Questions to ask before you start Ortho-K

Where you are right now

You have read about overnight lenses, you have probably compared them with the alternatives in Ortho-K, soft lenses or glasses for a child, and the evaluation is booked or about to be. This is the point where parents tell us afterwards they wish they had asked more. The questions below work for any fitter, including us. Our post on the eight questions parents ask about Ortho-K answers the common ones; this guide is the list to take into the room.

A note on who is answering. In New Zealand, Ortho-K is fitted by optometrists, and every practising optometrist is listed on the public register of the Optometrists and Dispensing Opticians Board, which shows whether they hold a current practising certificate. Checking takes a minute.

Questions about suitability

Ortho-K is not for every eye or every child. The evaluation exists to find that out before any lens is made, and the fitting process page describes what it involves. Ask:

• Is my child's prescription within the range you fit, and what about astigmatism? Ranges are on the Ortho-K page; ask how your child's numbers sit against them.
• What did the corneal map show, and is the shape a good one for reshaping? The American Academy of Ophthalmology describes mapping the cornea with a topographer as the first step, because the lens is designed to that surface.
• Is there anything about the eye surface that argues against it: dry eye, allergy, a history of infections? Our post on whether you are a good candidate covers the usual reasons to say no.
• How fast is the myopia moving, and will you measure axial length so we can tell whether it is slowing? The point for a child is myopia control, and that cannot be judged without a baseline.
• Is my child ready to have a rigid lens put in and taken out every night, and what happens if they are not? The Academy notes that children may be less able than adults to keep up hygiene, so this is a fair question to ask about your own child.

Questions about safety and hygiene

This is the part to be direct about. The American Academy of Ophthalmology says Ortho-K is associated with an increased risk of microbial keratitis, a serious infection of the cornea, and that overnight wear carries a higher risk than daytime wear. The risk is managed with hygiene and supervision, and the way a fitter talks about it tells you a lot. Ask:

• What exactly is the cleaning routine, which solution do we use, and how often is the case replaced? The CDC advises fresh solution every time, never water, hands washed and dried before handling, and a new case at least every three months.
• What are the symptoms that mean take the lens out and call you? The Academy's rule for any contact lens is a very red, painful, watery or light-sensitive eye, blurred vision, or discharge: remove the lens and call the same day.
• Who do we call if that happens at 7 am on a Sunday? A practice with an answer has thought about it. Healthify NZ says a contact lens wearer with a painful red eye needs to be seen urgently, so if the practice is closed you need to know where to go instead.
• How will you teach my child, and how do you know they have got it before we go home? Our post on whether Ortho-K is safe for children describes the practice's approach.
• What is your own experience and training with Ortho-K, and with children? In the United States the FDA requires fitters to be trained and certified for overnight Ortho-K lenses; New Zealand has no equivalent rule, so ask.

Questions about follow-up and results

The Academy says maximum correction can take two weeks or longer, that up to three temporary lenses may be used to reach the right prescription, and that regular check-ups are required for as long as the lenses are worn. The Cochrane 2025 review of myopia control adds a sobering note: Ortho-K was often poorly tolerated in studies, and in some more than half the children did not complete treatment. So ask what happens along the way, not only at the end:

When are the follow-up visits, and are they included? What does a good result look like at each one? How will you tell whether the myopia control is working, and over what period? If my child cannot tolerate the lens, or the vision is not sharp enough, what is the next step, and does it cost extra? Is there a point at which you would advise stopping?

Questions about money, replacements and stopping

Our published fees are on the consultation fees page, which lists the evaluation, the fitting and lens package, replacement lenses and follow-up visits. We do not repeat figures here. Whoever you see, ask what the package includes and what it does not: the initial eye test, the number of fitting visits, lens changes during fitting, a lost or damaged lens in the first months, and reviews after the fitting period. Ask how long a pair is expected to last, what a replacement pair costs, and whether there is any warranty.

Ask about funding too. Some health insurance plans, including Southern Cross, may provide partial cover for treatments such as Ortho-K, and our insurance and funding page explains how claims work with us. The Enable New Zealand children's spectacle subsidy page lists eye examinations, frames, lenses and repairs; it does not list contact lenses, so do not assume it applies.

Finally, ask how stopping works. The Academy says the effect is reversible: stop wearing the lenses and the cornea gradually returns to its original shape, and the short-sightedness comes back. That means your child needs a pair of glasses with a current prescription to fall back on, and that pausing for an illness or a holiday is possible but has a cost in daytime vision.

When this practice is the wrong place

If your child wakes with a red, painful eye, cannot tolerate light, has blurred vision that does not clear after the lens is out, or has discharge, that is not a question for the next review. Take the lens out, keep it in the case for the optometrist to see, and call us the same day. If we are closed, go to an after-hours clinic or the hospital emergency department. Healthify NZ says a contact lens wearer with a painful red eye needs to be seen urgently.

Call 111 or go straight to the emergency department for a chemical splash (flush with clean running water for at least 15 minutes first), anything that has pierced the eye, a sudden loss of vision, a shadow or curtain across the vision, or flashes with a sudden shower of floaters. Healthline on 0800 611 116 can help you decide. Nothing on this page is a reason to delay any of that.

What to bring to the evaluation

Bring your child's current glasses and any older prescriptions, a note of any eye infections, allergies or dry eye, a list of medicines, and your questions written down. The evaluation needs up-to-date eye test results, so if the last full exam was a while ago, book that first. The guide on what to bring to your eye appointment has the full checklist.