Orthokeratology (Ortho-K) uses specially designed rigid contact lenses worn during sleep to temporarily reshape the front surface of the cornea. The lenses are removed in the morning, and many patients can see clearly during the day without glasses or daytime contact lenses.
In children with progressive myopia, Ortho-K can also be one option in a broader myopia-management plan. Its daytime vision effect and its myopia-control purpose are related but not identical goals.
What Is Myopia?
Myopia, or nearsightedness, occurs when light focuses in front of the retina rather than directly on it. This commonly happens because the eye grows too long from front to back.
Myopia usually begins in childhood, often between about ages 6 and 14, and commonly progresses into the teenage years or early adulthood. Higher levels of myopia are associated with greater lifetime risk of retinal detachment, glaucoma, myopic macular degeneration, and some other eye conditions.
How Does Ortho-K Improve Daytime Vision?
An Ortho-K lens is designed from detailed measurements of the corneal shape. During overnight wear, the lens and the tear layer beneath it redistribute epithelial cells across the corneal surface, producing a controlled temporary change in curvature.
After the lens is removed in the morning, that altered corneal shape reduces the eye's myopic refractive error. The effect is temporary. If Ortho-K wear stops, the cornea gradually returns toward its original shape and the myopia correction wears off.
Does Ortho-K Permanently Cure Myopia?
No. Ortho-K does not permanently eliminate the underlying refractive tendency or permanently shorten an elongated eye.
The corneal reshaping effect needs to be maintained on the wearing schedule prescribed by the doctor. Some patients need nightly wear; others may eventually use another maintenance schedule depending on how their eyes respond.
How Can Ortho-K Help With Myopia Progression?
In children, specially designed myopia-management lenses can change the pattern of focus on the peripheral retina. Clinical studies show that Ortho-K can reduce the rate of axial eye growth in many children compared with ordinary single-vision correction.
That does not mean every child will respond the same way or that Ortho-K completely stops myopia. The goal of myopia management is to slow progression and reduce the chance of reaching a higher final level of myopia.
What Other Myopia-Management Options Are Available?
Park Slope Eye currently uses four broad approaches when appropriate:
- Stellest glasses: specialized eyeglass lenses that correct nearsightedness and help slow its progression, an option for children who prefer glasses. Stellest lenses are FDA authorized for children ages 6 to 12 when treatment begins.
- Ortho-K — overnight corneal reshaping lenses.
- Low-dose atropine — prescription eye drops used off-label in the United States for myopia management.
- NaturalVue multifocal daily contact lenses — daytime lens designs intended to provide vision correction while changing peripheral retinal focus.
Atropine doesn’t work simply by relaxing the focusing muscles; researchers are still studying how it slows myopia.
Who May Be a Candidate for Ortho-K?
Ortho-K can be used by selected children and adults with appropriate corneal health and refractive error. The amount of myopia and astigmatism that can be treated depends on the specific FDA-approved lens design and the patient's corneal shape.
For children, maturity and the ability of the family to follow careful lens hygiene are important considerations.
Is Sleeping in Ortho-K Lenses Safe?
Ortho-K is specifically designed and prescribed for overnight wear, but sleeping in any contact lens carries more infection risk than not wearing a lens overnight. Careful fitting, cleaning, disinfection, hand hygiene, follow-up, and avoidance of water exposure are essential.
Remove the lenses and contact an eye-care professional promptly for significant pain, redness, light sensitivity, discharge, or sudden blurred vision.
Something urgent? Don’t wait for an online appointment: see our urgent and emergency guidance.
What About LASIK?
LASIK or PRK can reduce refractive error in appropriate adults by permanently reshaping corneal tissue. They do not treat progressive childhood myopia, and they do not reverse the retinal or optic-nerve risks associated with an eye that is already highly myopic and elongated.
Refractive surgery is therefore a different decision from childhood myopia management.
What Happens at an Ortho-K Evaluation?
A recent comprehensive eye examination is required so the doctor has current prescription and eye-health information. Park Slope Eye also uses a corneal topographer to map the corneal surface for specialty lens design and follow-up.
If a comprehensive examination was completed elsewhere within about three months, Park Slope Eye can generally use it as long as we receive a copy of the complete exam record. An eyeglass prescription by itself is not enough. If we do not have documentation of the recent comprehensive examination, we will need to perform one before proceeding with the Ortho-K fitting.
Is Ortho-K Right for You or Your Child?
Ortho-K can provide daytime freedom from glasses or contacts and, in appropriate children, can also be part of a plan to slow myopia progression. The best choice depends on prescription, corneal shape, age, lifestyle, myopia progression, and the family's comfort with lens care.
See also All About Ortho-K Lenses.
To start, book a Pediatric Comprehensive Eye Exam (ages 6 months to 10) or a Comprehensive Eye Exam (ages 11 to 17). If your child had a comprehensive exam elsewhere in the last 3 months, email us first.
Originally published . Substantially updated .