Ortho-K Viable Option for Patients with Stable, Mild-to-Moderate Keratoconus

Overnight ortho-K lens wear is usually avoided in keratoconus patients, but this pilot study of 24 eyes found encouraging results in well-selected patients with stable, mild-to-moderate keratoconus. These images from the study show corneal topographic changes following ortho-K for keratoconus in one of the subjects. Photo: Zhang C, et al. Int Ophthalmol. April 17, 2026. Click image to enlarge. The safety and efficacy of orthokeratology (ortho-K) in patients with pathological corneal ectasia remain largely unexplored and potentially controversial, given the altered biomechanical properties of the keratoconic cornea. In a recent study, researchers assessed the efficacy and safety of ortho-K in 13 patients (24 eyes) aged 14 to 21 with stable, mild-to-moderate keratoconus and found that patients’ uncorrected visual acuity and refractive error showed rapid and sustained significant improvement. The findings were reported in International Ophthalmology.The patients were fitted with ortho-K lenses and monitored over an 18-month follow-up period. Visual improvements, corneal remodeling and safety, specifically regarding potential damage to Bowman's layer, were assessed.This study demonstrated that overnight ortho-K lens wear in patients with mild to moderate keratoconus induces characteristic corneal epithelial remodeling—central thinning and peripheral thickening—without causing a significant change in the cross-sectional area of Bowman’s layer. “Given that the core pathology of keratoconus involves structural disorganization and biomechanical weakening of the stromal collagen, these findings suggest that the mechanical effect of ortho-K may be primarily confined to the epithelial layer, without imposing a measurable additional impact on the already compromised deep stromal architecture,” the authors wrote in their paper.Uncorrected visual acuity significantly improved from 0.59 to 0.19 logMAR. Myopic refraction decreased significantly from -2.46D ±1.25D to -0.62D ±0.24D. Axial length remained stable (mean elongation: 0.14mm ±0.13mm).Regarding corneal remodeling, the treatment induced significant thinning in the central corneal epithelium and thickening in the nasal and temporal zones. “This confirms that even in keratoconic corneas with underlying stromal abnormalities, the corneal epithelium retains its plasticity in response to sustained mechanical stimuli,” the authors explained in their paper. “Notably, this remodeling exhibits a spatially complementary relationship to the typical pathological changes in early keratoconus, namely epithelial thinning at the cone apex accompanied by reactive thickening in the surrounding region.”The remodeled epithelial thickness profile remained stable over the 18-month follow-up period, suggesting that this active epithelial redistribution may enhance peripheral biomechanical support, partially counteracting the abnormal thickness distribution driven by anterior stromal protrusion. “This mechanism could contribute to the stabilization of overall corneal architecture and may partly explain the clinical safety profile of ortho-K observed in this cohort,” the authors wrote.Although total higher-order aberrations showed a clinically meaningful decreasing trend, the change did not reach statistical significance. The researchers noted this is likely due to the substantial inter-subject variability in higher-order aberrations among keratoconus patients, combined with the limited sample size of this study—leading to insufficient statistical power. “Nevertheless, this does not diminish the substantial clinical value of ortho-K in refractive control and visual improvement,” they wrote.No serious complications occurred. Five patients discontinued treatment due to visual symptoms (e.g., glare, halos, fluctuations) or intolerance issues like dry eye. A total of 23 episodes of mild corneal punctate staining were resolved with temporary lens discontinuation and pharmacological treatment.The study concludes that ortho-K is a viable, non-surgical adjunct for managing mild-to-moderate keratoconus in select patients, with successful application relying on personalized fitting, strict patient selection and education and standardized follow-up including corneal structural monitoring. Larger studies are warranted to elaborate on these findings. Click here for the journal source. Zhang C, Hu Z, Li W, et al. Orthokeratology for stable mild-to-moderate keratoconus: a pilot study on safety and corneal remodeling via quantitative OCT analysis. Int Ophthalmol. April 17, 2026. [Epub ahead of print.] This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.