This document discusses hyperopic orthokeratology (HOK) for correcting hyperopia. It provides guidance on ideal candidates, such as moderate hyperopes with strong motivation. It cautions that HOK is not FDA approved and notes challenges, such as fluctuation in vision and difficulty with unusual night patterns or dry eye. The document includes two case studies, one with a post-LASIK patient who was a good candidate, and another with an elderly woman who achieved excellent distance vision against design principles. Topography measurements and lens designs are discussed. Videos demonstrate ideal and less than ideal edge lift with HOK lenses.

1. Getting Hyped about
Hyperopic Ortho K
Gavin Cohen
gavin2020@comcast.net

2. When to offer
hyperopic ortho K
Moderate hyperopic presbyopes ideal
Strong motivation, from both the pt. and YOU
Aware of expectations – Reduce the dependency…
Strong dominant eye
Successful previous monovision (LASIK too!)

3. When NOT to offer HOK
Pts who are hypersensitive to changes in Rx
Pts who want perfect vision
Pts who’s travel makes it difficult
Night patterns that are unusual
Any EBMD
Early presbyopes with emmetropia

4. Caution
Not FDA approved
Not well published – no significant research vs OK
Unknown to most other docs – will get questions
Expensive
Watch that distance vision
Watch that VA fluctuation

5. A word about topography
Topos from scout are tangential topos, not axial
Remember red means steep, not elevation
Essentially measuring tearfilm layer
Watch the dry eye (consider +1.00 lens)
Randy Kojima – “Topographies sometimes lie”
Only measures inner 5 mm of K, rest is guesswork
All my HOK are large diameter designs so guesswork
comes into play

6. Video 1

7. Video 2

8. Ideal edge lift

9. Probably needs more lift

10. 34micron central clearance

11. Case 1 - SC
CEO 55 Male
LASIK 15 years previous
Excellent results
Wearing readers
Why is he a good candidate?

12. Post Lasik

13. Design method

14. Wave Edge Upgrade

15. Post Lasik Topos

16. Case 2 - GM
74 year old white female
OD : +3.75 20/25 Add : +2.50
OS : +2.25 -0.25 X 180 20/25
Referred by a friend
Could not wear lenses during the day. “Sick of glasses”
Extremely particular, but motivation high
Extensive patient education re expectations

17. OD

19. PERFECT RESULT,
RIGHT?

20. OD alteration for better distance VA

21. EXCELLENT DISTANCE VISION – Against
common design principles probably because
large plus required?

22. GM - OS

24. Case 3 - CH
55 YO Female
+1.50 hyperope OU
Dry eye, on Restasis
Narrow angles sent for PI to friendly MD
Glaucoma doc called me, amazed.

26. 9 and 3 o’ clock positions of design

27. Pre and post topo

28. OS dominant topos and design

29. Excellent distance vision, reading just OK