Long-term effects of orthokeratology on moderate myopia progression in children: A 3-year prospective study

Myopia is a global health concern, with an increasing prevalence in pediatric populations. Orthokeratology (OK) lenses have been explored as a non-invasive intervention that may slow axial elongation and improve refractive outcomes in children with myopia, potentially through peripheral retinal defocus remodeling. The present prospective cohort study evaluated the impact of OK lens wear on axial length, refractive error and visual parameters in myopic children over a 3-year period. A total of 188 myopic children <18 years of age (100 males; 88 females; mean age, 12.5±2.1 years), with baseline spherical equivalent refractive errors ranging from -1.00 to -6.00 D were enrolled. Participants were fitted with OK lenses and monitored at 1 week, 1 month and every 3 months thereafter to monitor compliance, assess lens fit and address any adverse events. Axial length increased from 24.12±0.63 mm at baseline to 24.70±0.12 mm over 36 months (mean elongation, 0.58 mm; P<0.01). Refractive error improved from -3.25±1.05 to -2.82±0.18 D (mean change, +0.43 D; P<0.01). Patient compliance levels were categorized according to adherence and adverse effects: High (n=120), moderate (n=50) and low (n=18). Compliance significantly influenced outcomes, with highly compliant participants having a lower mean axial elongation (0.35±0.07 mm) compared with that of participants with the lowest compliance (0.72±0.12 mm; P<0.01). Adverse events were infrequent, including corneal staining (n=15; 8.0%), lens intolerance (n=10; 5.3%) and conjunctival redness (n=20; 10.6%). The mean resolution time of these adverse effects ranged from 3.2 to 6.0 days. These findings indicate that OK lenses significantly improved refractive error and visual acuity in children with myopia. Compliance was identified as a critical factor influencing treatment efficacy. Therefore, it is suggested that OK should be considered an integral component of moderate myopia management protocols for pediatric patients.