Orthokeratology vs Myopia Control Spectacles in Pediatric Myopia

Key Takeaways

• Both orthokeratology and HALT were associated with less one-year myopia progression and less axial elongation than single-vision spectacles.
• Orthokeratology showed greater reported efficacy than HALT on the measured progression outcomes.
• Corneal staining was reported only with orthokeratology, resolved without sequelae, and the authors said the minor absolute difference between the active approaches needs larger randomized studies with longer follow-up.

Orthokeratology showed the smallest mean one-year myopic shift at -0.42 ± 0.52 D, compared with -0.55 ± 0.36 D for HALT and -0.86 ± 0.42 D for single-vision spectacles. In this prospective comparative study, children at Nanjing Children’s Hospital were followed for one year across three pediatric treatment groups. Both active approaches were associated with less refractive progression than single-vision spectacles, with the greatest effect in the orthokeratology group.

In this single-center hospital study, 375 children with myopia were enrolled from January 2023 to October 2023, with publication reported on 03 April 2026. Patients self-allocated to single-vision spectacles, orthokeratology, or Spectacle Lens with Highly Aspherical Lenslet Target, with 125 cases and 125 eyes in each group. Right-eye data were used for analysis, and baseline and one-year assessments included spherical equivalent refraction and axial length. Measurements were obtained before lens wear began and again after one year, keeping the follow-up interval uniform across groups. This provided a one-year comparison of refractive and biometric change across three self-selected groups.

Mean axial elongation measured 0.18 ± 0.12 mm with orthokeratology, 0.24 ± 0.14 mm with HALT, and 0.36 ± 0.16 mm with single-vision spectacles. Pairwise comparisons for the reported progression outcomes were p<0.001, and the ranking consistently favored orthokeratology over HALT over single-vision spectacles. SER regression occurred in 29.63% (32/108) of orthokeratology eyes, 13.16% (15/114) of HALT eyes, and 1.79% (2/112) of single-vision spectacle eyes. AL regression was 12.96% (14/108), 6.14% (7/114), and 0.00% (0/112), respectively, with regression proportion comparisons also reported at p<0.001. Both active interventions remained separated from the single-vision group on structural and refractive endpoints.

Adverse events were reported only in the orthokeratology group and consisted solely of corneal staining. Grade 1 staining occurred in 13.8% (15/108), and grade 2 staining occurred in 3.8% (3/108). All staining resolved without sequelae, and no severe adverse events occurred during the one-year follow-up period. No other adverse events were reported for any study group in the one-year safety results.

Pearson linear correlation analysis examined baseline factors associated with axial elongation and refractive progression in the orthokeratology and HALT groups. Age was the only baseline factor with a potential association with axial elongation and spherical equivalent progression. Investigators reported a negative association between age and axial elongation, alongside a positive association with spherical equivalent increase. The authors said the absolute difference between orthokeratology and HALT was minor despite the consistent numerical separation across progression measures. They added that its clinical significance remains to be evaluated in larger randomized trials with longer follow-up.