Corneal Refractive Surgery Considerations in Patients With History of Orthokeratology

To review the current literature describing corneal changes observed with orthokeratology (ortho-k) use and to formulate preliminary recommendations for these patients seeking corneal refractive surgery.

The literature search was conducted through the PubMed, Scopus, and Ovid databases through June 4, 2024, for articles regarding corneal physiological, tomographic, and biomechanical changes secondary to ortho-k use.

Forty-one articles were found describing several changes associated with ortho-k use, including higher corneal staining, central corneal epithelial thinning and midperipheral thickening, increased higher-order aberrations, decreased contrast sensitivity, reduced corneal hysteresis and corneal resistance factor, and alterations in the tear proteome. The majority of these parameters returned to baseline after ortho-k lens discontinuation, with timing potentially dependent on the amount of myopic correction, duration of ortho-k use, and age of lens fitting.

Despite the paucity of articles describing prior ortho-k patients undergoing corneal refractive surgery, it is evident that ortho-k use may potentially cause various corneal physiological, tomographic, and biomechanical changes in patients. Therefore, clinicians are advised to serially monitor ortho-k patients' refraction, tomography, pachymetry, and corneal biomechanics until stability is achieved before considering surgery.