New Zealand based optometrist Dr Jagrut Lallu was recently appointed one of four global ambassadors for the World Council of Optometry, in charge of the Asia Pacific region. That’s no mean feat. He was chosen for his extensive experience in myopia management in clinical and educational settings.
Who better to talk to for Myopia Awareness Week 2024! Read our interview to learn more about Dr Lallu’s background, and discover his myopia management and ortho-k (night lenses) insights and advice.
Hi Dr Lallu! Tell us about your history with myopia management.
We started the first myopia management clinic in New Zealand in 2009. We focused on Orthokeratology and at the time atropine – our board would not let optometrists prescribe low dose atropine for the prevention of myopia, however we were allowed to prescribe 1% atropine for the treatment of Amblyopia.
When you set up New Zealand’s first myopia management clinic, myopia wasn’t the priority it is now. How did you know the clinic would be a success? And what do you know now that you wished you knew starting out?
In my final year of University, we had a Myopia research unit of study where Dr John Phillips asked us to review a number of papers. When I reviewed the papers that were selected for us, it seemed obvious that this would be something that we would be addressing in the future. With the advent of the iPhone in June 2007 and its world wide uptake I thought that this would have a massive impact on Myopia. Sadly, this appears to be the case when it comes to near work and the impact of devices globally.
Why are you passionate about stopping children’s vision from getting worse, in the way that you do? And how transformative is ortho-k for the end user’s day to day?
I believe we have a duty to present the best evidence to our patients. The great news is that we now have multiple treatments to manage myopia. When it comes to Orthokeratology, I am still awed by the instant improvement in vision after the first night. It is not only great for myopia, but also astigmatism and presbyopia. It’s a fantastic alternative to laser or as a try before you buy laser. With the advent of modern day multifocal IOLs it will also serve as a great simulation of what these new products can hold, and help support more collaboration between Ophthalmology and Optometry globally. It’s like the feeling you get when you are a spectacle wearer and you go out in the rain for the first time with contact lenses on: you are just amazed that rain is hitting your face and you can see clearly.
So why does ortho-k work, and who does it work best for?
It works for most people, from those with hyperopia, myopia, astigmatism and presbyopia. Like anything, it’s all about being realistic. It’s not perfect. It is kind of like when we discuss presbyopia; it doesn’t matter if you are a laser surgeon, an optometrist or purveyor of snake oil – no one can (at least yet) give you the same vision you had when you were under forty. We are getting close, but as long as you treat Orthokeratology in the same manner, you will be fine.
Can you tell us about a particularly memorable case you’ve worked on?
All of our cases are memorable, but what is really nice is seeing those normal patients come in who have never heard of Orthokeratology. They come in and receive the treatment and gain great results from Day One!
This case is a low myope, around -3 with low astigmatism. The patient has been in ortho-k for myopia control for 12 years with no change in script. He’s only just now needing new Forge lenses due to wear and tear. As you can see from the tangential power maps, there is a decrease in the quality of the red ring which normally improves with a polish. Note how the topography maps taken with the Medmont E300 are interchangeable with the Medmont Meridia™️ maps taken more recently.
Twelve years is not bad for a set of lenses and stable myopia without any change. This patient is now becoming a doctor, so this modality has helped him halt myopia and get through medical school!
What would you say to practice owners who are hesitant about branching into ortho-k?
It is actually very low risk, with good topographers and software – anyone can be successful in Orthokeratology. It is very profitable, but more importantly, it delivers a huge amount of satisfaction to see myopia slow down completely.
We all have our preferred ways of fitting ortho-k, and some ECPs believe you don’t need a topographer to fit ortho-k. What do you see as the benefit of topography-led fitting and follow up over other methods?
It is categorically a massive NO if a practitioner thinks that you should approach fitting orthokeratology without a topographer. There are minimum standards of care and this is essential equipment. In fact, at EyeSpace you will not be supplied with lenses unless you have a topographer and pass a certification course on the Learning Management Platform.
How does your chosen topographer, the Medmont Meridia™️, contribute to ortho-k success?
It saves me chair time, delivers amazing imaging and is fast and easy to use.
Understandably, many ortho-k newbies shy away from custom lens design. You’re an advocate for EyeSpace and their Forge Ortho-K lenses. What makes EyeSpace a good choice for both novice and experienced fitters?
It really comes down to why EyeSpace was made. It was designed by practitioners, myself included, to aid and support workflow, make our lives easier in the consulting room, reduce chair-time and produce great results. Prior to EyeSpace, everything was very manual and it was a barrier to adoption of Orthokeratology.
Dr Lallu, thanks for taking the time to answer our questions. We appreciate your insights, as a leader in myopia management. Medmont supports the advocacy of ortho-k best practice and spreading the word about the importance of early myopia intervention and management.
Jagrut Lallu, OD
A New Zealand-based optometrist known for orthokeratology and keratoconus, Dr Jagrut Lallu is partner of Rose Optometry in Hamilton. Most recently he was made an ambassador for the World Optometry Council (WCO). He has co-authored a textbook entry on corneal topography and has created online virtual learning modules with Deakin University. Dr Lallu is a clinical Senior Lecturer at the Deakin School of Optometry and is currently publishing on a variety of topics related to Orthokeratology, dry eye, red light therapy and machine learning. In 2023 Jagrut established the New Zealand Eye Research centre with a focus on clinical trials and research.