How To Remove Ortho K Lenses
What’s the best way to remove ortho k lenses? Read on to learn more about pros and cons of popular methods. Video at the bottom
First, break the seal
No matter what method you or patients prefer for removing ortho k lenses, the first step is breaking the lens seal to the cornea. The entire ortho k effect hinges on a good, 360 degree seal of the alignment curve of the lens. This ensures the hydraulic force beneath the lens move fluid out of the central epithelium and into mid-peripheral cells. By gradually breaking the seal between the eye and the cornea, no excessive pulling forces are applied to the epithelium.
To break the seal, you can employ a few methods. We often suggest applying a few drops of either sterile saline or artificial tear prior to lens removal. Do not use water. The additional fluid on the ocular surface can penetrate beneath lens and lift or “float” the lens. It’s important that after additional fluid is applied that the wearer continues to blink frequently and move their eyes around under their lids to help the fluid get underneath the lens.
The lenses wearer may also close their eyes and gently manipulate the edge of the lens with their finger through the eyelid. The lens wearer can look down and manipulate the superior edge of the lens. Or they can look up and manipulate the inferior edge of the lens. The goal is to simply get the lens moving slightly to ensure the seal is broken.
How to remove ortho k lenses: fingers or plunger?
As with breaking the seal, how to remove ortho k lenses is a question with multiple answers. We recommend getting comfortable with a number of different methods that may or may not require extra tools. That ensures the ability to remove lenses safely in unfamiliar situations.
The Blink Method
The blink method of lens removal is one of the most popular techniques taught and does not require any extra tools. The blink method is easily described in 4 steps.
First, the lens wearer should have their face parallel to the floor. This position will put gravity on our side and aid in lens removal. We recommend placing a flat mirror on a table or countertop. The mirror allows the lens wearer to watch themselves during the removal process.
Second, the wearer should open their eyes as wide as possible. The goal is to be able to see white conjunctiva above the iris and below. Seeing “white and white” means that the lids have retracted enough to no longer be holding the lens to the surface.
Third, the wearer to should use their index finger to pull the lids tight. Using their finger to pull the skin at the outside corner of the eye to their ear will increase lid tension against the globe.
Finally, the wearer should blink forcefully. As the wearer blinks, the upper and lower lid will pass between the lens and the eye and “pop” the lens out. Everyone does this technique slightly differently, so some practice is often required to get it just right.
The Scissor Method
The scissor method is a less commonly used technique but also doesn’t require any extra equipment. The goal to get the lids between the eye and lens is the same as in the blink method, using a different technique.
Steps one and two of the scissor method are the same as with the blink method. Face parallel to the floor and eyes open wide. instead of pulling at the outside the eye, the wearer will use the index finger of one hand to manipulate the upper lid and the index finger of the other hand to manipulate the lower lid. Applying gentle pressure with the index fingers will allow the lid margin to get beneath the edge of the lens. The final step is simply to move the fingers toward one another in a scissoring motion.
The DMV or plunger removal method
Using a small rubber plunger or DMV is the easiest to learn but does require more than just the wearers fingers to remove the lens. Using the DMV ultra plunger with no hole usually works the best.
The first step is to ensure the lens is centered on the cornea. If the lens decentered during sleep and is under the upper or lower lid, applying the plunger to the corneal epithelium may cause a corneal abrasion. The wearer should check to confirm they see the edge of the lens near the limbus before using the plunger. A small amount of fluid, either sterile saline or artificial tear on the head of the plunger will help increase suction. Do not use water.
Watching in the mirror, the lens wearer should place the head of the plunger slightly off center on the lens. Many prefer to place the plunger on the inferior portion the lens. As you begin to pull the plunger away, the inferior edge of the lens will come away first and gradually break the surface tension of lens on the eye. If the wearer places the plunger directly in the center of the lens, equal force is applied 360 degrees and the lens can remain suctioned to the ocular surface.
Seeing it action
You can watch the three techniques of how to remove ortho k lenses or any corneal GP lens demonstrated in the video below. Again, we recommend becoming familiar with at least of the methods to ensure the lens wearer can remove their lenses safely in any situation.