Outcomes of orthokeratology: a nine-year retrospective review from a university-based optometry clinic in Malaysia
Medical hypothesis, discovery & innovation in optometry,
Vol. 6 No. 2 (2025),
31 July 2025
,
Page 65-73
https://doi.org/10.51329/mehdioptometry224
Abstract
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.
Keywords:
- orthokeratology
- corneal reshaping
- treatment zone size
- contact lens
- corneal topographies
- pupils
- optometries
- cost
- malay federation
References
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6. Ouzzani M, Mekki MB, Chiali S, Kail F, Chahed L. Practice of orthokeratology in Algeria: a retrospective study. J Optom. 2021 Apr-Jun;14(2):176-182. doi: 10.1016/j.optom.2020.05.003. Epub 2020 Sep 26. PMID: 32988782; PMCID: PMC8093529.
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8. Mohd-Ali B, Low YC, Mohamad Shahimin M, Arif N, Abdul-Hamid H, Wan Abdul-Halim WH, Mohidin N. Comparison of vision-related quality of life between wearing Orthokeratology lenses and spectacles in myopic children living in Kuala Lumpur. Cont Lens Anterior Eye. 2023 Feb;46(1):101774. doi: 10.1016/j.clae.2022.101774. Epub 2022 Oct 29. PMID: 36319519.
9. Low YC, Mohd-Ali B, Shahimin MM, Mohidin N, Abdul-Hamid H, Mokri SS. Peripheral Eye Length Evaluation in Myopic Children Undergoing Orthokeratology Treatment for 12 Months Using MRI. Clin Optom (Auckl). 2024 Feb 9;16:35-44. doi: 10.2147/OPTO.S448815. PMID: 38351972; PMCID: PMC10863466.
10. Liong SL, Mohidin N, Tan BW, Ali BM. Refractive error, visual acuity, and corneal-curvature changes in high and low myopes with orthokeratology treatment: A Malaysian study. Taiwan J Ophthalmol. 2015 Oct-Dec;5(4):164-168. doi: 10.1016/j.tjo.2015.07.006. Epub 2015 Sep 12. PMID: 29018692; PMCID: PMC5602134.
11. Heydarian S, Hashemi H, Shokrollahzadeh F, Yekta AA, Ostadimoghaddam H, Derakhshan A, Khabazkhoob M. The normal distribution of corneal eccentricity and its determinants in two rural areas of north and south of Iran. J Curr Ophthalmol. 2017 Dec 6;30(2):147-151. doi: 10.1016/j.joco.2017.11.006. PMID: 29988918; PMCID: PMC6033779.
12. Benes P, Synek S, Petrová S. Comparison of keratometric values and corneal eccentricity. Coll Antropol. 2013 Apr;37 Suppl 1:31-6. PMID: 23837219.
13. Liu T, Ma W, Wang J, Yang B, Dong G, Chen C, Wang X, Liu L. The effects of base curve aspheric orthokeratology lenses on corneal topography and peripheral refraction: A randomized prospective trial. Cont Lens Anterior Eye. 2023 Jun;46(3):101814. doi: 10.1016/j.clae.2023.101814. Epub 2023 Jan 20. PMID: 36681621.
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15. Ezinne NE, Bhattarai D, Ekemiri KK, Harbajan GN, Crooks AC, Mashige KP, Ilechie AA, Zeried FM, Osuagwu UL. Demographic profiles of contact lens wearers and their association with lens wear characteristics in Trinidad and Tobago: A retrospective study. PLoS One. 2022 Jul 22;17(7):e0264659. doi: 10.1371/journal.pone.0264659. PMID: 35867670; PMCID: PMC9307171.
16. Abokyi S, Manuh G, Otchere H, Ilechie A. Knowledge, usage and barriers associated with contact lens wear in Ghana. Cont Lens Anterior Eye. 2017 Oct;40(5):329-334. doi: 10.1016/j.clae.2017.05.006. Epub 2017 May 19. PMID: 28533022.
17. Chen X, Yang B, Wang X, Ma W, Liu L. The alterations in ocular biometric parameters following short-term discontinuation of long-term orthokeratology and prior to subsequent lens fitting: a preliminary study. Ann Med. 2023;55(2):2282745. doi: 10.1080/07853890.2023.2282745. Epub 2023 Nov 21. PMID: 37988719; PMCID: PMC10836244.
18. Singh K, Bhattacharyya M, Goel A, Arora R, Gotmare N, Aggarwal H. Orthokeratology in Moderate Myopia: A Study of Predictability and Safety. J Ophthalmic Vis Res. 2020 Apr 6;15(2):210-217. doi: 10.18502/jovr.v15i2.6739. PMID: 32308956; PMCID: PMC7151515.
19. Lu W, Song G, Zhang Y, Lian Y, Ma K, Lu Q, Jin Y, Zhao Y, Zhang S, Lv F, Jin W. The effect of orthokeratology lenses on optical quality and visual function in children. Front Neurosci. 2023 Apr 14;17:1142524. doi: 10.3389/fnins.2023.1142524. PMID: 37123367; PMCID: PMC10140410.
20. Zhu MJ, Ding L, Du LL, Chen J, He XG, Li SS, Zou HD. Photopic pupil size change in myopic orthokeratology and its influence on axial length elongation. Int J Ophthalmol. 2022 Aug 18;15(8):1322-1330. doi: 10.18240/ijo.2022.08.15. PMID: 36017053; PMCID: PMC9358181.
21. Kang SY, Kim BK, Byun YJ. Sustainability of orthokeratology as demonstrated by corneal topography. Korean J Ophthalmol. 2007 Jun;21(2):74-8. doi: 10.3341/kjo.2007.21.2.74. PMID: 17592236; PMCID: PMC2629700.
22. Zhang S, Zhu H, Zhang L, Gao M, Liu C, Zhao Q. Effects of orthokeratology on corneal reshaping and the delaying of axial eye growth in children. Heliyon. 2024 Jun 20;10(12):e33341. doi: 10.1016/j.heliyon.2024.e33341. PMID: 39022009; PMCID: PMC11253518.
23. Kou S, Ren Y, Zhuang X, Chen Y, Zhang X. Study on Related Factors of the Treatment Zone After Wearing Paragon CRT and Euclid Orthokeratology Lenses. Eye Contact Lens. 2023 Dec 1;49(12):521-527. doi: 10.1097/ICL.0000000000001035. Epub 2023 Sep 14. PMID: 37707469; PMCID: PMC10659246.
24. Wang A, Yang C. Influence of Overnight Orthokeratology Lens Treatment Zone Decentration on Myopia Progression. J Ophthalmol. 2019 Nov 15;2019:2596953. doi: 10.1155/2019/2596953. PMID: 31827908; PMCID: PMC6881772.
25. Guo B, Cheung SW, Kojima R, Cho P. Variation of Orthokeratology Lens Treatment Zone (VOLTZ) Study: A 2-year randomised clinical trial. Ophthalmic Physiol Opt. 2023 Nov;43(6):1449-1461. doi: 10.1111/opo.13208. Epub 2023 Aug 6. PMID: 37545099.
26. Lee YC, Wang JH, Chiu CJ. Effect of Orthokeratology on myopia progression: twelve-year results of a retrospective cohort study. BMC Ophthalmol. 2017 Dec 8;17(1):243. doi: 10.1186/s12886-017-0639-4. PMID: 29216865; PMCID: PMC5721542.
27. Agyekum S, Chan PP, Adjei PE, Zhang Y, Huo Z, Yip BHK, Ip P, Wong ICK, Zhang W, Tham CC, Chen LJ, Zhang XJ, Pang CP, Yam JC. Cost-Effectiveness Analysis of Myopia Progression Interventions in Children. JAMA Netw Open. 2023 Nov 1;6(11):e2340986. doi: 10.1001/jamanetworkopen.2023.40986. Erratum in: JAMA Netw Open. 2025 May 1;8(5):e2518553. doi: 10.1001/jamanetworkopen.2025.18553. PMID: 37917061; PMCID: PMC10623196.
28. Holmes M, Liu M, Singh S. Retrospective Analysis of Axial Length Changes in Overnight Orthokeratology in an Academic Myopia Control Clinic. Optom Vis Sci. 2023 Sep 1;100(9):597-605. doi: 10.1097/OPX.0000000000002060. Epub 2023 Aug 29. PMID: 37639686; PMCID: PMC10637306.
29. Skidmore KV, Tomiyama ES, Rickert ME, Richdale K, Kollbaum P. Retrospective review of the effectiveness of orthokeratology versus soft peripheral defocus contact lenses for myopia management in an academic setting. Ophthalmic Physiol Opt. 2023 May;43(3):534-543. doi: 10.1111/opo.13121. Epub 2023 Mar 15. PMID: 36919952.
30. Wang A, Shen L, Yang C. Influence of orthokeratology lens treatment zone decentration on myopia progression: a systematic review with meta-analysis. Pediatric Medicine. 2023 Aug 30;6:1-10. doi: 10.21037/pm-23-20.
2. Liu YM, Xie P. The Safety of Orthokeratology--A Systematic Review. Eye Contact Lens. 2016 Jan;42(1):35-42. doi: 10.1097/ICL.0000000000000219. PMID: 26704136; PMCID: PMC4697954.
3. Chan B, Cho P, Mountford J. Relationship between corneal topographical changes and subjective myopic reduction in overnight orthokeratology: a retrospective study. Clin Exp Optom. 2010 Jul;93(4):237-42. doi: 10.1111/j.1444-0938.2010.00489.x. Epub 2010 Jun 23. PMID: 20579079.
4. Nordin BA. Slowing Myopia Progression in Adolescents Using Orthokeratology: A Retrospective Chart Review. Cureus. 2025 Jun 30;17(6):e87073. doi: 10.7759/cureus.87073. PMID: 40600105; PMCID: PMC12208949.
5. Lv H, Liu Z, Li J, Wang Y, Tseng Y, Li X. Long-Term Efficacy of Orthokeratology to Control Myopia Progression. Eye Contact Lens. 2023 Sep 1;49(9):399-403. doi: 10.1097/ICL.0000000000001017. Epub 2023 Jul 20. PMID: 37471255; PMCID: PMC10442101.
6. Ouzzani M, Mekki MB, Chiali S, Kail F, Chahed L. Practice of orthokeratology in Algeria: a retrospective study. J Optom. 2021 Apr-Jun;14(2):176-182. doi: 10.1016/j.optom.2020.05.003. Epub 2020 Sep 26. PMID: 32988782; PMCID: PMC8093529.
7. Mohidin N, Mat Yacob A, Norazman FN. Corneal thickness and morphology after orthokeratology of six-month lens wear among young Malay adults. Med J Malaysia. 2020 Sep;75(5):538-542. PMID: 32918423.
8. Mohd-Ali B, Low YC, Mohamad Shahimin M, Arif N, Abdul-Hamid H, Wan Abdul-Halim WH, Mohidin N. Comparison of vision-related quality of life between wearing Orthokeratology lenses and spectacles in myopic children living in Kuala Lumpur. Cont Lens Anterior Eye. 2023 Feb;46(1):101774. doi: 10.1016/j.clae.2022.101774. Epub 2022 Oct 29. PMID: 36319519.
9. Low YC, Mohd-Ali B, Shahimin MM, Mohidin N, Abdul-Hamid H, Mokri SS. Peripheral Eye Length Evaluation in Myopic Children Undergoing Orthokeratology Treatment for 12 Months Using MRI. Clin Optom (Auckl). 2024 Feb 9;16:35-44. doi: 10.2147/OPTO.S448815. PMID: 38351972; PMCID: PMC10863466.
10. Liong SL, Mohidin N, Tan BW, Ali BM. Refractive error, visual acuity, and corneal-curvature changes in high and low myopes with orthokeratology treatment: A Malaysian study. Taiwan J Ophthalmol. 2015 Oct-Dec;5(4):164-168. doi: 10.1016/j.tjo.2015.07.006. Epub 2015 Sep 12. PMID: 29018692; PMCID: PMC5602134.
11. Heydarian S, Hashemi H, Shokrollahzadeh F, Yekta AA, Ostadimoghaddam H, Derakhshan A, Khabazkhoob M. The normal distribution of corneal eccentricity and its determinants in two rural areas of north and south of Iran. J Curr Ophthalmol. 2017 Dec 6;30(2):147-151. doi: 10.1016/j.joco.2017.11.006. PMID: 29988918; PMCID: PMC6033779.
12. Benes P, Synek S, Petrová S. Comparison of keratometric values and corneal eccentricity. Coll Antropol. 2013 Apr;37 Suppl 1:31-6. PMID: 23837219.
13. Liu T, Ma W, Wang J, Yang B, Dong G, Chen C, Wang X, Liu L. The effects of base curve aspheric orthokeratology lenses on corneal topography and peripheral refraction: A randomized prospective trial. Cont Lens Anterior Eye. 2023 Jun;46(3):101814. doi: 10.1016/j.clae.2023.101814. Epub 2023 Jan 20. PMID: 36681621.
14. Mohd Azlan S, Mohamad F, Dahlan R, Ismail IZ, Kadir Shahar H, Kamaruddin KN, Shibraumalisi NA, Syed Mohamad SN, Shamsuddin NH. Self-system and mental health status among Malaysian youth attending higher educational institutions: A nationwide cross-sectional study. Malays Fam Physician. 2024 Feb 7;19:12. doi: 10.51866/oa.34l. PMID: 38496770; PMCID: PMC10944643.
15. Ezinne NE, Bhattarai D, Ekemiri KK, Harbajan GN, Crooks AC, Mashige KP, Ilechie AA, Zeried FM, Osuagwu UL. Demographic profiles of contact lens wearers and their association with lens wear characteristics in Trinidad and Tobago: A retrospective study. PLoS One. 2022 Jul 22;17(7):e0264659. doi: 10.1371/journal.pone.0264659. PMID: 35867670; PMCID: PMC9307171.
16. Abokyi S, Manuh G, Otchere H, Ilechie A. Knowledge, usage and barriers associated with contact lens wear in Ghana. Cont Lens Anterior Eye. 2017 Oct;40(5):329-334. doi: 10.1016/j.clae.2017.05.006. Epub 2017 May 19. PMID: 28533022.
17. Chen X, Yang B, Wang X, Ma W, Liu L. The alterations in ocular biometric parameters following short-term discontinuation of long-term orthokeratology and prior to subsequent lens fitting: a preliminary study. Ann Med. 2023;55(2):2282745. doi: 10.1080/07853890.2023.2282745. Epub 2023 Nov 21. PMID: 37988719; PMCID: PMC10836244.
18. Singh K, Bhattacharyya M, Goel A, Arora R, Gotmare N, Aggarwal H. Orthokeratology in Moderate Myopia: A Study of Predictability and Safety. J Ophthalmic Vis Res. 2020 Apr 6;15(2):210-217. doi: 10.18502/jovr.v15i2.6739. PMID: 32308956; PMCID: PMC7151515.
19. Lu W, Song G, Zhang Y, Lian Y, Ma K, Lu Q, Jin Y, Zhao Y, Zhang S, Lv F, Jin W. The effect of orthokeratology lenses on optical quality and visual function in children. Front Neurosci. 2023 Apr 14;17:1142524. doi: 10.3389/fnins.2023.1142524. PMID: 37123367; PMCID: PMC10140410.
20. Zhu MJ, Ding L, Du LL, Chen J, He XG, Li SS, Zou HD. Photopic pupil size change in myopic orthokeratology and its influence on axial length elongation. Int J Ophthalmol. 2022 Aug 18;15(8):1322-1330. doi: 10.18240/ijo.2022.08.15. PMID: 36017053; PMCID: PMC9358181.
21. Kang SY, Kim BK, Byun YJ. Sustainability of orthokeratology as demonstrated by corneal topography. Korean J Ophthalmol. 2007 Jun;21(2):74-8. doi: 10.3341/kjo.2007.21.2.74. PMID: 17592236; PMCID: PMC2629700.
22. Zhang S, Zhu H, Zhang L, Gao M, Liu C, Zhao Q. Effects of orthokeratology on corneal reshaping and the delaying of axial eye growth in children. Heliyon. 2024 Jun 20;10(12):e33341. doi: 10.1016/j.heliyon.2024.e33341. PMID: 39022009; PMCID: PMC11253518.
23. Kou S, Ren Y, Zhuang X, Chen Y, Zhang X. Study on Related Factors of the Treatment Zone After Wearing Paragon CRT and Euclid Orthokeratology Lenses. Eye Contact Lens. 2023 Dec 1;49(12):521-527. doi: 10.1097/ICL.0000000000001035. Epub 2023 Sep 14. PMID: 37707469; PMCID: PMC10659246.
24. Wang A, Yang C. Influence of Overnight Orthokeratology Lens Treatment Zone Decentration on Myopia Progression. J Ophthalmol. 2019 Nov 15;2019:2596953. doi: 10.1155/2019/2596953. PMID: 31827908; PMCID: PMC6881772.
25. Guo B, Cheung SW, Kojima R, Cho P. Variation of Orthokeratology Lens Treatment Zone (VOLTZ) Study: A 2-year randomised clinical trial. Ophthalmic Physiol Opt. 2023 Nov;43(6):1449-1461. doi: 10.1111/opo.13208. Epub 2023 Aug 6. PMID: 37545099.
26. Lee YC, Wang JH, Chiu CJ. Effect of Orthokeratology on myopia progression: twelve-year results of a retrospective cohort study. BMC Ophthalmol. 2017 Dec 8;17(1):243. doi: 10.1186/s12886-017-0639-4. PMID: 29216865; PMCID: PMC5721542.
27. Agyekum S, Chan PP, Adjei PE, Zhang Y, Huo Z, Yip BHK, Ip P, Wong ICK, Zhang W, Tham CC, Chen LJ, Zhang XJ, Pang CP, Yam JC. Cost-Effectiveness Analysis of Myopia Progression Interventions in Children. JAMA Netw Open. 2023 Nov 1;6(11):e2340986. doi: 10.1001/jamanetworkopen.2023.40986. Erratum in: JAMA Netw Open. 2025 May 1;8(5):e2518553. doi: 10.1001/jamanetworkopen.2025.18553. PMID: 37917061; PMCID: PMC10623196.
28. Holmes M, Liu M, Singh S. Retrospective Analysis of Axial Length Changes in Overnight Orthokeratology in an Academic Myopia Control Clinic. Optom Vis Sci. 2023 Sep 1;100(9):597-605. doi: 10.1097/OPX.0000000000002060. Epub 2023 Aug 29. PMID: 37639686; PMCID: PMC10637306.
29. Skidmore KV, Tomiyama ES, Rickert ME, Richdale K, Kollbaum P. Retrospective review of the effectiveness of orthokeratology versus soft peripheral defocus contact lenses for myopia management in an academic setting. Ophthalmic Physiol Opt. 2023 May;43(3):534-543. doi: 10.1111/opo.13121. Epub 2023 Mar 15. PMID: 36919952.
30. Wang A, Shen L, Yang C. Influence of orthokeratology lens treatment zone decentration on myopia progression: a systematic review with meta-analysis. Pediatric Medicine. 2023 Aug 30;6:1-10. doi: 10.21037/pm-23-20.
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