Orthokeratology slows myopic progression in young patients

This Ophthalmic Technology Assessment evaluated the ability of orthokeratology (ortho-K) treatment to reduce myopic progression compared with standard refractive correction (spectacles or daytime contact lenses).

Study design

Researchers performed a literature search for evidence on orthokeratology for treatment of myopia. Of the 162 citations identified, 13 were clinically relevant and were included in the analysis. There were 3 prospective, randomized clinical trials, 7 nonrandomized prospective comparative studies and 3 retrospective case series. The majority of evidence was level II (11 studies); the remaining 2 studies were level I and III.

Outcomes

The assessment demonstrated that ortho-K generally reduced the axial elongation by approximately 50% over a 2-year period. The impact was greater in individuals younger than 9 years. The rate of myopic progression was most affected in the first and second year of treatment, but some effects were still noted in the third year. None of the studies measured adverse events as a primary outcome.

Limitations

The most serious side effect—microbial keratitis—is still a concern. Contact lens wear is the most common cause for keratitis in children and most cases led to a permanent central corneal scar. The authors therefore recommend cautious use.

Clinical significance

Myopia control in children is important because rates of myopia continue to increase, especially in developed countries. Orthokeratology is effective in reducing myopia progression especially in children aged 6 to 8 years. However, all options for myopia control (atropine eye drops) should be discussed with the family.