Ortho-k for myopia control in children
- There is strong evidence for ortho-k in myopia control for children aged 6-14 years.
- Children who start wearing ortho-k from age 6-8 receive the greatest benefit for slowing myopia progression.
- Ortho-k is safe for children, as long as wear and care systems are followed.
- The research reveals that ortho-k wear should ideally be continued until at least age 14. If it is stopped sooner than this, a ‘rebound’ effect can occur where myopia progression can commence again, at an accelerated rate.
In this article
In children, ortho-k has been shown to slow myopia progression with only marginal increase in time required to achieve successful lens fit compared to adults.
- Myopia control in children
- Ortho-k for children
- Ortho-k for myopia control in children
- How does ortho-k compare to other myopia control options?
- When should I consider starting ortho-k to slow myopia progression in my child?
- How do I know if ortho-k is working to slow myopia progression in my child?
- Is ortho-k for myopia control safe in children?
- What happens if ortho-k for myopia control in children is stopped?
Myopia control in children
Myopia, also known as short-sightedness or near-sightedness, causes vision to become blurred in the long distance, and the need for glasses or contact lenses to bring the eye back into focus.
In most cases, myopia starts in childhood, and then progressively increases typically up until early adulthood when it stabilizes.1 Myopia is a lifelong condition and increases risk of potentially sight threatening conditions in later life, causing the World Health Organization to classify myopia as a global health concern.2
'Myopia control' has become the increasingly adopted term to describe any approach that aims to slow progression of myopia. Myopia control is particularly important in children, because this is the stage in life when myopia is most likely to progress or worsen quickly. Taking action to control progression of myopia in children during this fast progression stage in their life will therefore likely achieve the most gains.3
Ortho-k for children
Ortho-k is a special type of rigid contact lens which is worn overnight, while sleeping, to gently reshape the cornea (the clear dome at the front of the eye) so that daytime wear of glasses or contact lenses is not needed.4
As a way to correct vision, ortho-k was first tried back in the 1960's when it was predominantly used in adults. In more recent years there has been a marked increase in children wearing ortho-k, because of its proven ability to slow progression of myopia.5
Ortho-k has been shown to be safe way to correct vision in children, with a low risk of problems.6,7
Ortho-k for myopia control in children
How ortho-k slows progression of myopia is not fully understood, however the current consensus is that it favorably alters the way light is focused onto the retina. In addition to correcting myopia, the focus pattern created by ortho-k is believed to send a stop signal to the eye to slow down eye growth.8
The main reason for myopia developing and progressing in children is because the eye grows faster than it should, which causes the eye to fall out of focus. Eye growth is typically fastest at this stage of life than any other.1 Consequently myopia can quickly progress in children when standard (non myopia control) glasses or contact lens vision correction is used.
Research reveals ortho-k to provide a 50% myopia control effect, meaning that it can slow progression of myopia by around half. At this age when eye growth is typically fast, this offers the potential to achieve a greater myopia control effect than if ortho-k is started at an older age when eye growth tends to naturally slow.9
Read more about how ortho-k provides a myopia control effect in our article Ortho-k for myopia control.
How does ortho-k compare to other myopia control options
There are a growing number of ways that your child's myopia can be corrected while providing a myopia control effect, including special types of spectacles, soft contact lenses and atropine eye drops.
Ortho-k is one of the best currently available options for myopia control, with the largest amount of research to support its ability to slow myopia progression.10
Read more about how ortho-k compares to other myopia control options in our article Which is the best option for myopia control.
When should I consider starting ortho-k to slow myopia progression in my child
The short answer is that a child should ideally benefit from myopia control as soon as they become myopic. Children will benefit more from myopia control at a younger age because myopia progresses faster in younger eyes.10
There is strong evidence for ortho-k in myopia control for children aged 6-14 years,4,9 and children who start wearing ortho-k from age 6-8 receive the greatest benefit for slowing myopia progression.11
Read more about starting myopia control in our article When should we start myopia control and when should we stop?
How do I know if ortho-k is working to slow myopia progression in my child
Myopia control aims to slow down myopia progression. No treatment can promise to stop myopia progression. Myopia progression can be measured by refraction (the power of glasses or contact lenses) and axial length (front-to-back measure of the eye).10
In ortho-k, refraction is altered to correct vision during waking hours, so if ortho-k is working well then there will be a minimal refraction to measure. A stable refraction over time can indicate minimal myopia progression, but a more accurate outcome is found by measuring axial length and comparing changes over time to published research data.
Is ortho-k for myopia control safe in children
Yes, ortho-k is safe for children, as long as correct wear and care systems are followed. You do need to be aware that ortho-k increases risk of eye infection, however, current research reveals this to be low at around 1-2 cases of corneal eye infection per 2,000 patient wearing years.6,7
To read more about safety of ortho-k in children see the section on safety in our article ortho-k for children
What happens if ortho-k for myopia control in children is stopped
The research reveals that ortho-k wear should ideally be continued until at least age 14. If it is stopped sooner than this, a ‘rebound’ effect can occur where myopia progression can commence again, at an accelerated rate.12
Once ortho-k is started in children it should ideally not be stopped. If wear is stopped then it is important for children to be monitored closely by an optometrist or eye doctor, and ideally receive an alternative myopia control option like specially designed spectacles, soft contact lenses and atropine eye drops.
- Hou W, Norton TT, Hyman L, Gwiazda J; COMET Group. Axial Elongation in Myopic Children and its Association With Myopia Progression in the Correction of Myopia Evaluation Trial. Eye Contact Lens. 2018 Jul;44(4):248-259. (link)
- The impact of myopia and high myopia. Report of the Joint World Health Organization-Brien Holden Vision Institute Global Scientific Meeting on Myopia. 2015 (link)
- Gifford KL, Richdale K, Kang P, Aller TA, Lam CS, Liu YM, Michaud L, Mulder J, Orr JB, Rose KA, Saunders KJ, Seidel D, Tideman JWL, Sankaridurg P. IMI - Clinical Management Guidelines Report. Invest Ophthalmol Vis Sci. 2019 Feb 28;60(3):M184-M203. (link)
- Vincent SJ, Cho P, Chan KY, Fadel D, Ghorbani-Mojarrad N, González-Méijome JM, Johnson L, Kang P, Michaud L, Simard P, Jones L. CLEAR - Orthokeratology. Cont Lens Anterior Eye. 2021 Apr;44(2):240-269. (link)
- Efron N, Morgan PB, Woods CA, Santodomingo-Rubido J, Nichols JJ; International Contact Lens Prescribing Survey Consortium. International survey of contact lens fitting for myopia control in children. Cont Lens Anterior Eye. 2020 Feb;43(1):4-8. (link)
- Bullimore MA, Sinnott LT, Jones-Jordan LA. The risk of microbial keratitis with overnight corneal reshaping lenses. Optom Vis Sci. 2013 Sep;90(9):937-44 (link)
- Bullimore MA, Mirsayafov DS, Khurai AR, Kononov LB, Asatrian SP, Shmakov AN, Richdale K, Gorev VV. Pediatric Microbial Keratitis With Overnight Orthokeratology in Russia. Eye Contact Lens. 2021 Jul 1;47(7):420-425. (link)
- Smith EL 3rd. Optical treatment strategies to slow myopia progression: effects of the visual extent of the optical treatment zone. Exp Eye Res. 2013 Sep;114:77-88. (link)
- Sun Y, Xu F, Zhang T, Liu M, Wang D, Chen Y, Liu Q. Orthokeratology to control myopia progression: a meta-analysis. PLoS One. 2015 Apr 9;10(4):e0124535. (link)
- Brennan NA, Toubouti YM, Cheng X, Bullimore MA. Efficacy in myopia control. Prog Retin Eye Res. 2021 Jul;83:100923. (link)
- Cho P, Cheung SW. Protective Role of Orthokeratology in Reducing Risk of Rapid Axial Elongation: A Reanalysis of Data From the ROMIO and TO-SEE Studies. Invest Ophthalmol Vis Sci. 2017 Mar 1;58(3):1411-1416. (link)
- Cho P, Cheung SW. Discontinuation of orthokeratology on eyeball elongation (DOEE). Cont Lens Anterior Eye. 2017 Apr;40(2):82-87. (link)