Braces Vs. Ortho-K

Let us reshape the world of Myopia together!
A comparison view on Orthokeratology VS. Orthodontics.
By Dr. Glenda Aleman-Moheeputh. OD.
Often when eye doctors explain ortho-k treatment to patients and parents, we use the analogy that ortho-K is like braces for the eye. Why do eye doctors like using this analogy?
It might be because eye doctors know that parents understand the concept of braces (orthodontics), and they can relate to it. Furthermore, parents are aware that orthodontics treatment will not be covered by dental insurance. Interestingly enough, the cost of braces does not keep parents from getting braces for their kids.

Why is the cost not an issue for parents saying yes to braces; However, there is a significant pushback regarding the cost of ortho-k?

1) Parents are familiar with the concept of braces. Their concrete understanding of how braces work, why they are needed, how much braces cost, and most importantly, they have been hearing about it for years from their pediatric dentist. For example, when we explain the mechanism by which ortho-K works, the parent will often finish the sentence and say something like the following “It is like braces for the eye,” and we enthusiastically respond
yes. That is right; you got it!
2) Nonetheless, parents are apprehensive about starting ortho-k because they probably never heard about myopia progression or ortho-K. They do not understand what ortho-k is, how it works, or its efficacy. After interviewing several optometrists, we concluded that in addition to cost, one of the barriers to getting the parents to say yes to myopia management and, more specifically, ortho-K is the lack of consumer awareness and understanding about Myopia and myopia management (MM) treatment options. Many parents are hearing about MM and ortho-K for the first time, and it is up to us optometrists to give a clear and compelling message to convince the parent of the importance of MM.
Myopia is the domain of Optometrists. As primary eye care providers, we are at the forefront of the myopia epidemic; we have the unique opportunity to 1 change our patient’s quality of life in the short term and the long term. Untreated myopia progression increases the risk of visual impairment exponentially. We know that Myopic maculopathy is the leading cause of irreversible visual impermanent. As Mark Bullimore said in his paper, “Myopia Control: Why Each Diopter Matters,” every diopter of increase in Myopia progression increases the risk of visual impairment by 67%, on the other hand, one diopter decrease in myopia progression reduces the risk of visual impairment by 40%. to understand why orthodontists are so successful at getting parents to say yes to braces, we interviewed a general dentist, an endodontist, and an orthodontist and asked the following questions.
Questions:
1) Why do general dentist feel it is essential to refer their patients to the orthodontist?
2) What is the long-term dental health risk associated with no orthodontics
treatment?
3) What percentage of parents agree to the treatment once it is recommended?
4) What is the most common age kids get braces?
We discuss the answer to the questions asked above.
Dentists reported that they refer patients to their fellow orthodontist colleagues because having straight teeth helps to promote good dental health, reduces the risk of cavities, fixes an overbite, and gives the patient a better smile, hence improving the patient’s self-esteem. When we asked about the long-term effects of no treatment, they answered as follows; Crooked teeth lead to a higher incidence of cavities, overbite, and low self-esteem. Other than that, nothing is significantly detrimental to the oral health of the patient. Braces are prescribed in childhood, between the ages of eight and sixteen (8-16 YO), and about eighty-five (85%) percent of parents will sign up their kids for braces.
Now we will take a look at ortho-K; Some of the benefits ortho-k provides to myopic patients include, ortho-k improves the quality of life of our patients by providing them with clear vision without glasses or contacts during the day. Ortho-K allows the patient to practice some of their favorite activities free of correction while slowing myopia progression up to fifty percent (50%) depending on the child’s refractive error. Most practitioners fit ortho-K in children between eight and sixteen (8-16 ) years old, the best time to start parent and patient education is when we can identify risk factors for myopia
progression. Risk factors for a child becoming myopic, a six-year-old or younger patient with a refractive error of ( +0.75) or less hyperopic, a myopic patient with two myopic parents, and reduced time outdoor activity. Finally, the average cost of ortho-K is between fifteen hundred ($1,500) to forty-five hundred ($4,500), similar to braces.

In conclusion, the analogy of comparing ortho-K to braces is justified due to the similarities between braces and ortho-K. What can eye doctors learn from dentists? Our fellow dentists’ colleagues work as a team to educate parents about the importance of orthodontics treatment. They understand that early education is critical, and they are into the habit of referring within their profession. Whether they are general dentists or specialists, endodontists, or periodontists, they refer their patients to their fellow specialists within dentistry. Let us be more like our dentist friends and start planting the seed about myopia progression and treatment options early; the more often parents hear about myopia progression, the more likely they will say yes to MM and ortho-k. Let us reshape the future of Myopia by engaging in early education, start spreading awareness, and start referring to our fellow optometrists who specialize in myopia management.

References:
1)Bullimore MA, Brennan NA. Myopia Control: Why Each Diopter Matters. Optom Vis Sci.
2019 Jun;96(6):463-465. doi: 10.1097/OPX.0000000000001367. PMID: 31116165.
2) The Risks and Benefits of Myopia Control
Bullimore, Mark A. et al.Ophthalmology, Volume 128, Issue 11, 1561 – 1579
3)Straighter Teeth Can Improve Oral Health, JADA, Vol. 138 http://jada.ada.org April 2007