Japanese Journal of Ophthalmology

, Volume 62, Issue 3, pp 327–334 | Cite as

The effect of orthokeratology on axial length elongation in children with myopia: Contralateral comparison study

  • Miri Na
  • Aeri YooEmail author
Clinical Investigation



To evaluate the effectiveness of the orthokeratology (OK) lens slowing myopic progression compared with no intervention in pediatric eyes


A retrospective review of medical records was performed on 45 monocular myopic subjects 7 to 13 years of age who were treated with monocular ortho-k lens and followed-up for more than 12 months. The monocular myopia in the subjects’ eyes was -0.75 to -4.25 D (diopter), and near emmetropia in the contralateral and with-the-rule astigmatism no greater than -1.50 D. Axial elongation OU, reflecting the progression of myopia was measured at baseline using the same AL-Scan Optical Biometer and compared between the two eyes of each individual every six months for one year in all subjects and for two years in 9 subjects.


After 12 months of lens wear, axial length had increased by 0.36 ± 0.23mm in the control eyes (P < 0.001) but showed far less change (+0.07 ± 0.21 mm) in the OK eyes (P = 0.038). The nine subjects followed-up for 2 years showed no axial length change (+0.16 ± 0.25 mm) in the OK eyes (P = 0.095) after 24 months and significant axial length growth (+0.38 ± 0.26 mm; P = 0.002) in the control eyes. Control eyes showed progressive axial length growth throughout the study compared with the one OK lens eye.


Using a contralateral eye study design, which prevented the influence of potential confounding factors, Effectiveness of the OK lens was proved. Myopic progression within a subject was excellent compared with no intervention


Orthokeratology Myopia progression Myopia control Axial length 




Financial disclosure

The authors have no financial or proprietary interest in any of the materials or methods discussed in this study.

Conflicts of interest

M. Na, None; A. Yoo, None.


  1. 1.
    Kempen JH, Mitchell P, Lee KE, Tielsch JM, Broman AT, Taylor HR, et al. The prevalence of refractive errors among adults in the United States, Western Europe, and Australia. Arch Ophthalmol. 2004;122:495–505.CrossRefPubMedGoogle Scholar
  2. 2.
    He M, Xiang F, Zeng Y, Mai J, Chen Q, Zhang J, et al. Effect of time spent outdoors at school on the development of myopia among children in china: a randomized clinical trial. JAMA. 2015;314:1142–8.CrossRefPubMedGoogle Scholar
  3. 3.
    Morgan IG, Ohno-Matsui K, Saw SM. Myopia. Lancet. 2012;379:1739–48.CrossRefPubMedGoogle Scholar
  4. 4.
    Li SM, Ji YZ, Wu SS, Zhan SY, Wang B, Liu LR, et al. Multifocal versus single vision lenses intervention to slow progression of myopia in school-age children: a meta-analysis. Surv Ophthalmol. 2011;56:451–60.CrossRefPubMedGoogle Scholar
  5. 5.
    Li SM, Kang MT, Wu SS, Meng B, Sun YY, Wei SF, et al. Studies using concentric ring bifocal and peripheral add multifocal contact lenses to slow myopia progression in school-aged children: a meta-analysis. Ophthalmic Physiol Opt. 2017;37:51–9.CrossRefPubMedGoogle Scholar
  6. 6.
    Saw SM, Gazzard G, Au Eong KG, Tan DT. Myopia: attempts to arrest progression. Br J Ophthalmol. 2002;86:1306–11.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Song YY, Wang H, Wang BS, Qi H, Rong ZX, Chen HZ. Atropine in ameliorating the progression of myopia in children with mild to moderate myopia: a meta-analysis of controlled clinical trials. J Ocular Pharmacol. 2011;27:361–8.CrossRefGoogle Scholar
  8. 8.
    Huang J, Wen D, Wang Q, McAlinden C, Flitcroft I, Chen H, et al. Efficacy comparison of 16 interventions for myopia control in children: a network meta-analysis. Ophthalmology. 2016;123:697–708.CrossRefPubMedGoogle Scholar
  9. 9.
    Si JK, Tang K, Bi HS, Guo DD, Guo JG, Wang XR. Orthokeratology for myopia control: a meta-analysis. Optom Vis Sci. 2015;92:252–7.CrossRefPubMedGoogle Scholar
  10. 10.
    He M, Du Y, Liu Q, Ren C, Liu J, Wang Q, et al. Effects of orthokeratology on the progression of low to moderate myopia in Chinese children. BMC ophthalmol. 2016;16:126.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Sun Y, Xu F, Zhang T, Liu M, Wang D, Chen Y, et al. Orthokeratology to control myopia progression: a meta-analysis. PloS One. 2015;10:e0124535.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Swarbrick HA, Alharbi A, Watt K, Lum E, Kang P. Myopia control during orthokeratology lens wear in children using a novel study design. Ophthalmology. 2015;122:620–30.CrossRefPubMedGoogle Scholar
  13. 13.
    Cheung SW, Cho P, Fan D. Asymmetrical increase in axial length in the two eyes of a monocular orthokeratology patient. Vision Res. 2004;81:653–6.Google Scholar
  14. 14.
    Hashemi H, Khabazkhoob M, Emamian MH, Shariati M, Abdolahi-nia T, Fotouhi A. All biometric components are important in anisometropia, not just axial length. Br J Ophthalmol. 2013;97:1586–91.CrossRefPubMedGoogle Scholar
  15. 15.
    Zeng J, Cui Y, Li J, Xie W, Li Z, Zhang L, et al. Correlation of axial length and corneal curvature with diopter in eyes of adults with anisometropia. Int J Clin Exp Med. 2015;8:13639–43.PubMedPubMedCentralGoogle Scholar
  16. 16.
    Smith EL 3rd, Hung LF, Huang J. Relative peripheral hyperopic defocus alters central refractive development in infant monkeys. Vision Res. 2009;49:2386–92.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Liu Y, Wildsoet C. The effect of two-zone concentric bifocal spectacle lenses on refractive error development and eye growth in young chicks. Invest Ophthalmol Vis Sci. 2011;52:1078–86.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Zhu MJ, Feng HY, He XG, Zou HD, Zhu JF. The control effect of orthokeratology on axial length elongation in Chinese children with myopia. BMC ophthalmol. 2014;14:141.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Paune J, Morales H, Armengol J, Quevedo L, Faria-Ribeiro M, Gonzalez-Meijome JM. Myopia control with a novel peripheral gradient soft lens and orthokeratology: a 2-year clinical trial. Biomed Res Int. 2015;2015:507572.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Chan KY, Cheung SW, Cho P. Orthokeratology for slowing myopic progression in a pair of identical twins. Cont Lens Anterior Eye. 2014;37:116–9.CrossRefPubMedGoogle Scholar
  21. 21.
    Deng L, Gwiazda J, Manny RE, Scheiman M, Weissberg E, Fern KD, et al. Limited change in anisometropia and aniso-axial length over 13 years in myopic children enrolled in the correction of myopia evaluation trial. Invest Ophthalmol Vis Sci. 2014;55:2097–105.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Kang P, Swarbrick H. Peripheral refraction in myopic children wearing orthokeratology and gas-permeable lenses. Optom Vis Sci. 2011;88:476–82.CrossRefPubMedGoogle Scholar
  23. 23.
    Lyu Byul, Hwang Kyu Yeon, Kim Sun Young, Kim Su Young, Na Kyung Sun. Effectiveness of toric orthokeratology in the treatment of patients with combined myopia and astigmatism. Korean J Ophthalmol. 2016;30:434–42.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Chen Z, Xue F, Zhou J, Qu X, Zhou X. Effects of orthokeratology on choroidal thickness and axial length. Optom Vis Sci. 2016;93:1064–71.CrossRefPubMedGoogle Scholar

Copyright information

© Japanese Ophthalmological Society 2018

Authors and Affiliations

  1. 1.Department of OphthalmologySaevit Eye HospitalGoyangRepublic of Korea

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