Three-Year Visual Quality Evaluation in Children Using Orthokeratology Lenses: A Retrospective Study With OPD-Scan III Measurements.

Abstract

Purpose: To evaluate long-term visual quality outcomes, refractive changes, and safety during orthokeratology lens wear in children with myopia over a 3-year period.

Methods: We conducted a retrospective analysis of 130 myopic children aged 8-18 years who wore corneal refractive therapy (CRT) lenses from February 2021 to November 2024. Participants underwent comprehensive ocular examinations, including assessments of visual acuity, refractive error, axial length, corneal thickness, and visual quality parameters at baseline, 1.5 years, and 3 years. Data were analyzed with repeated measures ANOVA, and post hoc comparisons were conducted using the Bonferroni test.

Results: Over the three-year period, there was a slight increase in myopic refractive error and axial length (spherical equivalent: from -1.36 ± 1.17D to -1.69 ± 1.24D; cylindrical power: from -0.70 ± 0.83D to -1.18 ± 0.99D; axial length: from 24.62 ± 0.83 to 25.08 ± 0.85 mm). Overall ocular visual quality improved significantly, with increases in Strehl ratio and modulation transfer function (p < 0.001), while root mean square (RMS) of total ocular aberrations decreased (p < 0.001). After 1.5 years of wear, the corneal high-order aberration (HOA) RMS, corneal spherical aberration (SA) RMS, corneal coma RMS, and corneal tilt RMS all significantly increased (p < 0.0167), while corneal HOAs in the 5-mm optical zone were generally greater than those in the 3-mm optical zone (p < 0.05). Total intraocular aberration RMS decreased significantly in both zones (p < 0.001). No significant changes were observed in corneal endothelial cell density, and no cases of microbial keratitis or other vision-threatening complications occurred.

Conclusion: Long-term CRT lens wear was associated with improved overall and intraocular visual quality, despite increased corneal HOA, with better optical performance in the 3-mm zone. The observed axial elongation and refractive changes over 3 years were broadly consistent with previously reported orthokeratology outcomes. CRT lenses also demonstrated a favorable safety profile in this cohort.