ALTHOUGH ORTHOKERATOLOGY (ortho-k) has been used in clinical practice since the 1960s, there have been many advancements since its inception. Most notably, ortho-k lenses are now available in highly oxygen permeable materials and can be custom designed using advanced corneal mapping, improving both patient outcomes and practitioner efficiency. The future of ortho-k is poised to be exciting, thanks to many groundbreaking innovations that will undoubtedly lead to a new era of more personalized patient care and better outcomes.
As myopia prevalence continues to rise across the globe, the need for effective myopia control options will also rise. Ortho-k has been shown to slow myopia progression by slowing axial elongation between 40% and 60% (Lipson et al, 2018). It is currently viewed by parents and practitioners as an ideal option for children who desire or need freedom from daytime correction or for younger children who require assistance during contact lens wear.
More recently, studies are being conducted to determine whether combination therapy with low-dose atropine provides additional myopia control benefits. These trials have confirmed that 0.01% atropine in combination with ortho-k is more effective than ortho-k alone (Xu et al, 2023; Tang et al, 2024; Sánchez-González et al, 2020). Despite the benefit of adding atropine to ortho-k, no combination of treatment modalities has yet to show 100% efficacy in controlling myopia progression.
Combination therapy may be most beneficial for high-risk children—myopes demonstrating rapid progression with monotherapy, high myopes (–6.00 D or higher), younger myopes, or children who have a strong family history of high myopia (Sankaridurg et al, 2025). Future studies will likely discern the ideal patient profile for which combination therapy will be most beneficial and further explore the most effective atropine dosage.
A second path of potential growth for ortho-k is the more widespread use of those lenses for both hyperopia and presbyopia. The appeal of ortho-k for these patients may be even greater, because many of them are grappling with the idea of needing vision correction for the first time in their adult life. For hyperopic ortho-k, the opposite of myopic ortho-k occurs. Instead of central compression and midperipheral thickening, the central epithelial tissue is thickened and the midperipheral tissue is compressed to create a plus lens effect. For presbyopic ortho-k, the lens design essentially creates multifocality by mimicking either a center-distance or center-near multifocal contact lens after reshaping both the central and midperipheral cornea.
Currently, there are a limited number of commercial manufacturers producing these lens designs. In addition, patient selection is crucial; patients must be motivated, and expectations should be appropriately managed to prevent frustration for both the patient and the practitioner. As technology and lens designs continue to advance, this area of ortho-k is likely to experience further growth in the coming years.
While talking about the future, it would be remiss not to mention the potential benefits of artificial intelligence (AI). A recent study explored the use of AI to assist with ortho-k fitting. An algorithm was created using 11,502 records from 7,376 ortho-k patients (Lan et al, 2024). Both new and experienced clinicians (7 total) tested the algorithm and concluded that it significantly decreased the number of trial lenses needed to determine the final lens in all but 1 clinician. Theoretically, use of a standardized algorithm should improve clinical efficiency and reduce discrepancies in clinical success among new and seasoned ortho-k fitters.
Ortho-k has been a mainstay treatment option for myopia control for several years. With continued advancements, ortho-k will undoubtedly provide more sophisticated, successful treatment outcomes not only for myopic patients but also for those who have a variety of different refractive needs.
References
1. Lipson MJ, Brooks MM, Koffler BH. The role of orthokeratology in myopia control: a review. Eye Contact Lens. 2018;44(4):224-230. doi: 10.1097/ICL.0000000000000520
2. Xu S, Li Z, Zhao W, et al. Effect of atropine, orthokeratology and combined treatments for myopia control: a 2-year stratified randomised clinical trial. Br J Ophthalmol. 2023;107(12):1812-1817. doi: 10.1136/bjo-2022-321272
3. Tang T, Lu Y, Li X, et al. Comparison of the long-term effects of atropine in combination with orthokeratology and defocus incorporated multiple segment lenses for myopia control in Chinese children and adolescents. Eye (Lond).2024;38(9):1660-1667. doi: 10.1038/s41433-024-02987-5
4. Sánchez-González JM, De-Hita-Cantalejo C, Baustita-Llamas MJ, Sánchez-González MC, Capote-Puente R. The combined effect of low-dose atropine with orthokeratology in pediatric myopia control: review of the current treatment status for myopia. J Clin Med. 2020;9(8):2371. doi: 10.3390/jcm9082371
5. Sankaridurg P, Chia A, Kang P. Should combination treatments be the standard of care to maximise efficacy for myopia treatment? Ophthalmic Physiol Opt. 2025. doi: 10.1111/opo.13474.
6. Lan WZ, Tang H, Wen LB, et al. Artificial intelligence-assisted prescription determination for orthokeratology lens fitting: from algorithm to clinical practice. Eye Contact Lens. 2024;50(7):297-304. doi: 10.1097/ICL.0000000000001091
