Update on orthokeratology in managing progressive myopia in children: Efficacy, mechanisms, and concerns

Myopia is an important public health issue, and high myopia may lead to severe complications if left untreated. Orthokeratology lenses, worn overnight to reshape the cornea, are one of many recent modalities used to slow down the progression of myopia in children. This treatment has been proven successful, as evidenced by decreased spherical refractive error and axial length relative to the control at interval follow-up ranging from 6 months to 5 years. In this systematic review, the authors collected published controlled studies that analyzed the efficacy of orthokeratology lens wear and calculated longitudinal relative changes in axial length, revealing a weighted average of -45.1% change in axial length at the 2-year follow-up. The exact mechanism by which orthokeratology lenses reduce myopia progression is unknown, but research shows that the corneal reshaping decreases peripheral hyperopic defocus and therefore increases peripheral myopic defocus to likely reduce stimuli for axial elongation and subsequent development of myopia. Use of orthokeratology lenses is generally safe, but cases of associated infectious keratitis may have a higher incidence of virulent organisms such as Pseudomonas, Acanthamoeba, and antibacterial-resistant strains of Staphylococcus, partially due to the required overnight use of these lenses. Orthokeratology is regarded as one of the most effective non-pharmacologic measures to slow progression of myopia in children and, with regular follow-up to ensure safety, continues to be one of the most effective treatments for myopia management around the world.