Ortho-k for children

• Ortho-k, short for orthokeratology, is a special type of rigid contact lens worn overnight while sleeping.
• When fitted correctly, ortho-k corrects vision during the day without needing glasses or contact lenses.
• For children, ortho-k is a great option for active lifestyles, boosting confidence compared to wearing glasses, and to slow progression of myopia.
• Ortho-k is an established modality for correcting vision in children and can be worn safely by 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). The cornea acts like a lens for the eye, with the corneal shape changes made by ortho-k in effect increasing or decreasing its focusing power.

On waking, the ortho-k lenses are removed where the change in focusing power they make to the cornea provides the same effect as wearing glasses or daytime contact lenses. When fit correctly, ortho-k overcomes the need for daytime glasses or contact lenses.

Lens wear needs to be continued each night to maintain the shape change that is made to the cornea, and for clear vision during the day. For a more detailed deep dive into ortho-k, read our article What is ortho-k?

Alongside correcting vision, there is growing evidence that ortho-k is effective in slowing progression of myopia in children.¹ To learn about ortho-k for myopia control in children read our article Ortho-k for myopia control in children.

Ortho-k provides the freedom for your child to see clearly during waking hours without needing to wear any spectacles or contact lenses.¹ This can bring the added benefit of allowing them to see clearly for school, sports and other recreational activities without glasses getting in the way.

Children from ages 6-14 have been shown to prefer wearing ortho-k to spectacles, rating their overall vision, appearance, ability to participate in activities and satisfaction as higher with ortho-k.²

Compared to traditional daytime wear contact lenses, ortho-k offers the benefit of overnight lens wear, thereby bringing all lens wear inside the home environment and making it easier for parents to supervise all lens care and cleaning procedures.

Absolutely! As long as parents and children are both happy with overnight contact lens wear, and children are able to handle ortho-k lens application, removal and care, then ortho-k is a suitable option to provide vision correction. It appears that more children are now wearing ortho-k lenses, which is attributed to the growing body of research supporting ortho-k's ability to slow progression of myopia.³

When it comes to safety, the research reveals ortho-k to have a high safety profile in children, with risk of microbial keratitis infection reported at around 1-2 cases per 2,000 patient wearing years.^4,5 This is a similar safety profile to daily wear soft silicone hydrogel contact lens wear in children.⁴

Although rare, the most concerning type of infection in contact lens wear is acanthamoeba keratitis, which is caused by interaction between contact lenses and the acanthamoeba organism, which often lives in water.⁶ Ortho-k lenses are considered one of the safest forms of contact lens wear because they are not worn during the day, making them an ideal way to correct childrens vision without glasses or soft contact lenses, if they enjoy swimming or water sports.¹

The ortho-k lens fit process is the same for children as it is for adults. Refraction (eye prescription) and the shape profile of the cornea (the clear dome at the front of the eye) is measured, which are then used to assess suitability for ortho-k.

Before starting wear, your child will be taught how to apply and remove the lenses, alongside all of the care steps that are required to look after the lenses. The research reveals that children are highly proficient at learning to handle contact lenses, and on overage take only 10-15 mins longer than teenagers to learn.⁷

Once your child is comfortable with handling ortho-k lenses, overnight lens wear will be started - typically for just one night, to get started. Corneal topography measurements will then be repeated the next morning.¹

At follow-up visits, refraction and corneal topography will be re-measured to compare against previous measurements to assess how much corneal flattening has occurred. If all is well, overnight wear is continued, with subsequent adjustments being made to the ortho-k lens design if the eye shape changes fall short of what was expected.

The initial assessment to determine whether ortho-k is suitable for your child may not require lenses to be ordered. Once started down the actual lens fit process, you will start to incur costs for the eye doctor's time and for the lenses themselves.

The need for more visits at the start of the lens fit process typically makes for a higher upfront cost compared to standard daily wear soft contact lenses, however once a successful lens fit is achieved ongoing visits are typically the same as for daily wear soft contact lenses, which in children are recommended every 6 months.⁸

In general you should expect a successful outcome if you have been told that your child is suitable for ortho-k. However, even with the best intentions, there will still be cases where ortho-k just doesn't work for no pre-determinable reason.

Because of this possibility, before commencing the lens fit process it is wise to ask whether any of the costs will be reimbursed in the event that ortho-k is found to be unsuccessful for your child.

1. 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)
2. Santodomingo-Rubido J, Villa-Collar C, Gilmartin B, Gutiérrez-Ortega R. Myopia control with orthokeratology contact lenses in Spain: a comparison of vision-related quality-of-life measures between orthokeratology contact lenses and single-vision spectacles. Eye Contact Lens. 2013 Mar;39(2):153-7. (link)
3. 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)
4. 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)
5. 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)
6. Ibrahim YW, Boase DL, Cree IA. How Could Contact Lens Wearers Be at Risk of Acanthamoeba Infection? A Review. J Optom. 2009;2(2):60–6. (link)
7. Walline JJ, Jones LA, Rah MJ, Manny RE, Berntsen DA, Chitkara M, Gaume A, Kim A, Quinn N; CLIP STUDY GROUP. Contact Lenses in Pediatrics (CLIP) Study: chair time and ocular health. Optom Vis Sci. 2007 Sep;84(9):896-902. (link)
8. 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)