Orthokeratology Use Factors Identified in a Pediatric Cohort

Orthokeratology use factors among children with myopia may depend on demographic characteristics, such as age and BMI.

Orthokeratology use factors among children and adolescents with myopia have been identified and include age, body mass index (BMI), and parental myopia, according to a study published in Eye.

Despite a growing body of research affirming the safety and efficacy of orthokeratology for managing myopia in pediatric patients, few studies have investigated usage rates and predictors for uptake.

Researchers enrolled children (N=72,920; mean age, 11.96 years; 50.97% boys) from 104 schools using cluster sampling in the cross-sectional study. Participants underwent ophthalmic examinations and provided information pertaining to demographics, vision correction methods used, and parental myopia status using a questionnaire. The team assessed orthokeratology use factors among the cohort.

Overall, 1021 participants (1.4%) reported using ortho-k lenses. Among patients who fit the criteria for orthokeratology treatment (-5.0≤ spherical equivalent [SE] ≤-1.0 diopter [D]; n=32,259), 3.1% actually received the therapy.

Public education is imperative so that the awareness of myopia control is increased in parents of young children and to help parents make informed decisions.

Among orthokeratology lens wearers, 53.0% were aged 10-13 years and 53.0% were in the target range of -3.0 to -1.0 D. In the potential population, orthokeratology lens use was higher among children aged 9 to 13 years (c2, 88.25; P <.001).

Orthokeratology treatment factors include starting refractive error correction at an age younger than 12 years (odds ratio [OR], 1.75; 95% CI, 1.31–2.33, P <.001) and parental myopia (either: OR, 2.09; 95% CI, 1.58–2.75; P < 0.001; both: OR, 3.94; 95% CI, 3.04–5.11, P <.001). Age was negatively associated with this myopia treatment modality (OR, 0.91; 95% CI, 0.88-0.95; P <.001), with 53.2% of users having ages between 10 and 13 years. Obesity also demonstrated a negative correlation with orthokeratology (OR, 0.48; 95% CI, 0.35–0.66; P <.001).

A total of 12.4% of individuals who chose orthokeratology treatment had a corrected logarithm of the minimum angle of resolution (logMAR) visual acuity of 0.3 or worse. Orthokeratology use factors independently associated with this visual acuity included a spherical equivalent correction target of −3.0 D or worse (OR 2.05; 95% CI, 1.38–3.05; P <.001) and a nightly sleep duration of 6 hours or less (OR, 4.19; 95% CI, 2.03–8.64; P <.001), according to the report.

“[Orthokeratology] is an effective method for myopia control, but for reasons related to safety and efficacy, examinations, health education and clinical follow-up of children who use these lenses must be strengthened,” according to the researchers. “Public education is imperative so that the awareness of myopia control is increased in parents of young children and to help parents make informed decisions.”

Study limitations include the use of noncycloplegic refraction and the potential for recall bias.


Zhao W, Wang J, Chen J, et al. The rate of orthokeratology lens use and associated factors in 33,280 children and adolescents with myopia: a cross-sectional study from Shanghai. Eye. Published online April 12, 2023. doi:10.1038/s41433-023-02503-1