The role of compliance in the safe use of orthokeratology lenses in children and adolescents

Abstract

   Background.  Orthokeratology lenses (OK lenses) are widely used for myopia control in children and adolescents. Their overnight wear has specific effects on ocular surface structures, including the corneal epithelium, tear film, and meibomian glands. Despite advances in OK lens design and materials, the risk of complications persists. The role of patient compliance — adherence to the prescribed lens wear and care regimen— remains a key yet insufficiently systematized aspect of orthokeratology safety.    Purpose:  To summarize current evidence on the safety of orthokeratology treatment in children and adolescents, with emphasis on ocular surface status, complications, and the role of compliance.    Materials and methods.  An analytical review of Russian and international literature indexed in PubMed/MEDLINE and eLIBRARY was conducted. The review included 30 publications – clinical studies, case series, systematic reviews, and other reviews – reporting data on ocular surface status, complications, or compliance in children and adolescents. Studies involving mixed-age populations were included when their findings were applicable to pediatric practice.    Results.  A substantial proportion of candidates for orthokeratology treatment already have subclinical signs of lacrimal functional unit dysfunction before OK lens fitting. Short-term changes are heterogeneous: increased corneal staining is the most consistently reported finding, whereas changes in the tear film and meibomian glands are often minimal. OK lens wear for more than 5 years is associated with greater meibomian gland loss in the lower eyelid. Participation in water sports and meibomian gland dysfunction were identified as modifiable risk factors for infiltrative keratitis; infection prevention requires avoiding any contact between lenses and water. In a large multicenter study, the incidence of microbial keratitis during orthokeratology treatment was comparable to that associated with daytime wear of soft contact lenses. The available evidence supports the need for systematic assessment of ocular surface structures before OK lens fitting, education of patients and their parents or families, and ongoing monitoring of ocular surface status throughout orthokeratology treatment.    Conclusion.  Compliance is a central determinant of safe OK lens use. The patient’s and family’s ability to comply with lens wear and care requirements should be considered a mandatory component of screening, alongside clinical evaluation of the ocular surface.