February 1, 2024
By Dwight Akerman, OD, MBA, FAAO, FBCLA, FIACLE
Photo Credit: Konstantin Iuganov, Dreamstime
Myopia is a common condition among children and adolescents that can lead to serious eye disease later in life. In recent years, there has been growing interest in the use of orthokeratology to control myopia progression in children. A new meta-analysis of randomized controlled trials conducted by Li et al. (2023) has evaluated the effectiveness of OrthoK in controlling juvenile-onset myopia.
There are many studies on the effectiveness of OrthoK in controlling myopia progression, but there are differences in follow-up time, research design, research objectives, etc. This study aimed to minimize these differences and systematically evaluate research on OrthoK in controlling the progression of myopia in school-age children.
The meta-analysis included 14 randomized controlled trials with a total of 2,058 children included. The studies were conducted in various countries, including China, Korea, Taiwan, and the United States. The participants were children and adolescents aged 6 to 18 years with myopia of varying degrees. The studies compared the use of OrthoK lenses with other types of lenses or no treatment.
The meta-analysis found that OrthoK was effective in slowing down the progression of myopia in children. The amount of ocular axis change after two years of lens wear was evaluated. The pooled mean difference in axial length elongation (ocular axis change) after two years between the OrthoK group and the control group was -0.53 mm (95% CI, -0.96 to -0.11). This means that the axial length of the eye, which is a measure of myopia progression, increased by 0.53 mm less in the OrthoK group compared to the control group after two years of wearing OrthoK.
Interestingly, from 2015–2016, there were four meta-analyses published summarizing the effects of OrthoK on myopia progression over two years of treatment. 1-4 The treatment effect for each meta-analysis is very similar and lower than found in the Li et al. (2023) meta-analysis.
Si et al.:1 –0.26 mm (95 % CI: –0.31 to –0.21 mm)
Sun et al.:2 –0.27 mm (95 % CI: –0.32 to –0.22 mm)
Wen et al.:3 –0.25 mm (95 % CI: –0.30 to −0.21 mm)
Li et al.:4 –0.27 mm (95 % CI: –0.32 to –0.23 mm)
The authors concluded that OrthoK is a promising option for controlling juvenile-onset myopia, especially those with moderate to high myopia. However, they noted that the long-term effects of OrthoK on visual function and ocular health are still uncertain and require further investigation. They also emphasized the importance of proper fitting, monitoring, and follow-up of OrthoK lenses to ensure optimal performance and safety.
Abstract
Orthokeratology in Controlling Myopia of Children: A Meta-Analysis of Randomized Controlled Trials
Xue Li , Meiling Xu , Shanshan San , Lanzheng Bian , Hui Li
Background: Delaying the development and lowering the progression of myopia in children is the focus of current ophthalmology research. We aimed to evaluate the role of orthokeratology in controlling myopia in children and to provide insights into the clinical treatment and care of children with myopia.
Methods: Two investigators searched the Cochrane Library, Embase, Pubmed, China national knowledge infrastructure, China biomedical literature database, WanFang and Weipu databases for randomized controlled trials (RCTs) on the role of orthokeratology in controlling myopia of children up to November 5, 2022. Two researchers independently searched, screened, and extracted the studies according to the inclusion and exclusion standards. RevMan5.3 software was used for statistical analysis.
Results: A total of 14 RCTs involving 2058 children were included in this meta-analysis. Synthesized outcomes indicated that orthokeratology improved the uncorrected visual acuity(MD = 0.40, 95%CI: 0.05 ~ 0.74), reduced the diopter change(MD=-3.19, 95%CI: -4.42~-1.95), changes of corneal curvature(MD=-3.21, 95%CI: -3.64~-2.79), the length of ocular axis (MD=-0.66, 95%CI: -1.27~-0.06) and amount of ocular axis change(MD=-0.42, 95%CI: -0.64~-0.21) after 1 year of wearing orthokeratology(all P < 0.05). Besides, orthokeratology reduced the diopter change (MD=-3.22, 95%CI: -4.86~-1.58), the length of ocular axis (MD=-1.15, 95%CI: -2.25~-0.06), and the amount of ocular axis change after 2 years of wearing orthokeratology (MD=-0.53, 95%CI: -0.96~-0.11) after 2 years of wearing orthokeratology (all P < 0.05). No publication biases were found amongst the synthesized outcomes (all P > 0.05).
Conclusions: Orthokeratology delays the progression of myopia in children. The long-term effects of orthokeratology need further investigations in future studies.
Li, X., Xu, M., San, S., Bian, L., & Li, H. (2023). Orthokeratology in controlling myopia of children: a meta-analysis of randomized controlled trials. BMC ophthalmology, 23(1), 441.
DOI: https://doi.org/10.1186/s12886-023-03175-x
References
1 Si, J. K., Tang, K., Bi, H. S., Guo, D. D., Guo, J. G., & Wang, X. R. (2015). Orthokeratology for myopia control: a meta-analysis. Optometry and Vision Science, 92(3), 252-257.
2 Sun, Y., Xu, F., Zhang, T., Liu, M., Wang, D., Chen, Y., & Liu, Q. (2015). Orthokeratology to control myopia progression: a meta-analysis. PloS one, 10(4), e0124535.
3 Wen, D., Huang, J., Chen, H., Bao, F., Savini, G., Calossi, A., … & Wang, Q. (2015). Efficacy and acceptability of orthokeratology for slowing myopic progression in children: a systematic review and meta-analysis. Journal of ophthalmology, 2015.
4 Li, S. M., Kang, M. T., Wu, S. S., Liu, L. R., Li, H., Chen, Z., & Wang, N. (2016). Efficacy, safety and acceptability of orthokeratology on slowing axial elongation in myopic children by meta-analysis. Current eye research, 41(5), 600-608.
