The general length of your treatment will be primarily
determined by your prescription and your compliance
with the prescribed Ortho-K wearing schedule. Ortho-K
lenses are to be refitted annually like a soft contact lens.
Typically, we expect to see 90% of the vision changes
within the first week of treatment and full treatment within
the first 30 days. Some eyes will require a longer period to
complete the process. Thereafter, the lenses will have to
be worn routinely to maintain treatment vision.
What is included:
(If patient in not complaint with the care and wear
schedule then this will not be covered and will be
considered an out-of-pocket cost.)
- All check in appointments throughout the therapy
include a 30min wellness check which include
testing Visual Accuity, Overall health of the surface
of the eye, and Topography testing which maps
the surface of eye.
- Specialty Contact lens fitting
- Specialty refitting’s
(Ortho-K fits are not the same as a soft contact lens
fitting, however they are to be done annually to
maintain the therapeutic results.)
- Lens training (insert and removal)
- Medical visits pertaining only to the Ortho-K therapy
Check In Schedule:
Therapy follow-up visits will occur in the order of:
1 Day,1 Week (7th day), 1 Month (30th day), 2 Month (60th
day), 6th Month, 8th month (if needed)
Follow-up schedule will restart in year two from the date of
Any additional follow-ups may be requested should there
be any complication with the patients wearing schedule.
Therapy follow-ups are crucial to treatment. We are
mapping the surface of your eye as you are being
treated. Constant monitoring is important for the first
60days of the therapy.
Patient Responsibility Acknowledgement
1. I understand that the success of the Corneal Refractive
Therapy Program is directly dependent on my compliance
with the program; I must wear the Ortho- K lenses no less
than 6 hours every night and abide by the proper ocular
hygiene for best results.
2. I understand that certain personal, physiological, and
environmental factors may adversely affect the successful
use of the Ortho-K contact lenses and may necessitate:
- A change in the prescribed wearing schedule
Switch to a myopia control program (Atropine)
- Termination of lens wear due to:
- Inability or unwillingness to return to follow-up visits.
- Poor lens hygiene or Continual breakage due to
- Allergic reaction o Manual dexterity problems which
would prevent lens removal, and cleaning.
- Poor concentration of lenses due to changes in the
cornea, astigmatism, asymmetry of cornea, excessive
or uneven lid pressure or other factors.
3. I understand that in case Ortho-K contact lenses are not
suitable for my eyes, the doctor may choose to switch to
myopia control Atropine Program, which also uses
therapeutic application in the form of eye drops to help
reduce and control myopia.
4. I understand the risk of using contact lenses and
complications associated with contact lens usage which
also applies to orthokeratology lenses, commonly known
as Ortho- K.
5. I understand that this agreement is only for Ortho- K
follow-ups visits. I understand that any services that I may
need rendered during this therapy treatment caused by
poor hygiene will not be covered under the corneal
refractive therapy package. I understand that there may
be additional medical visit costs if I fail to recognize and
abide by the Patient Responsibilities’.
6. I understand that medical conditions are not part of the
corneal refractive therapy package and will not be
covered under said contracted services.
7. I understand that my Ortho- K lenses should be worn
according to the prescribed schedule alter the corneal
refractive therapy program to maintain maximum results.
8. I understand that if my child/ ward is under the age of
10, has ASD, or any other debility, and is having trouble
inserting or extracting the ortho k lens that it is my
responsibility to help them.
9. I understand that this procedure is designed to change
my own / Child’s/ Ward’s vision through the process of
10. I understand that altered vision through my current
eyeglasses and or contact lens prescription lenses is due
to the change of corneal curvature results of the corneal
refractive therapy. I understand there is no guarantee that
my uncorrected vision will improve.
11. I understand that during the program, my doctor has
recommended that I keep my backup pair of glasses for
12. I understand that I should report all emergencies
related to treatment immediately by calling Pupila Family
Eyecare or emailing Support@pupilaeyecare.com
13. I understand that if I started the program with a certain
case level and within 1 year there should be an increase
in my prescription that falls into a different case RX range
level, that I am responsible for the price difference.
14. I understand that it is imperative that I schedule my
follow-up examinations and agree to keep these
appointments scheduled for myself and to follow
instructions for contact lens wear and care.
15. I understand that this program does not include any
contact lens solution or eye drops and that it is my
responsibility to obtain these to maintain the quality of my
prescribed Ortho-K lenses.
16.I understand that my doctor has instructed that I use
Boston Simplus for the cleaning of my Ortho- K lenses, and
that I will use this solution and follow treatment plan for
proper cleaning of my lenses.
The following signed by the patient, parent, or guardian for
the patient, child, or ward that is participating in the Orthou0002K treatment. The following signed, agrees to the terms of
Patient Responsibility and Acknowledgement.