Outcomes of orthokeratology: a nine-year retrospective review from a university-based optometry clinic in Malaysia

Background: Orthokeratology (Ortho-K) is a non-surgical approach to myopia management that uses specially designed gas-permeable lenses to reshape the cornea temporarily and improve vision. While its efficacy is established, real-world data from diverse clinical settings remain limited. In this study we aimed to support evidence-based, individualized Ortho-K practice in routine optometric care by evaluating corneal and visual outcomes, lens designs, and treatment costs at a university-based optometry clinic in Malaysia. Methods: In this retrospective study, we analyzed clinical records of individuals fitted with Ortho-K lenses at SEGi EyeCare, SEGi University, between January 2015 and October 2024. Eligible individuals were identified via electronic health records and included if they completed key follow-up visits at 1-night, 1–2-weeks, and 1–3-months post-dispensing. Exclusion criteria included incomplete records or missed follow-up visits. Data extracted included unaided distance visual acuity (UADVA) in logarithm of the minimum angle of resolution (logMAR), corneal topography (flat and steep keratometry, eccentricity), pupil size, treatment-zone diameter, age, lens design, and total treatment cost. Measurements were obtained using the Tomey TMS-5 topographer. For each patient, both eyes were analyzed independently. Results: Data from 30 eyes of 15 patients (mean age and standard deviation [SD]: 23.3 [9.1] years) were analyzed. Significant improvements in corneal curvature and UADVA were observed across follow-up visits (all P < 0.05). Mean (SD) steep keratometry decreased from 43.79 (1.87) D to 42.08 (2.17) D, and flat keratometry from 42.40 (1.61) D to 40.59 (2.31) D at the final visit (both P < 0.05). UADVA improved from 0.93 (0.36) logMAR to 0.23 (0.24) logMAR (P < 0.05) at the final visit. Pupil size and treatment-zone diameter remained stable (both P > 0.05), indicating consistent lens centration. The mean (SD) Ortho-K cost per patient was RM 3736.67 (514.25), equal to USD 846.20. Conclusions: Ortho-K treatment at this university-based optometry clinic significantly improved corneal curvature, refractive error, and UADVA, with most clinical changes stabilizing within the first month of lens wear. The stability of pupil size and treatment-zone diameter suggests consistent lens performance. These findings affirm the effectiveness of Ortho-K as a non-surgical option for myopia management in real-world practice. Future studies should incorporate axial length measurements and extended follow-up to validate treatment efficacy in slowing myopia progression.