Previous experience in evaluating an ophthalmologic treatment will influence our opinion on the procedure for future patients. Orthokeratology treatment involves a small segment of the population in the United States, primarily myopic Asian children. I have cared for several patients who were being treated by orthokeratology who developed a corneal ulcer or severe keratitis. As a result of those occurrences, I have not been a proponent of orthokeratology. In this issue, Li et al. carefully pointed out the high incidence of a variety of species recovered from corneal isolates of patients with infectious keratitis who used orthokeratology. However, the authors also reviewed studies showing that extended use of orthokeratology can reduce the rate of myopia as determined by axial measurements and/or spherical refractive error evaluation. The cost of orthokeratology is approximately $1,500 to $2,500, as reported by the authors. The high cost will certainly discourage some families from pursuing orthokeratology and they will seek other access to treatment. Further studies with larger patient populations are necessary to determine the success and incidence of complications of orthokeratology.
Leonard B. Nelson, MD, MBA