Ortho-k for myopia control in teenagers

• Ortho-k has strong evidence for slowing myopia progression in teenagers up to age 16, and limited evidence for older teenagers and young adults, but it can still be a great option to correct vision into adulthood.

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 during school years, 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 the use of treatments aimed to slow progression of myopia. These treatments can include spectacles, contact lenses or atropine eye drops. Although myopia tends to progress fastest before the teenage years, teens are still susceptible to myopia progression and likely to benefit from myopia control.³

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 and teenagers wearing ortho-k, because of its proven ability to slow progression of myopia.⁵

Ortho-k has been shown to be safe type of contact lens for teenagers to wear.^6,7

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 and teenagers is because the eye grows faster than it should, which causes the eye to fall out of focus. Eye growth is typically fastest in children but still occurs as teenagers into early adulthood.¹ Consequently myopia can still progress in teenagers 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. While ortho-k is most likely to provide a greater overall myopia controlling effect in younger children, there is strong evidence that ortho-k significantly slows progression of myopia in teenagers with most evidence for teenagers up to 15 to 16 years of age.⁹

After age 16, there is little evidence for treatments to slow myopia progression, partly because around half of teenagers with myopia will reach a stable plateau and cease myopia progression by age 16.¹

Ortho-k is the only myopia control treatment which has a small amount of evidence for stabilizing myopia in older teens and young adults, but this evidence is not at the same standard as that in children and younger teens.^10,11

There are a growing number of ways that teenager'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.¹²

The short answer is that children and teenagers should ideally benefit from myopia control as soon as they become myopic. Each year of myopia progression accumulates towards total myopia in adulthood, meaning that the sooner myopia control is started, the more likelihood there is of gaining benefit from slowing its progression.¹²

Read more in our article When should we start myopia control and when should we stop?

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.

Yes, ortho-k is safe for teenagers, 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 revels this to be low at around 1-2 cases of corneal eye infection per 2,000 patient wearing years.^6,7

Ortho-k works well for myopia control in children aged 6-16.^4,9 Research has shown that if ortho-k wear is is stopped before age 14, a ‘rebound’ effect can occur where myopia progression can commence again, at an accelerated rate.¹³

Half of teenagers with myopia will stop progressing and show stable vision by age 16, but this means half will still progress into their later teens and early adulthood.¹ For this reason, ortho-k should ideally be worn until early adulthood where possible.

There is no reason to stop wearing ortho-k if your teenager is seeing well and enjoying the freedom and benefits that ortho-k provides. Older teenagers and adults can successfully wear ortho-k as a convenient way to correct their vision.⁴

1. 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)
2. 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)
3. 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)
4. 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)
5. 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)
6. 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
7. 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)
8. 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)
9. 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)
10. Gifford KL, Gifford P, Hendicott PL, Schmid KL. Zone of Clear Single Binocular Vision in Myopic Orthokeratology. Eye Contact Lens. 2020 Mar;46(2):82-90. (link)
11. González-Méijome JM, Carracedo G, Lopes-Ferreira D, Faria-Ribeiro MA, Peixoto-de-Matos SC, Queirós A. Stabilization in early adult-onset myopia with corneal refractive therapy. Cont Lens Anterior Eye. 2016 Feb;39(1):72-7. (link)
12. Brennan NA, Toubouti YM, Cheng X, Bullimore MA. Efficacy in myopia control. Prog Retin Eye Res. 2021 Jul;83:100923. (link)
13. Cho P, Cheung SW. Discontinuation of orthokeratology on eyeball elongation (DOEE). Cont Lens Anterior Eye. 2017 Apr;40(2):82-87. (link)