Safety of Orthokeratology Contact Lens Wear in Slowing the Axial Elongation of the Eye in Children

In clinical practice, a common concern among parents is the safety of sleeping with contact lenses, especially orthokeratology lenses. Santodomingo–Rubido et al addressed this concern through an analysis of data from three prospective studies that compared overnight orthokeratology contact lens wearers with a control group of single-vision spectacle lens wearers over a 2-year period.

The study analyzed data from 101 children wearing orthokeratology lenses and 88 children wearing single-vision spectacles who completed the study. There were no significant differences in dropout rates between the two groups. A total of 19 orthokeratology lens wearers experienced adverse events, six of which were considered significant; in contrast, only one adverse event was reported in the control group. Notably, fewer adverse effects were observed in Hong Kong Chinese patients than in White European patients. The authors offer possible explanations, such as improved compliance through familiarity with orthokeratology in Hong Kong and differences in the methods used by each clinic to assess adverse events.

The authors concluded that approximately 13% of eyes wearing overnight orthokeratology contact lenses are likely to experience an adverse event over a 1-year period. They noted that the figure is lower when considering events directly related to the contact lens; it is also important to note that the events categorized as significant were not deemed serious. There was no loss of best-corrected visual acuity as a result of an adverse event. The authors concluded that 10% to 20% of eyes wearing overnight orthokeratology contact lenses are likely to experience adverse events over 1 year, with this figure below 10% when considering lens-related adverse events alone, supporting overnight orthokeratology as a safe option for myopia management in children.

I found the frequency of adverse events in this study to be higher than what I encounter in my clinical practice. The safety of overnight orthokeratology can revolve around two key factors: the experience of the eye professional fitting the lens and the compliance of the family interested in myopia management through contact lenses. An explanation for the discrepancy can be the limitation of using one type of orthokeratology lens design (Menicon Z Night) in all three studies, as well as the experience of the clinic fitting the lens. This is particularly relevant given that children in Hong Kong had fewer adverse events where orthokeratology has long been used as a form of myopia management, which would enhance both clinical familiarity with the technique and patient compliance.