My Dearest OrthokeratologyHappy Silver Jubilee Dr Oliver Woo describes the love / hate relationship he initially endured with orthokeratology (OK) and how it has now settled into a symbiosis that (almost) only ever brings joy. WRITER Dr Oliver Woo ”OK. How are you? My name is Oliver Woo. It’s nice to meet you.” I was introduced to OK by Dr John Mountford 25 years ago. Little did I know that it would become my first love. At that time, Dr Mountford also introduced me to the EZM lens design made from Boston XO material, a mysterious friend of OK that could reshape the cornea at night to achieve perfect vision during the daytime without wearing spectacles or contact lenses. During our first five years in OK practice, we experimented with how to achieve satisfactory results. Even after many attempts, we were unable to get things right! This was a painful and expensive journey in corneal reshaping. But the ‘course of true love never did run smooth’. At times I almost wanted to give up. Instead, I persevered. My breakthrough came when I met my revered teacher and mentor, Nick Stoyan, in 2002. He shared his reverse geometry design and inspired me to see the relationship and love force between the cornea and lens. Over the past 25 years, I have witnessed ongoing developments in this specialty lens area. Back in the day, we never thought it would be possible to correct Rx over -3.00D or astigmatism over -1.00D. Today, it is incredibly easy to order and have manufactured the latest OK lens technology that can do all of this – and more. These lenses are very effective in myopia reduction. Improvements in lens materials and advancements in technology – both topographers and manufacturing – are helping us correct refractive error more safely and effectively. We are blessed. LAUGHTER AND TEARSDuring my professional career I have used diagnostic lens trial fitting, empirical trial fitting and software-based designs to prescribe OK. The experience has been filled with both joy and pain; a lot of lenses have gone into the rubbish bin. Your journey in OK prescribing will also be filled with ups and downs. You’ll love the feeling when you get the goal in just one fit, and the enjoyment of resolving difficult cases. You’ll feel proud and satisfied when you help a myopic patient with 9.00DS and -3.75 DC to see 20/20. But you’ll experience disappointment and frustration when you cannot achieve a successful fit, even after using many lenses. And like me, you’ll need to remind yourself that every patient is unique. No two corneas will respond in the same way to treatment. So, we need to approach and treat each person, and every eye, individually. I always love to close my eyes after I take the topography of the cornea. I imagine I can see and feel it in a three-dimensional way. I love to give the cornea the maximum hug (diameter). I want and need to offer a stable relationship, with a good alignment between the lens and the cornea, whether single or double (but perhaps I am taking my analogy too far...) The biggest challenge in making the reshaping effect happen is determining where the reverse curve needs to be placed, taking into consideration the height, width, and elevation of the cornea. A good understanding of each curve’s functions and characteristics helps me to achieve optimal results in corneal reshaping. The perfect bulls-eye topography will always bring joy (and headaches when the topography shows big decentration). HOW’S YOUR RELATIONSHIP WITH OK?With the latest designs, scientific evidence, and research, we feel confident in using OK to manage and slow the progression of myopia. But there is always more to learn and for that reason I will forever consider myself to be an I apprentice. To grow this specialty service is not easy. It requires patience, commitment, and dedication. I remember, many years ago, speaking with my good friend and mentor, Dr D, about my plans to establish an OK practice. When I told him I wanted to fit 10–15 patients a week he said: “Oliver, if you can achieve that in the next three months, please do not let me know about it, because you will NOT be providing the best service or offering your patients the best attention.” I was shocked by his comment, and initially incredibly sad. But his words galvanised me. I took my time recruiting suitable patients for OK and committed myself to being a good and responsible orthokeratologist; to providing them with the best professional service. Consequently, my patients are impressed and happy with my care. THE REWARDS The most amazing aspect in offering OK is not the financial gain. It is how we help people to see the world more clearly by managing their myopia. We don’t just change their vision; we change their lives. Each of my patients is special, but none more so than the young ones. Their smiles after the first night of OK treatment are the best gift and the encouragement I need to maintain my passion for myopia management. Doing one thing persistently is not easy. It is incredibly challenging. A MULTI-GENERATIONAL STORYMy patient Eva came in to visit me recently with her second child. She is one of my first OK patients and is still using it, more than 20 years later. She asked my view on whether her children were becoming myopic, and told me that when the time came, she would definitely use OK to manage their myopia. Before she left my practice that day, she asked me when I would retire. I smiled and replied, “not until your kids get married”. She laughed loudly and flashed that same big smile I first saw 20 years ago. During my journey with OK, I have seen many thousands of patients, like Eva, grow from kids into adults, and progress from primary school to university. For many, I have witnessed their graduations, weddings, and parenthood.“ Improvements in lens materials and advancements in technology – both topographers and manufacturing – are helping us correct refractive error more safely and effectively My patients have become my greatest fans. Your patients can become your greatest fans too. There are very few specialty areas in eye care that will present the same opportunities. “So, orthokeratology, I’ll finish this epistle by saying that you always amaze me. Thank you for being there for me every day and I look forward to partnering with you for the next 25 years. Keep smiling. Yours, Oliver.” Dr Oliver Woo is an optometrist at his own practice, Oliver Woo Optometrist, in the north-western Sydney suburb of Eastwood. He has a special interest in orthokeratology and is a myopia management consultant. “There is always more to learn and for that reason I will forever consider myself to be an apprentice” My dear friends, Don’t rush to reach fitting your first 100 patients in your first years. Offering your patients quality service is far more important than quantity. We are mostly using OK to manage myopia, so please don’t anticipate that you will use it to conquer myopia. Make sure you keep a good standard with optimal protocols. Your patients and their parents will be your best marketing managers. You will have a fruitful and blessed practice, springing from your love of OK. I am sure your business will flourish as a result of your commitment and passion.