11-year-old white female presented for myopia management consultation. She was in 5th grade. She had read about orthokeratology in a magazine advertisement. Her current spectacles were six months old. She was a competitive swimmer and water polo player. She had no history of myopia management. Her mother was nearsighted and her father wore reading glasses.

• Visual Acuities (VAs)
  • • Without correction: OD: 20/100, OS: 20/100
    • With correction: OD: 20/20, OS 20/25
• Lensometry:
  • • OD: -2.00DS
    • OS: -2.25 -0.25 x 180
• Manifest refraction:
  • • OD: -2.00DS, VA 20/20
    • OS: -2.00DS, VA 20/20
• Slit Lamp Examination:
  • • Unremarkable OD, OS
• Topography OD, OS (Figure 1):

• • Axial length
    • • OD: 24.91 mm
      • OS: 24.97 mm
  • Dilated Fundus Examination (DFE)
    • • Unremarkable

• Need to consider the refractive error and the corneal topography when deciding between myopia management options.
• She was a candidate for all myopia management treatments given refractive error and corneal topography.
• She was a swimmer and water polo player. This positioned orthokeratology at the top of my list.

• Orthokeratology lenses were fit empirically with refraction, simulated keratometry, and horizontal visible iris diameter (HVID).
• Initial lens parameters:

• Dispense Visit
  • • OU: Fluorescein pattern: Bullseye pattern with adequate edge lift.
    • VA:
      • OD: 20/20
      • OS: 20/20
    • OR:
      • OD: +0.25 DS
      • OS: plano
• One week follow-up visit (approximately 4 pm)
  • • VA without correction
      • OD: 20/20
      • OS: 20/20
    • Manifest refraction
      • OD: plano
      • OS: plano
    • Topography – tangential maps OD, OS (Figure 2)

• • • She did not bring the lenses with her so we could not evaluate them.
• One month follow-up visit
  • • VA without correction:
      • OD: 20/20
      • OS: 20/20
    • Manifest refraction
      • OD: plano
      • OS: plano
    • Topography OD, OS (Figure 3)

• Fluorescein pattern
  • • OU: bullseye pattern, well centered
• VA
  • • OD: 20/20
    • OS: 20/20
• OR
  • • Plano OU

• It is important to take into consideration the patient’s activities and hobbies when deciding between myopia management options.
• Take multiple topographies per visit!