March 1, 2026
By Dr. Nancy Huang
Photo generated by Gemini
Orthokeratology contact lenses have been effective for myopia control, reducing progression of spherical equivalent refraction (SER) and axial length (AL). However, overnight lens wear is associated with potential complications including ocular infection, corneal neovascularization, ocular surface abrasion and dry eye disease (DED).
Artificial tears are routinely recommended during OrthoK treatment to assist lens handling and relieve discomfort. This retrospective multi-centered cohort study from Taiwan compared 85 patients using hyaluronic acid (HA)-containing artificial tears with 95 patients using non-HA formulations over six-months of OrthoK treatment. Myopia control efficacy was assessed using SER and AL, while ocular surface status was evaluated using the Oxford corneal staining and the Ocular Surface Disease Index.
Baseline demographics and ocular surface measures were comparable between groups. The non-HA group demonstrated significantly greater ocular surface staining and more severe DED-related symptoms across visits, with no significant differences in myopia-control outcomes. The authors proposed that the higher molecular weight and viscosity of HA may reduce mechanical friction and provide anti-inflammatory benefits during OrthoK wear. However, an important limitation is that HA formulations were preservative-free, while non-HA formulations contained preservatives, which are known to compromise ocular surface health and may have contributed to the observed differences.
Clinically, these findings support the use of preservative-free, HA-containing artificial tears to improve ocular comfort and support adherence to OrthoK treatment.
Abstract
The Application of Hyaluronic Acid-containing Artificial Tears on the Ocular Surface of Children Receiving Orthokeratology Contact Lens Treatment
Purpose
The purpose of this study was to compare the effects of the application of hyaluronic acid (HA)-containing artificial tears and non-HA artificial tears on the ocular surface of children receiving orthokeratology contact lens treatment.
Method
Charts of patients fitted with orthokeratology contact lenses in any of 20 local clinics were reviewed in this retrospective cohort study. The patients were then categorized according to the artificial tear type used, resulting in 85 and 95 patients being placed into the non-HA and HA groups, respectively. The primary outcomes include fluorescein ocular surface staining and dry eye disease (DED)-related symptoms which were measured at 1, 3 and 6 months after orthokeratology contact lens treatment. An independent t test and Chi-square test were used for statistical analysis.
Results
At one month, there was a statistically significant greater number of non-HA patients with staining (14 non-HA, 4 HA, P=0.017). In the final visit, the incidence of ocular surface stain was also significantly lower in the HA group (12 non-HA, 2 HA, P = 0.010). At one month, there was a statistically significant greater number of non-HA patients with DED-related symptoms (24 non-HA, 12 HA, P = 0.029). Finally, the number of DED-related symptoms was significantly lower in the HA group (P = 0.005). After a 6-month follow-up, the spherical equivalent refraction (SER) and axial length (AXL) values between the two groups showed no significant difference (all P > 0.05).
Conclusions
The application of HA-containing artificial tears resulted in less ocular surface staining and fewer DED-related symptoms in children wearing overnight orthokeratology contact lenses.
DOI: 10.7150/ijms.113380
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Dr. Qianna (Nancy) Huang is a therapeutically-endorsed, AHPRA-registered optometrist and PhD candidate at the University of Melbourne. She works clinically as a staff optometrist and clinical educator at Melbourne Eyecare Clinic and ACO Eye Health, and as a research optometrist alongside her doctoral studies. Her research focuses on keratoconus, with particular interest in corneal inflammation, immune cell imaging, and translational biomarkers. Nancy’s clinical interests include anterior eye disease, ocular pathology, advanced contact lens practice, and myopia management, with a strong commitment to evidence-based care and research translation. |
