High Rate of Noncompliance in Orthokeratology Patients

Close up of man putting in contact lens.
More effective ways of educating orthokeratology patients on proper wear and care guidelines may help to improve compliance.

Compliance rates for orthokeratology (ortho-k) patients are low and plummeted after a year of wear, according to a study published in BMC Ophthalmology.

Researchers assessed 238 participants with ortho-k lenses and analyzed wear and care behaviors through a survey. They reported that adherence with wear and care behaviors was 19.7%, with patients self-reporting an adherence rate of 96.6%. Higher compliance was noted in those wearing the lenses for fewer than 12 months (P <.001). 

The average age of participants was 11.3 years with a range of 7 to 25 years. No associations between adherence and age, sex, or lens care operator were observed.

Investigators examined adherence rates at different time periods during the first year of use and found no significant differences indicating that adherence to wear and care behaviors is consistently low, despite 96.6% of patients claiming to practice compliance.

Categories showing the poorest adherence during the first year of wear included  “lens case replacement according to ECPs’ recommendation” and “removal of lens deposition interval according to ECPs’ recommendation.” Adherence with regard to “avoiding exposure of lenses to non sterile solutions” decreased dramatically after 1 year.

“While some noncompliance was unintentional, some patients were intentionally noncompliant,” according to the researchers. “Therefore, it is important to re-examine ortho-k lenses patients’ wear and care practices to identify the wear and care behaviors that wearers are not following.”

Study limitations include convenience sampling, a single center design, and the inability to pinpoint specific reasons for the decline in compliance.


Bian Z, Xu X, Chen D, Ni H. Assessment of patient compliance in Orthokeratology and analysis of influencing factors: A cross-sectional study. BMC Ophthalmology. Published online November 16, 2021. doi:10.1186/s12886-021-02148-2