Efficacy of Orthokeratology in Controlling Axial Elongation in Myopic Children and Adolescents: A Systematic Review and Meta-Analysis of Comparative Interventions

Abstract

Background: Myopia represents a growing global public health concern, with prevalence projected to reach 4.9 billion people by 2050. Orthokeratology has emerged as a non-invasive optical intervention for myopia control in children. This systematic review and meta-analysis evaluated the efficacy of orthokeratology in reducing axial length (AL) growth compared to spectacles, atropine combinations, multifocal contact lenses, gradient soft contact lenses, modified orthokeratology with enhanced peripheral defocus (enhanced OK), and atropine therapy with single-vision spectacle correction. Methods: A systematic literature search was conducted in PubMed and Google Scholar for studies published in the past 20 years (2004–2024) using keywords “orthokeratology” OR “corneal reshaping” AND “myopia control.” Inclusion criteria comprised longitudinal clinical studies (randomized or non-randomized) with AL measurements, at least two groups including orthokeratology, and publication in English or Portuguese. Meta-analysis was performed using Review Manager 5.0.25 with random-effects models. Heterogeneity was assessed using I2 statistics, and subgroup analyses were conducted by follow-up duration. Results: Thirty-one studies met inclusion criteria. Orthokeratology significantly reduced AL growth compared to spectacles (25 studies, 4267 patients; mean difference [MD] = −0.16 mm, 95% CI −0.19 to −0.14, p < 0.00001, I2 = 97%). Combined orthokeratology with atropine showed superior efficacy to orthokeratology alone (8 studies, 888 patients; MD = 0.09 mm, 95% CI 0.06 to 0.12, p < 0.00001, I2 = 98%). Orthokeratology demonstrated equivalent efficacy to multifocal contact lenses (3 studies, 208 patients; MD = 0.00 mm, 95% CI −0.04 to 0.05, p = 0.85, I2 = 83%). Atropine therapy with single-vision spectacle correction and enhanced OK showed superior myopia control compared to conventional orthokeratology. Conclusions: Orthokeratology effectively slows axial elongation in myopic children compared to spectacles, with efficacy comparable to multifocal contact lenses. Combination therapies, particularly orthokeratology with atropine, demonstrate additive benefits. High heterogeneity across studies highlights the need for standardized protocols and long-term follow-up studies to optimize myopia control strategies.