Clinical Report: Orthokeratology Today

Overview

Orthokeratology (ortho-k) serves as a reversible, nonsurgical option for myopia control, significantly slowing axial elongation by an average of 50%. Key factors such as lens centration and treatment zone size are critical for optimizing myopia management in patients.

Background

The increasing prevalence of myopia, particularly in children, necessitates effective interventions to slow its progression and mitigate associated ocular health risks. Orthokeratology has emerged as a first-line optical option, offering both immediate visual correction and long-term myopia control. Understanding the mechanisms and fitting factors of ortho-k lenses is essential for clinicians to maximize patient outcomes.

Data Highlights

Ortho-k can slow myopia progression by an average of about 50% (Walline, 2016; Hiraoka et al, 2012; Swarbrick et al, 2015).

Evidence shows reduced axial elongation in patients wearing a lens design with a 5mm back optic zone diameter (BOZD) compared to a 6mm BOZD (Gong et al, 2024).

Key Findings

• Ortho-k lenses create myopic defocus, crucial for slowing axial elongation.
• Proper lens centration is vital for effective treatment and consistent vision.
• A smaller treatment zone may enhance myopia control due to increased peripheral higher-order aberrations.
• Low to moderate myopia (-0.50D to -4.50D) and up to -1.50D astigmatism are optimal for ortho-k candidates.
• Higher refractive errors may lead to partial correction and reduced vision.

Clinical Implications

Clinicians should prioritize proper lens fitting, including centration and treatment zone size, to optimize myopia control with ortho-k. Individual patient characteristics, such as refractive error and pupil size, must be considered when designing ortho-k lenses.

Conclusion

Orthokeratology represents a transformative approach to myopia management, combining effective vision correction with significant long-term benefits for ocular health. Continued advancements in lens design and fitting techniques will enhance its clinical application.

References

1. Hiraoka T, Eye Contact Lens, 2022 -- Myopia Control With Orthokeratology: A Review
2. Walline JJ, Eye Contact Lens, 2016 -- Myopia Control: A Review
3. Gong G, Eye Vis (Lond), 2024 -- Efficacy of orthokeratology lens with the modified small treatment zone
4. Cho P, Cheung SW, Invest Ophthalmol Vis Sci, 2012 -- Retardation of myopia in Orthokeratology (ROMIO) study
5. Swarbrick HA, Ophthalmology, 2015 -- Myopia control during orthokeratology lens wear in children
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