What are the advantages of using Ortho-K to correct vision over LASIK?

Ortho-K is a non-permanent treatment of refractive errors using rigid contact lens wear overnight, every night, to mould the cornea into shape during the day.

For higher degrees of refractive errors, the effect may not be long enough to last through the day. It is also uncomfortable, especially for new users (those who had worn hard contact lenses can attest to it), and has a higher risk of being associated with corneal ulcers and infections as the hard lenses are worn during sleep, when the eyes may be unwittingly exposed/traumatized, compared to normal daily contact lens use.

In general it is used for childhood myopia sufferers as laser-based refractive surgeries are not recommended for children and adolescents whose eye power is not yet stable.

LASIK (together with its alternative techniques such as SMILE and surface ablation, and also implantable contact lens) on the other hand offers a much more permanent solution of freedom from optical aid.

It offers a versatile treatment for a wide range of eye power, from low to pretty high myopia, as well as astigmatism and longsightedness, and with proper planning and understanding, even presbyopia as well. A successful LASIK surgery should provide spectacle and contact-lens freedom for the individual for at least 10-15 years.

Generally, apart from the temporary side effects such as dry eyes and some glare and halos which usually subside with time, significant complications are rare.

Provided the eye power is stable and the eye assessment is safe for LASIK, it can be performed from 18-21 year old onward, (depending on which clinic you visit) in Singapore.

A great question, but one that requires a bit of consideration not just with regards to the characteristics of each option but also the specific goals of the individual patient. Ortho K is a non-surgical option that can be useful for patients who are looking for an alternative to be spectacles independent.

Patients have to wear the hard lens overnight to maintain the changes to the corneal shape needed to temporarily correct the patient’s refractive error. The main advantages of this method are that it is non-surgical and reversible.

However, the patient still has to invest time and effort in maintaining the hygiene of the lens which can be bothersome for those who travel frequently. Similarly, as with all contact users, patients are at risk of developing corneal infections and contact lens intolerance. LASIK is a surgical & non-reversible method of correcting one’s refractive error.

The main advantage of LASIK is that patients are freed from use of ANY visual aids whether it be contact lens or spectacles. Hence, there should be cost savings in the long term as well as increased convenience of not having to maintain contact lens hygiene. LASIK as with all surgeries are not without risks.

Fortunately, the incidence of serious complications from LASIK is rare. To be sure, not everyone is suitable for LASIK surgery. Hence, my patients are often subjected to a detailed eye assessment to manage the patient’s risk well and to maximise stable long term results. Finally, LASIK is an option best suited for patients whose refraction has stabilised. Hence, this option is not suited for children or teenagers below 18 years of age.

As with all things relating to treatment choices, there isn’t such a thing as “best treatment”. Do not be drawn by advice that only proposes one type of laser technique or contact lens product. Your healthcare provider must discuss the various options available and propose the choice that best suits your own eyes and goals. I hope this will guide you towards achieving your goals of spectacles independence.

Dr David Chan

Hi Kai

Just as a quick recap, orthokeratology (Ortho-K) means wearing a specially shaped rigid/hard contact lens to sleep - pressure exerted by the lens on the cornea while sleeping flattens it in certain areas thereby providing clear vision after the lens is removed during the day time. LASIK also flattens the cornea in certain areas, but uses an excimer laser to do so permanently.

In many ways, the pros of Ortho-K are similar to the pros of other contact lenses-ie no surgery, flexibility - option to change corrective power should there be any refractive change over time, reversibility-option to stop at any time and go with glasses or conventional contact lenses.

The pros of LASIK are convenience - no hassle of wearing and removing, no storage solutions or containers to replace or clean, and no risk of allergies or other (uncommon) contact lens related issues. There is only a one time risk of infection (extremely rare) with LASIK, versus recurrent risk with contact lenses everytime they are worn (also uncommon).

The cons of Ortho-K vs LASIK are partly related to the impermanence of the effect. Generally speaking, Ortho-K lenses need to be worn every night to maintain its effect. Sometimes with high spectacle powers, the effect may wear off towards the end of the day, so that by late afternoon or evening, vision starts to get a bit blurry. Also, if for whatever reason the lens cannot be worn, such as eye infection/irritation/allergy, there could be several days where the spectacle power is unstable and vision is not clear because there are no suitable glasses around. Wearing a contact lens to sleep also carries a somewhat higher risk of corneal infection than conventional contact lenses, because of reduced tear flow, absent blink and relative hypoxia of the surface of the eye while asleep.

The cons of LASIK vs Ortho-K? Perhaps the one time risk of surgical complications and the difficulty of reversing it should a rare complication causing visual blurring occur.

Many people would actually be suitable for both Ortho-K and LASIK. But comparing the 2,

1.Ortho-K can be used for people with unstable refractive power while LASIK only when spectacle power is stable

2. Ortho-K can be used in people who are otherwise ineligible for LASIK due to corneal thickness or other eye issues

3. LASIK is preferable for those who cannot wear contact lenses for whatever reason or who value the convenience offered by LASIK

As a final note, it is worth also mentioning conventional daily wear contact lenses in this answer. Personally, given a choice between Ortho-K and conventional contact lenses, I would prefer conventional contact lenses. But that would be an answer for another question on another day…..

Ortho-K and Lasik surgery are 2 fundamentally different approaches to vision correction. Ortho-K is a rigid gas-permeable contact lens that is usually applied to the cornea for a prolonged period overnight whilst the patient is sleeping.

It aims to re-shape the cornea to provide clear vision in the morning when the lens is removed. It's advantage is that no surgery is required, and the application is done overnight whilst the patient is sleeping and hence unawares.

There is also some evidence to support its role in reducing the rate of myopia progression when used in young children / adolescents.

However the disadvantages are not insignificant, in that it carries the risk of cornea damage and hypoxia since the contact lens is worn overnight, increasing the risk of serious eye infections. During the day, the power of the eye will fluctuate as the power regresses back to the pre-treatment prescription.

After consideration of the potential risks and benefits, we do not offer this service as the significant risks do not outweigh its purported benefits. We do offer low-dose Atropine eyedrops for myopia retardation in children though.

Lasik on the other hand is a surgical procedure that involves re-shaping of the cornea using an excimer laser. It is permanent and carries the potential risks of any surgical procedure namely the rare occurrence of flap complications, over or under correction of the desired power, glare or haloes in low-light conditions as well as dry eyes.

This procedure can only be performed on patients once their refraction is stable for a minimum of 2 years. and with no other ocular problems including cataracts.

In comparison to Ortho-K, vision is stable throughout the day and does not need any after-care one the post-operative period is over.

Again however, you should discuss your options with your ophthalmologist after a detailed examination. This will allow a fully tailored solution for your vision needs!