February 23, 2026
By Ashley Tucker, OD, FAAO, FSLS
Image generated by Gemini
This 2026 systematic review and meta-analysis evaluated the effectiveness of orthokeratology lenses for slowing myopia progression in children and adolescents aged 6–18 years. The authors synthesized data from randomized and prospective controlled trials comparing OrthoK with single-vision spectacles, soft contact lenses, or conventional OrthoK designs, focusing primarily on changes in axial length as the key outcome.
Purpose
- To quantify the effect of OrthoK on axial elongation in myopic children.
- To explore whether modified OrhoK lens designs provide additional benefit over conventional designs.
Methods
- Comprehensive searches of PubMed, Embase, Web of Science, Scopus and Cochrane Library through April 2025.
- Included 15 clinical trials comprising 1,065 participants.
- Primary outcome: mean difference in axial length change between OrthoK and control groups.
- Subgroup analyses examined follow-up duration and lens design.
Key Findings
- Children wearing OrthoK lenses demonstrated significantly slower axial elongation than controls.
- At approximately 12 months, OrthoK reduced axial length growth by about 0.15 mm compared with single-vision correction.
- In studies with 24 months or longer follow-up, the axial length difference increased to roughly 0.19 mm, indicating a sustained treatment effect.
- Trials evaluating modified OrthoK designs (e.g., smaller optical zones or higher compression factors) showed an additional reduction in axial elongation of approximately 0.12 mm compared with conventional OrthoK designs, although the number of studies was limited.
- The treatment effect was generally consistent across age groups within the 6–18 year range.
Interpretation
- The magnitude of axial length reduction corresponds to a clinically meaningful slowing of myopia progression.
- The results support the concept that peripheral myopic defocus induced by OrthoK lenses plays a key role in eye growth regulation.
- Modified OrthoK designs may enhance treatment efficacy by increasing the strength or spatial distribution of peripheral defocus.
Limitations
- Most included studies were conducted in East Asian populations, limiting generalizability.
- Variability existed in study design, lens parameters and follow-up duration.
- Safety outcomes and adverse events were not uniformly reported.
Clinical Implications
- OrthoK is a validated and effective myopia control option for school-aged children.
- Expected treatment benefit is on the order of 0.15–0.20 mm less axial elongation over one to two years.
- Lens design selection and optimization may further improve outcomes.
- OrthoK should be considered as part of a comprehensive myopia management strategy that may also include lifestyle counseling and combination therapies.
Abstract
Effectiveness of Orthokeratology in Controlling Myopia in Adolescents Aged 6-18 Years: A Systematic Review and Meta-Analysis
Background
Global childhood myopia is rising, with longer axial length increasing ocular risks. Orthokeratology corrects vision and may slow axial elongation via peripheral defocus, but the efficacy of newer OK lens designs and long-term persistence of effect remain to be comprehensively evaluated.
Methods
Adhering to PROSPERO and PRISMA 2020, PubMed, Embase, Web of Science, Scopus, and Cochrane Library were searched through 18 April 2025. Included studies prospectively compared axial-length changes in children (6-18 years) with OK versus single-vision spectacles, soft contact lenses, or conventional OK. Hartung-Knapp-adjusted random-effects meta-analyses were performed, with subgroup, sensitivity, and leave-one-out analyses addressing heterogeneity.
Results
Fifteen trials (1,065 participants) met inclusion criteria. At 12 ± 2 months, OK slowed axial elongation by a pooled mean difference (MD) of – 0.15 mm (95% CI – 0.20 to – 0.10; I2 = 90.8%). Five studies with ≥ 24-month follow-up showed a sustained benefit (MD – 0.19 mm, – 0.32 to – 0.06; I2 = 79%). Four head-to-head trials suggested modified OK designs (e.g., smaller optical zones, higher compression factors) provided an additional – 0.12 mm (- 0.23 to – 0.01) at one year, after excluding one discordant soft-lens study. Funnel plots and Egger’s tests indicated no small-study bias. Most studies had low risk of bias; limitations included lack of masking and predominantly East-Asian samples.
Conclusions
Axial elongation in myopic children is reduced by approximately 0.15 mm in the first year with OK, and this effect persists for up to three years. Modified lens designs may offer additional benefit. Larger, multi-ethnic trials with long-term follow-up and standardised safety reporting are needed.
DOI: 10.1007/s10792-026-03976-1
