Therapeutic efficacy of orthokeratology lenses with different back optic zone diameters in myopia control: A systematic review and meta-analysis.

Objective: This study evaluates the efficacy of orthokeratology lenses with different back optic zone diameters (BOZD) in controlling myopia progression among adolescents.

Methods: Following PRISMA 2020 guidelines, a systematic search was performed across multiple databases, including PubMed, Web of Science, EMBASE, Cochrane Library, EBSCO, Scopus, Ovid, CBM, CNKI, VIP, and Wanfang. Inclusion criteria encompassed randomized controlled trials (RCTs) and controlled studies comparing the effectiveness of orthokeratology lenses with various BOZD designs for myopia control in adolescents. Relevant data were extracted and analyzed using RevMan 5.3 for meta-analysis, assessing the risk of bias. Primary outcomes included axial length (AL), spherical equivalent refraction (SER), treatment zone diameter (TZD), and treatment zone area (TZA). Secondary outcomes included uncorrected distance visual acuity (UDVA), best-corrected visual acuity (BCVA), higher-order aberrations (HOAs), and eccentricity (E).

Results: A total of 17 studies were included, comprising 12 RCTs and 6 controlled studies. Meta-analysis showed that compared to conventional BOZD, smaller BOZD lenses significantly inhibited axial elongation (SMD = -0.83, P < 0.00001), reduced TZD (SMD = -1.38, P < 0.00001) and TZA (SMD = -2.05, P < 0.00001), and improved SER (SMD = 0.81, P < 0.0001) and BCVA (SMD = 0.27, P = 0.04). No significant effects were found on eccentricity (P = 0.79) or UDVA (P = 0.31), while HOAs increased (SMD = 1.01, P = 0.02). Longer follow-ups resulted in more reliable findings.

Conclusions: Orthokeratology lenses with smaller BOZD effectively control myopia progression, improving axial elongation, TZD, TZA, and SER, and increase HOAs, but do not significantly affect eccentricity, UDVA.