Cómo citar este artículo: Ortega Pacific EJ, Rodríguez Rodríguez A. Control de la miopía con ortoqueratología. Cienc Tecnol Salud Vis Ocul. 2017;15(1):69-78. doi: http://dx.doi.org/10.19052/sv.3905 RESUMEN La ortoqueratología ha tenido un gran auge en los últimos años, debido a la aparición de nuevos materiales y diseños que han facilitado su aplicación; por esta razón, se planteó desarrollar una revisión que permitiera analizarla desde aquellos pacientes en quienes se ha usado. Objetivos: mostrar la evidencia científica del uso de la ortoqueratología para el control de la miopía. Materiales y métodos: revisión bibliométrica de 50 artículos científicos escritos entre 1999 y 2015, con grado de recomendación B y nivel de evidencia II-3, según la escala United States Preventive Services Task Force (USPTS). Se consideraron las variables edad, defecto refractivo, longitud axial y curvatura corneal. Resultados: el 47 % de los pacientes eran menores de 15 años de edad. Las modificaciones más importantes a través de la ortoqueratología se encontraron en pacientes con valores refractivos menores de −4,00 D (80 %); al mes de tratamiento se presentaron reducciones en promedio de −3,11 D. En su mayoría, el diseño de los lentes utilizados fue de geometría inversa, con materiales con permeabilidad mayor a 100. Conclusiones: la ortoqueratología retarda la progresión de la miopía; esto se evidencia en el 100 % de los artículos analizados. Hay mayor eficacia en el control de la miopía en valores bajos (miopías de hasta 4 D, según Borish): un 55 % con miopías de −0,25 a −1,00 D, mientras que el 45 % restante se reparte con poderes entre −1,25 y −7,00 D.Palabras clave: ortoqueratología, moldeamiento corneal, control de la miopía.

Toric ortho-k lenses can slow axial elongation effectively in myopic children with moderate-to-high astigmatism. (ClinicalTrials.gov number, NCT00978692.).

Citation: Lau JK, Vincent SJ, Cheung S-W, Cho P. Higher-order aberrations and axial elongation in myopic children treated with orthokeratology. Invest Ophthalmol Vis Sci. 2020;61(2):22. https://doi.org/10.1167/iovs. 61.2.22 PURPOSE. This retrospective longitudinal study aimed to examine the relationship between ocular higher-order aberrations (HOA) and axial eye growth in young myopic children undergoing orthokeratology (ortho-k) treatment. METHODS.Axial length and ocular HOA, measured under cycloplegia annually over a 2year period from the right eyes of myopic children, who previously completed ortho-k clinical trials, were retrieved. Linear mixed model analyses were applied to determine the association between ocular HOA, other known confounding variables (age, sex, and refractive error), and axial eye growth. RESULTS.Data from 103 subjects were analyzed. The root-mean square (RMS) values of total ocular HOA (third to sixth orders combined), spherical (Z 0 4 and Z 0 6 combined), and comatic (Z −1 3 , Z 1 3 , Z −1 5 , and Z 1 5 combined) aberrations increased by approximately 3, 9, and 2 times, respectively, after 2 years of ortho-k treatment. After adjusting for age, sex, and refractive error, higher RMS values of total HOA and spherical aberrations were associated with both longer axial length and slower axial elongation (all P < 0.01). For individual Zernike term coefficients, a higher level of positive spherical aberration (Z 0 4 ) was also associated with longer axial length and slower axial elongation (both P < 0.01), after adjusting for baseline HOA. CONCLUSIONS.Ortho-k for myopia control significantly increases the Zernike coefficients and therefore the RMS values for a range of total ocular HOA terms or metrics in children. These findings suggest the potential role of HOA, particularly spherical aberration, as the possible mechanism of slowing axial elongation in ortho-k treatment.

Purpose: To present the 1-year results of the Variation of Orthokeratology Lens Treatment Zone (VOLTZ) Study, which aims to investigate the myopia control effect of orthokeratology (ortho-k) lenses with different back optic zone diameters (BOZD). Method: Children, aged 6 to <11 years, having myopia −4.00 D to −0.75 D, were randomly assigned to wear ortho-k lenses with 6 mm (6-MM group) or 5 mm (5-MM group) BOZD. Data collection included changes in refraction, vision, lens performance and binding, ocular health conditions, axial length and characteristics of the treatment zone (TZ) area. Results: The 1-year results of 34 and 36 subjects (right eye only) in the 6-MM and 5-MM groups, respectively, are presented. No significant differences in baseline demographics were found between the groups (p > 0.05). The first-fit success rates, based on satisfactory centration at the 1-month visit, were 100% and 94% respectively. Horizontal TZ size was 0.92 mm and 0.72 mm smaller in the 5-MM group at the 6-month and 12-month visits, respectively (p < 0.05). At the 12month visit, no significant between-group differences were found in the incidence of corneal staining (low grade only), lens binding and visual performance (all p > 0.05). Axial elongation was slower in the 5-MM group (0.04 AE 0.15 mm) than the 6-MM group (0.17 AE 0.13 mm) (p = 0.001). A significant positive correlation was observed between the horizontal TZ size and axial elongation (r = 0.36, p = 0.006). Conclusion: Clinical performance of the two ortho-k lenses was similar, indicating that a smaller BOZD (5 mm) did not affect lens performance or ocular integrity. However, a smaller BOZD led to a reduced TZ, with retardation of axial elongation by 0.13 mm compared to conventional 6 mm BOZD ortho-k lenses after one year of lens wear.

Purposes:The aim of this study was to analyse clinical data of children undergoing orthokeratology (ortho-k) and to investigate patients'/parents' perspective on ortho-k via telephone interviews. Methods: Clinical records of children undergoing ortho-k from a university optometry clinic were reviewed and the effects of ortho-k on refraction, vision and cornea were investigated. A telephone interview was conducted to solicit patients'/parents' perspective of the treatment. Results: One hundred and eight files were reviewed. Median age of the children was nine years (range six to 15); mean (ϮSD) pre-treatment refractive sphere was -3.56 Ϯ 1.49 D and the median refractive cylinder was -0.50 D (range zero to -4.25 D). Significant refractive spherical reduction (58 per cent), improvement in unaided vision and corneal topographical changes were noted after only one night of wear. No significant change in astigmatism was found. Corneal staining was the most commonly observed complication with ortho-k and more than 80 per cent of patients were advised to apply ocular lubricants to loosen the lens before lens removal. Ortho-k was mainly undertaken for myopic control and about 90 per cent of the respondents reported good/very good unaided vision after ortho-k and ranked the treatment as satisfactory or very good. Lens binding and ocular discharge were the most frequently reported problems during the treatment. Conclusion: Under close monitoring, overnight ortho-k is effective and safe for reducing low to moderate myopia and the treatment is well accepted by the children.

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changes in axial length and choroidal thickness in children during and following orthokeratology treatment with different compression factors.

Background:Cycloplegia has been shown to have no effect on axial length measurement made with the IOLMaster in adults. The current study aimed at evaluating the effect of cycloplegia on axial length and anterior chamber depth (ACD) measurements made with the IOLMaster and an ultrasonic biometer in children. Methods: Pre-and post-cycloplegic axial length and ACD were measured with the IOLMaster followed by the Sonomed A-5500 in 31 children aged from seven to 15 years by the same examiner. The 95% limits of agreement (LoA) were determined, if there were no significant correlations found between the mean differences and their means. Results: Seven subjects were excluded. Results from the remaining 24 subjects show that the effects of cycloplegia, instruments, and interaction between cycloplegia and instrument on axial length measurement were insignificant (repeated measure ANOVA F 1,23 < 2.19, p > 0.15). The 95% LoA in cycloplegia were better with the IOLMaster (-0.04 to 0.04 mm) than with the Sonomed A-5500 (-0.13 to 0.14 mm). The 95% LoA between the two instruments were similar with and without cycloplegia (pre-cycloplegia: -0.20 to 0.27 mm; post-cycloplegia: -0.17 to 0.22 mm).There was no significant interaction between cycloplegia and instrument in ACD measurement (repeated measure ANOVA F1,23 = 0.85, p = 0.37), however, ACD was 0.05 to 0.06 mm shorter before cycloplegia (repeated measure ANOVA F1,23 = 44.70, p < 0.001) and was 0.06 to 0.08 shorter measured with the IOLMaster (repeated measure ANOVA F1,23 = 28.81, p < 0.001). Conclusion: Effects of cycloplegia on axial length measurement in children made with IOLMaster and Sonomed A-5500 were insignificant. In contrast, ACD measurement was significantly affected by cycloplegia and different instruments.