Ortho-k involves the use of highly specialized contact lenses to be worn during sleep that will gently and non-surgically reshape your corneas as you sleep. The goal is to remove the lenses upon awakening to allow for clear uncorrected vision during the waking hours. This sophisticated process requires an extensive evaluation beyond a comprehensive eye examination and can only be conducted by a certified ortho-k practitioner. The process includes a thorough analysis of refractive error (prescription measurement), eye health, corneal size, shape and curvature (via corneal topography) and evaluation to determine the proper lenses that will provide non-surgical corneal reshaping resulting in improved, unaided vision.
TREATMENT PROTOCOL
The length of time to achieve your full treatment will be primarily determined by your prescription and your compliance with the prescribed ortho-k wearing schedule. Typically, we expect to see 90% of the vision changes within the first week of treatment and full treatment within two weeks. Some eyes will require a longer period of time to complete the process. During the time that full correction is yet to be reached, patients may wear their ortho-k lenses, disposable soft lenses, or glasses during the daytime to maximize clarity of vision. Even once full treatment is reached, the ortho-k lenses will have to be worn routinely each night to maintain clear uncorrected daytime vision.
PROFESSIONAL FEES
The fee for ortho-k includes all professional services that are required to complete the treatment up to one year from the date of the initial fitting. The fees discussed in this agreement will cover your ortho-k treatment until one year from the date this document is signed.
The $800 ortho-k initial service fee includes:
- The initial ortho-k evaluation and corneal topography
- 1 day follow up evaluation and topography
- 1 week follow up evaluation and topography
- 1 month follow up evaluation and topography
- Additional follow up visits as necessary
The $700 ortho-k material fee includes:
- Initial pair of therapeutic lenses, $350 per lens.
- Temporary soft disposable lenses, if necessary, until full correction is achieved.
- Warranty Period: There is a 90-day warranty period from the date the lens is initially ordered.
- This covers damaged or broken lenses: you must provide the damaged lens, or a photo, to submit for a new lens.
- Additional lenses necessary for treatment enhancement, eye health or comfort (provided upon an exchange with the initial lens) as prescribed by the doctor.
- This does NOT cover a lost lens.
NOTE: Replacement lenses for lost, damaged (out of the 90-day warranty), or spare lenses will cost an additional $350 per lens. We recommend that you always have a spare pair of lenses. Treatment may be compromised if disrupted by discontinued wear due to lost or damaged lenses.
If you are within the 90-day warranty period and your contact lens fit is finalized, you may purchase a spare pair at a 50% discount, $175 per lens or $350 for the pair.
The total $1500 fee must be paid in full before your ortho-k lenses are dispensed. This fee may be handled with cash, check, credit card, or through our convenient patient financing program.
CONTINUING CARE
As with all contact lens wearers, routine follow-up evaluations are required to maintain proper eye health and visual functioning. After the first year of ortho-k, you will need to be evaluated annually for corneal topography, contact lens fit assessment, and vision evaluation. This will cost of $155.00 per year in addition to your comprehensive examination fees. Also, ortho-k lenses will need to be replaced annually at a cost of $350 per lens.
CANCELLATION POLICY
If there is a need or desire to discontinue ortho-k, the fees shall be adjusted whether the decision to discontinue is made by either the Patient or the Provider within the term of the agreement. There are no refunds after 60 days. Fees for a non-discounted case will be refunded on the prorated basis shown below*:
- Discontinue within 30 days: Refund of all fees, with the exception of $250**
- Discontinue within 31-60 days: Refund all fees, with the exception of $500**
*Any discounts from insurance or other programs will not be included in a refund to the patient.
**Fees for lost, damaged, or non-returned lenses will not be refunded (at a rate of $350/lens).
PATIENT RESPONSIBILITIES
1. Follow all verbal and written contact lens care and wearing instructions given by your certified ortho-k practitioner.
2. Attend all scheduled appointments.
3. Use only the prescribed lens care system.
4. Comply with the prescribed wearing schedule for the lenses.
Report all treatment related emergencies immediately.
INFORMED CONSENT
- I understand that this procedure is designed to change my vision through corneal reshaping. There is no guarantee that my uncorrected vision will improve following ortho-k.
- I understand that I will experience altered vision through my current eyeglasses and/or contact lenses due to the change in corneal curvature as a result of ortho-k.
- I understand that the therapeutic effect of ortho-k will decrease if the lenses are not continued to be worn everyday.
- I understand and agree to seek immediate care by calling (614) 898-9989 during regular hours or following the prompts to contact the on-call doctor after hours, should I experience eye pain, excessive redness, light sensitivity, excessive tearing or discharge, or a sudden loss of vision.
You have signed an agreement acknowledging that you have read and understand the above and are in complete agreement with the contents of this agreement. As such, you hereby agree to the terms of this agreement and agree to perform their responsibilities in an effort to achieve optimum success in the ortho-k treatment.