Ortho-K Displays More Favorable Outcomes in Older Children

An average AL increase in one year for children under the age of 11 with lower initial myopia (> -3.00D) was 0.35mm ±0.16mm, which was a less favorable outcome than in older children. Photo: Langis Michaud, OD. Click image to enlarge. Potential avenues of myopia control are multifaceted, and it is not always easy to pick an option that clearly stands out against the others. Of course, every modality may offer its own set of advantages and setbacks, and orthokeratology (ortho-K) lenses are no different. In a recently published study in Frontiers in Medicine, researchers retrospectively analyzed factors affecting outcomes upon ortho-K treatment.The investigation included 200 kids aged eight to 15 with spherical equivalent (SE) refraction from -1.00D to -6.00D and binocular anisometropia less than -1.00D. Multiple factors were analyzed to determine what was associated with changes in axial length (AL) over a one-year period. Mean AL growth after one year was 0.20mm ±0.16mm, with baseline age and SE being significant predictors of change in AL. Further subgroup analysis revealed that kids over age 11 with a baseline SE greater than -3.00D had the most favorable treatment outcomes. Lens decentration patterns were also significantly correlated with treatment efficacy.The researchers mentioned in the paper that the mean AL seen is consistent with prior literature and represents around a 40% to 50% reduction in expected progression in untreated myopic kids. As the study authors explain, this degree of reduction is significant, since a decrease of 0.1mm in annual axial growth maps onto about 0.25D to 0.30D less progression per year. Over time, high myopia and the risk of developing associated sight-threatening complications would be reduced. The link seen here of baseline age and treatment outcomes suggests older kids respond more favorably to ortho-K. They attribute this to potentially being true due to factors of better lens wear compliance, stabler corneal biomechanics and maybe even different peripheral defocus patterns in older kids.The interesting finding that worse baseline SE (≤ -3.00D) correlated with better response is contrary to the traditional thought of early intervention offering better preventive care. The authors believe this may be the case due to peripheral myopic defocus induced by ortho-K, which may be more pronounced in higher myopic eyes because of the greater extent of corneal reshaping needed.Finally, temporal decentration more than 0.5mm was found linked to improved treatment outcomes. This adds to existing evidence that peripheral refraction profiles induced by lens positioning significantly influences efficacy of myopia control. For this observation, they offer the explanation that the benefit may come a from resultant asymmetric peripheral refraction profile. When the lens is decentered slightly temporally, a stronger myopic defocus is created in the nasal retina, which may be an area more responsive to defocus signals for ocular growth regulation. What’s more, temporal decentration could optimize functional optics of treatment via better aligning with natural temporal displacement of the visual axis relative to the pupillary axis.“This finding carries important clinical implications, suggesting that slight temporal decentration could be beneficial in ortho-K lens fitting, rather than detrimental,” the investigators hypothesized.They added that, in general, “the identified age and refractive error thresholds can help clinicians predict treatment outcomes more accurately and adjust management strategies accordingly.”Click here for the journal source. Wang F, Wang W, Yin C, et al. Factors affecting myopia control outcomes with orthokeratology treatment in children: a retrospective analysis. Front Med. 2025;12:1580023.