A narrative review on orthokeratology for myopia control: Lens design, combination therapies, and clinical management

Orthokeratology (OK) is considered an effective intervention for slowing the progression of myopia. It provides users with unaided corrected daytime vision by wearing contact lenses overnight. This review summarizes contemporary evidence on OK in several aspects, including treatment efficacy, biological mechanisms, lens design, safety, and the use of combination therapies. A structured literature search of PubMed and the Cochrane Library was conducted to identify eligible studies. Studies investigating the efficacy of OK in myopia control demonstrated advantages in reducing axial growth. The mechanisms underlying this effect include the induction of peripheral myopic defocus, changes in higher-order aberrations, and alterations in choroidal thickness. This review synthesizes the zones and fitting considerations of OK lenses. Main and novel lens designs are also discussed. Common adverse events associated with OK use, including corneal staining and lens binding, as well as less frequent but serious adverse events, such as microbial keratitis, are listed in this article. In addition, this review summarizes current evidence for combination therapy, demonstrating additive effects with low-concentration atropine and early findings with repeated low-level red light therapy; however, further investigations regarding rebound and safety are required.