Clinical Scorecard: Mastering Myopia: A Love Letter to Orthokeratology

At a Glance

Key Highlights

• Orthokeratology slows myopia progression by approximately 50% over 2 years in children aged 6-16 years.
• Effective for low-to-moderate myopia, moderate to high astigmatism (1.25 to 3.50 DC), anisometropia, and partial correction in high myopia (>6 D).
• Demonstrates improved quality of life compared to single-vision spectacles and has a favorable safety profile with low microbial keratitis risk (~5 per 10,000 patient years).

Guideline-Based Recommendations

Diagnosis

• Assess myopia progression via axial length and refractive error measurements in children aged 6-16 years.
• Evaluate presence and degree of astigmatism and anisometropia to determine suitability for ortho-k.

Management

• Initiate orthokeratology lens wear, especially in children aged 6-8 years for maximal efficacy.
• Consider toric ortho-k lenses for moderate to high astigmatism and partial correction strategies for high myopia.
• Combine ortho-k with low-dose atropine (0.01%) for potential additive efficacy in the first 6 months.
• Tailor treatment zone size to optimize myopia control outcomes.

Monitoring & Follow-up

• Regular follow-up to monitor axial length progression and ocular health.
• Monitor for signs of microbial keratitis and other complications, emphasizing hygiene and lens care.
• Evaluate patient satisfaction and quality of life periodically.

Risks

• Risk of microbial keratitis approximately 5 per 10,000 patient wearing years in pediatric ortho-k.
• Potential adaptation effects within first 6 months of combined treatments requiring close observation.

Patient & Prescribing Data

Children and teenagers with progressing myopia, including those with astigmatism, anisometropia, and high myopia

Orthokeratology is effective as monotherapy or combined with low-dose atropine, improves quality of life compared to spectacles, and is adaptable to various refractive profiles with a strong safety record.

Clinical Best Practices

• Start ortho-k treatment early, ideally between ages 6 and 8, to maximize myopia control benefits.
• Use toric ortho-k lenses for patients with moderate to high astigmatism to maintain efficacy.
• Implement partial correction ortho-k in high myopes with residual spectacle correction.
• Consider combination therapy with atropine 0.01% for enhanced early treatment effect.
• Educate patients and caregivers on lens hygiene to minimize infection risk.
• Regularly assess treatment zone size and adjust to optimize myopia control.

References

• Cho et al, 2005 - Pilot study on ortho-k for myopia control
• Sun et al, 2015 - Meta-analysis on ortho-k efficacy
• Cho and Cheung, 2017 - Protective role of ortho-k in axial elongation
• Chen et al, 2013 - Toric orthokeratology for astigmatism
• Charm and Cho, 2013 - Partial reduction ortho-k in high myopia
• Tsai et al, 2021 - Ortho-k effect on anisometropia
• Tsai et al, 2022 - Combined atropine and ortho-k efficacy
• Guo et al, 2023 - Variation of ortho-k lens treatment zone
• Santodomingo-Rubido et al, 2013 - Quality of life with ortho-k
• Yang et al, 2021 - Vision-related quality of life in ortho-k
• Bullimore et al, 2021 - Pediatric microbial keratitis risk in ortho-k
• Stapleton et al, 2008 - Contact lens-related microbial keratitis incidence
• Chua et al, 2006 - Atropine for childhood myopia
• Sankaridurg et al, 2023 - IMI 2023 Digest on myopia management