A recent report by the American Academy of Ophthalmology suggests that orthokeratology (ortho-K) may be effective in slowing myopic progression for children and adolescents, with a potentially greater effect when initiated at an early age—at six to eight years old.

The review panel analyzed the published evidence to evaluate the ortho-K’s ability as a treatment to reduce myopic progression in children and adolescents compared with the use of spectacles or daytime contact lenses for standard refractive correction. The assessment included 13 studies that the panel deemed clinically relevant for full-text review.

In these studies, ortho-K typically reduced axial elongation by approximately 50% over a two-year study period. This corresponds to average axial length change values of about 0.3mm for ortho-K patients compared with 0.6mm for control patients, corresponding to a typical difference in refraction of about 0.5D. The reviewers believe that ortho-K may have a greater effect on younger age groups and individuals with larger than average pupil size.

The panel did notice that rebound could occur after discontinuation or change to alternative refractive treatment. While they recommend ortho-K, they concluded that practitioners and patients should discuss the possible safety risk of blinding microbial keratitis from contact lens wear.

VanderVeen DK,Kraker RT, Pineles SL, et al. Orthokeratology for the prevention of myopic progression in children: a report by the American Academy of Ophthalmology. Ophthalmology. November 23, 2018. [Epub ahead of print].