% was for Ortho-K," says Barr.

Employer-sponsored vision benefits typically cover the examination and diagnostic work around eye care and some financial offset for the purchasing of contact lens and frames.

Ortho-K is a multiple-lenses process, and with the cost where it is, "we haven't had many employers cover the procedure under their vision plans," says John W. Lahr, divisional vice president and medical director of EyeMed Vision Care. "So far, we haven't been approached about a laser vision correction alternative."


Other innovations

Ortho-K is not the only emerging development taking place in the vision clinical space.

"Innovative lens technology that improves our vision continues to be developed and brought to today's marketplace. Freeform or digitally surfaced progressive lenses are no exception to innovation, as new technology now makes it possible to create truly customized lenses for any patient, based on their unique vision needs," explains Melody Healy, VSP Vision Care's director of product strategy and integration.

In addition, as the economy begins to improve, Healy says she expects to see a rise in demand for more premium lenses and options, including broad choices in customized progressive lenses and increased coverage for lens options such as anti-reflective coatings and photo-chromic lenses.

"As the population and workforce continues to age, employers are likely to consider offering vision plans that include richer coverage for a variety of high-value and high-technology lenses - from single vision to the more advanced, customized progressive lenses," Healy adds. "With the increase in mobile computing, computer vision care needs are extending beyond the office into our home and [to] our families."

During the economic downturn, some employers eliminated vision benefits, converted over to a voluntary plan or shifted more of the premium costs to workers.

Yet, even as the economy stabilizes, the momentum toward these options will not fade away, says Chris Covill, a partner with Mercer and national practice leader for Mercer Integrated Benefits.

Employers are looking for ways to save costs, so increasing the benefit level to vision plan is unlikely, given that employers are still focusing on the rising cost of health care and premiums, and the implication of health law on cost structure, explains Covill.

According to Mercer's 2010 research, 70% of large employers (500 or more employees) and 45% of all employers offer vision coverage to their employees. These figures include employers that require employees to pay 100% of the cost of coverage.

The momentum around vision benefits being more than just a discount on contact lenses and glasses is taking shape, explains Pat Huot, director of the managed vision care program at Transitions. Employers are starting to see vision benefits as an entry into the health care system for folks who are at risk for a chronic disease.

Huot explains that research indicates that about 22% of the general working population gets an annual physical, while 66% of individuals with a vision plan go out and use the benefit.




Corneal reshaping FAQ

Similar to Ortho-K, corneal reshaping treatment is a nonsurgical process which reshapes the cornea of the eye using custom-designed reverse-geometry contact lenses, thereby reducing the dependence upon eyewear.

To fit a patient for CRT, a corneal topographer is used to map the topography of the cornea. The lens materials and fitting technology, as well as years of research, combine to make CRT an advanced way for patients to experience clear vision, without full-time contact lenses, glasses or surgery.


How safe is CRT?

Many people have been able to eliminate their dependence upon their glasses and standard contacts with no adverse effects or eye damage and without the risk of surgery. As with all contact lenses, care must be taken to maintain eye health.


Who can benefit from CRT?CRT works best on nearsightedness and astigmatism, but lens designs for farsightedness are also being developed. Not everyone meets the criteria for CRT.


Is CRT permanent?After treatment and maximum results are achieved, retainer lenses are worn to stabilize the new corneal shape. Failure to wear the retainer lens on an ongoing basis will result in the return to the pre-existing prescription. Retainers may be prescribed during day or night.

Source: North Suburban Vision Consultants

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