Orthokeratology lenses are FDA approved medical devices that, when properly maintained, may be worn with minimal risk of eye infection and inflammation. Proper maintenance of Orthokeratology lenses involves using appropriate device cleaning and care systems. Certain systems are appropriate for certain devices, so be sure to ask your doctor which system is best for your child’s devices and how best to care for your ortho-k lenses. Common Orthokeratology cleaning systems include:
Clear Care Solutions
Opti-Free GP Multi-Purpose Solution
Barnes-Hind Comfort Care
Bausch & Lomb Wetting and Soaking Solution
DO NOT use Boston Simplus
*Lobob soaking solution MUST be washed off the lens with sterile saline (not tap water) BEFORE inserting in eye, as opposed to Boston and Boston Advance soaking solution which can go right in the eye
Tap water, while clean enough to drink poses certain risks when used to rinse, clean or store Orthokeratology devices. We strongly recommend your devices and device storage containers not come in contact with standard tap water, distilled water or bottled water. Should the lens come in contact with water and be used overnight, the risk for a serious eye infection called Acanthamoeba keratoconjunctivitis may result.
Rinsing of cleaning solutions off of lenses should be performed with sterile contact lens salines. Be sure not to let the dropper tip touch any surface, or the entire bottle becomes contaminated.
Steps for cleaning:
Your cleaning kit should contain (1) a cleaning solution (2) a soaking/rinsing solution if it is a 2-step system prescribed by your doctor (3) a clean storage case and possibly (4) eye drops for rewetting the devices while in the eye (Natural Ophthalmics Ortho-k Thick drops).
(A) 1 STEP CLEAR CARE/HYDROGEN PEROXIDE SOLUTIONS
Using a clean storage case that is provided with each new contact lens solution bottle, fill it with the solution to the line on the vial and place the lenses in the corresponding cages. Screw down top tightly and set aside, careful not to tip over; solution will start to bubble around the disc at the bottom.
(B) STEP 1 – CLEANING WITH CLEANING SOLUTION (2 step systems)
This solution is a very mild abrasive and is used in conjunction with finger-rubbing to dislodge and remove debris from the lens surface. The cleaner is in suspension, so shaking it is necessary before use. Dispense 2-3 drops of cleaning solution into the palm of the hand and place the Orthokeratology device in the palm. Without too much pressure, gently massage the cleaning solution across both surfaces of the lens for approximately 1 minute. Most solutions start out clear and foam up as you clean. To ensure you have cleaned long enough, the foam should be milky white and thick when finished.
The concave side of Orthokeratology lenses has a circular “edge” which can be challenging to clean. The front side is spherical and smooth and easily cleaned, but rubbing with finger tip pads isn’t always sufficient to dislodge and remove debris from within this “edge”. Spending extra time rubbing with the cleaning solution on the concave side of the lens is recommended, or one may use a q-tip soaked cotton applicator to clean the concave side to ensure debris comes out of the “edge” of the lens.
We at Shady Grove Eye and Vision Care also suggest a professional strength polish (PROGENT cleaner) and clean bi-annually for best comfort and clarity. This procedure is offered free of charge to our existing Ortho-k patients! Although recently approved for at home use, the bleaching potential and risk is still too high for us at SGEVC to feel comfortable with anyone but your eyecare professionals to thoroughly clean them for you.
STEP 2 – RINSING CLEANING SOLUTION OFF THE DEVICE (2 step systems)
Once the device has been cleaned manually with cleaning solution, it is important to remove the abrasive cleaner from the device before putting the device in an eye or back in it’s case. It is a good idea to wash the cleaning solution from the previous step off your palms before proceeding to rinse the cleaning solution off the device.
Obtain sterile saline from a pharmacy, drugstore or other retail store. Place the device in the palm of the hand and use a strong stream of saline by squeezing the bottle firmly to rinse each side of the device. Be sure to pull the stopper up in the sink or lay a paper towel over the drain so the device isn’t accidentally washed out of your palm and down the drain during the rinsing process.
STEP 3 – STORING THE DEVICE
Using a clean storage case, fill it with the soaking solution and place the newly cleaned lens in the case. The case MUST be a screw-down plastic case – the sample cases given in the doctors office that are press-down are only temporary cases and should not be used more than one day.
PROCEDURES FOR USE
Ortho-K devices are worn during sleep. To achieve maximum effect, at least 8 hours of sleep is required. More than 8 hours has no additional benefit as 8 hours should be sufficient to achieve results. A clean Orthokeratology device should be removed from the case after hand washing with anti-bacterial soap. Do not rub the eyes when the devices are on.
Inserting and sleeping with Orthokeratolgy devices
Upon insertion, the child should be directed to go directly to sleep. Wearing the orthokeratology devices while awake for more than a few minutes is not recommended and has resulted in eye irritation, discomfort and small abrasions that can lead to other temporary problems wearing the devices. When the eyes are open, orthokeratology devices are often described as anywhere from “itchy” to “irritating”. When the eyes are closed, while there may be some “awareness”, it is generally not described as discomfort. It is normal to experience some type of discomfort for the first 2 weeks, which gradually dissipates from day 1 to day 14. Any irritation that remains when the child’s eyes are closed after 2 weeks should be reported to the doctor. The case should be emptied of soaking solution, dried with a clean paper towel and wiped with an alcohol wipe in the well where the lens was stored as well as on the screw-down cap and around the threads on the case that the cap screws onto. After the alcohol rub-down, the case and cap should be stored upside down on the paper towel to minimize risk of contamination. DO NOT screw the cap on the empty case; the potential of creating a dark, moist, air-free environment within the case that encourages colonization of bacteria is enhanced by cleaning and shortly thereafter sealing the case by screwing the cap on.
Awakening after wearing Orthokeratology devices
In the morning, the child should make their way to the bathroom, wash their hands for several minutes with antibacterial soap, pull the stopper in the sink or lay down a paper towel over the drain and remove their devices. The devices should be cleaned according to the procedure outlined in steps 1 and 2, the case filled with fresh storage solution and put into the case in the storage solution with the appropriate lens for each eye in the side of the case labeled “L” for left or “R” for right. The case lids should be screwed down.