Mastering Myopia: Efficacy and Benefits of Orthokeratology in Myopia Control

Overview

Orthokeratology (ortho-k) has a robust evidence base demonstrating its efficacy in slowing myopia progression in children and teenagers, particularly those aged 6 to 16 years. It is effective across a range of refractive errors including moderate to high astigmatism and anisometropia, with additional quality-of-life benefits and a favorable safety profile.

Background

Myopia progression in children is a significant clinical concern due to its association with ocular complications later in life. Orthokeratology involves the use of specially designed contact lenses worn overnight to temporarily reshape the cornea, thereby reducing refractive error during the day. Since the first clinical trial published 20 years ago, ortho-k has been extensively studied and shown to slow axial elongation and vitreous chamber depth growth by approximately 50% over two years. It remains a key intervention alongside atropine and newer optical treatments for myopia management.

Data Highlights

Key Findings

• Ortho-k slows axial elongation and vitreous chamber depth growth by about 50% over two years in children and teens.
• Greatest efficacy is observed in younger children aged 6 to 8 years, with a low number needed to treat (1.8) to prevent rapid myopia progression.
• It uniquely controls myopia progression in patients with moderate to high astigmatism through toric lens designs.
• Partial ortho-k treatment combined with spectacles is effective in high myopes, matching full correction outcomes in lower myopes.
• Ortho-k reduces anisometropia progression by controlling growth of the more myopic eye.
• Combination therapy with low-dose atropine and treatment zone modification can provide an early “boost” in efficacy.
• Children report better vision-related quality of life with ortho-k compared to single-vision spectacles.
• Safety data indicate a low risk of microbial keratitis, potentially lower than overnight soft contact lens wear in adults.

Clinical Implications

Orthokeratology offers a versatile and effective option for myopia control, especially in younger children and those with astigmatism or anisometropia. Its safety profile and positive impact on quality of life make it a valuable treatment modality. Clinicians can consider ortho-k alone or in combination with low-dose atropine to optimize myopia management tailored to individual patient needs.

Conclusion

With two decades of evidence supporting its efficacy, safety, and patient satisfaction, orthokeratology remains a cornerstone in myopia management. Its unique benefits across diverse refractive profiles and potential for combination therapy underscore its enduring clinical value.

References

1. Cho et al, 2005 -- The longitudinal orthokeratology research in children (LORIC) pilot study
2. Sun et al, 2015 -- Orthokeratology to control myopia progression: a meta-analysis
3. Cho and Cheung, 2017 -- Protective role of orthokeratology in reducing risk of rapid axial elongation
4. Chen et al, 2013 -- Myopia control using toric orthokeratology (TO-SEE study)
5. Charm and Cho, 2013 -- High myopia-partial reduction ortho-k: a 2-year randomized study
6. Tsai et al, 2021 -- Effect of orthokeratology on anisometropia control: A meta-analysis
7. Tsai et al, 2022 -- Efficacy of atropine, orthokeratology, and combined atropine with orthokeratology
8. Guo et al, 2023 -- Variation of Orthokeratology Lens Treatment Zone (VOLTZ) Study
9. Santodomingo-Rubido et al, 2013 -- Myopia control with orthokeratology contact lenses in Spain
10. Yang et al, 2021 -- Vision-related quality of life of Chinese children undergoing orthokeratology
11. Bullimore et al, 2021 -- Pediatric microbial keratitis with overnight orthokeratology