A year with orthokeratology

A year ago, I did something that’s very rare for me, I made an expensive impulse purchase. Specifically, I was fitted for orthokeratology lenses. These are a vision correction technique: hard contact lens you wear while you sleep, that mold your cornea into a corrected shape so that you don’t need to use vision correction while you’re awake.

I have mild myopia (-1.75 left and -0.75 right, I think) and very mild right-eye astigmatism and I’ve had vision correction since I was about ten (initially only for my left eye, my right eye only became measurably myopic about 5 years after that). I’ve worn glasses and contact lens each about half the time. I like contacts better than glasses but still find them annoying when they are dry or one gets stuck to the wrong part of my eye. I have enough medical and surgical anxiety that I’m not going to be interested in surgical correction any time soon. So that was the appeal of orthokeratology.

To cut to the chase, while I’ll keep wearing them now I have a good fit, my recommendation is mixed at best.

The first few days and weeks were not promising. The problem with anything that’s supposed to be “uncomfortable” or “take some getting used to” is determining when something is actually wrong. So when I first put my lenses in in the optometrist’s office and my eyelids slammed shut in agony over the top, I figured it was par for the adjustment course. In addition, it took a while to achieve good correction, I think a week or more to be reasonable and another week or two until I tested as having an acceptably negligible prescription. During this time, in transition, I couldn’t use my glasses either. So in the evening, it was a question of putting them in and then immediately staggering upstairs feeling my way to bed while my husband probably cooed lovingly at his loyal un-painful glasses. It’s also, as you would think, not especially easy to get to sleep when your eyes are trying to alert you to their imminent death, although once I was asleep I tended to sleep well and wake up with them adhered to my eyeballs (once they seal on, it hurts less). The crisis in the mornings seemed to be more that they adhered too well, and the force required to get them off tended to flick them around the bathroom at random and I’d get stressed and need to get Andrew downstairs to help me find the lenses (replacement cost is multiple hundreds of dollars).

Which reminds me, these require touching your eyes a lot more than soft contact lenses do. Getting them on involves applying them straight to your pupil, and getting them off is done (most easily) with a little suction device, again, more or less applied to the lens over the pupil. Getting them off sounds like it should hurt, but it doesn’t, it’s just a slight pulling sensation. But a large number of people cannot bear to touch their eyes, or at least not very much. That is, at least, a caution to many people. This wasn’t something I was asked about or warned about at all; luckily I am very able to touch my eyes, but it seems like I should have been asked.

Once the teething pains, as it were, were over, I had a nice few weeks of naked daytime eyes. Even Andrew briefly expressed envy, swimming at Waikiki, that I could see everything and also not have to worry about losing a lens in the water. It wasn’t to last long, as on that same trip, one morning I woke up with my eyes in agony. The only relief I could get, even slight, was to keep them open behind very dark glasses for most of the morning. I put it down to bad cleaning and made a note to be extra careful.

But it kept happening, with increasing frequency. On the fourth or fifth time, back in Australia, I ended up at the optometrist. He couldn’t find anything wrong other than dryness… and that my vision correction was weakening badly to boot, so I wasn’t even getting much for the pain. He wanted me to stop wearing them. He doesn’t seem to be a terribly good communicator; all I could get out of him was a vague promise that I wouldn’t be out of pocket. I got a call a few weeks later to come and pick up new lenses. He wasn’t even around so I didn’t really know what the deal was until my next check up: it emerged he’d actually done a fair bit of work phoning different suppliers trying to find lenses big enough to cover my (of course) enormous corneas, thinking that probably the fit was actually the issue.

Sure enough, the bigger set of lenses have solved the problem of the mornings of extreme pain and dryness. They were also never as painful as the first set, despite several weeks break before starting to use them, which makes me wonder if the level of pain inserting the first set was always a bad sign. (But then, “may take some adjusting” and “may be uncomfortable” means “don’t complain for a while”, so they’ll never know.) I also don’t end up having to scan the bathroom inch by inch for them every morning. The correction is pretty good; I actually have to be careful with the right eye not to wear a lens every night because it’s easy to overcorrect. I wear the left one about three nights in four and the right one one or two nights in four. It’s more of an artform than I’d like, to be honest.

Given the initial pain and the lengthy adjustment period, I think with hindsight that I wouldn’t choose to start the process, which is why I am hesitant to recommend it to others. Most reviews I’ve read have had better experiences, although the only other person I know who tried it had to give it up entirely because it caused such bad night blindness it wasn’t safe for her to drive (not a problem I’ve had). Proceed with care.

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