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Safety of Orthokeratology Contact Lens Wear in Slowing the Axial Elongation of the Eye in Children
TAKE-HOME MESSAGE
- An analysis of data from three prospective studies on the outcomes of orthokeratology lens wear in children with myopia showed that most adverse events were insignificant. These events included corneal abrasion, papillary conjunctivitis, rhinitis, corneal staining, corneal infiltrative events, blepharitis, bacterial conjunctivitis, hordeolum, conjunctival hyperemia, conjunctival staining, corneal neovascularization, dimple veiling, and chalazion. All of these adverse events resolved, and vision was unaffected. There were no serious adverse events.
- The combined results of three studies indicate that 10% to 20% of eyes wearing orthokeratology lenses will experience adverse events over 1 year of lens wear; however, most are insignificant. The authors conclude that overnight orthokeratology lens wear is safe in this population.
abstract
This abstract is available on the publisher's site.
Access this abstract now Full Text Available for ClinicalKey SubscribersPURPOSE
To evaluate the safety of orthokeratology contact lens wear in slowing the axial elongation of the eye in myopic children.
METHODS
Safety data from three prospective studies, which evaluated the use of orthokeratology for slowing myopia progression in children in comparison to a parallel control group of single-vision spectacle lens wearers over a 2-year period, were pooled together for analysis. The primary and secondary safety endpoints are the comparisons of adverse events and slit-lamp findings grades ≥ 2 between orthokeratology and control groups, respectively.
RESULTS
Collectively, data from 125 orthokeratology and 118 control subjects were analyzed in this study. Of these, 101 (81 %) and 88 (75 %) orthokeratology and control subjects completed the 2-year follow-up period, respectively. Nineteen orthokeratology subjects experienced 28 adverse events, of which 6 were significant, whereas just one adverse event was found in the control group; this difference was statistically significant (p < 0.001). Most adverse events found in the orthokeratology group were corneal in nature, primarily corneal abrasion/staining, accounting for around 40 % of all adverse events. Of the 28 adverse events, only 18 (3 significant) are likely to be contact lens-related, leading to incidence rates of total and device-related adverse events per 100 patient years of lens wear (95 % confidence intervals) of 13.1 (9.2-18.2) and 8.4 (5.4-10.7), respectively. No significant differences were found between groups in the total number of silt-lamps findings with grades ≥ 2 (p > 0.05).
CONCLUSION
Around 13% of eyes wearing overnight orthokeratology contact lenses are likely to experience an adverse event over one year of lens wear, with this figure being lower when considering device-related adverse events alone. No serious adverse events were found, with most being non-significant. These results inform eye care practitioners on the safety of orthokeratology lenses when prescribed for slowing myopia progression to myopic children.
Additional Info
The safety of orthokeratology contact lens wear in slowing the axial elongation of the eye in children
Cont Lens Anterior Eye 2024 Jul 12;[EPub Ahead of Print], J Santodomingo-Rubido, SW Cheung, C Villa-CollarFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
In clinical practice, a common concern among parents is the safety of sleeping with contact lenses, especially orthokeratology lenses. Santodomingo–Rubido et al addressed this concern through an analysis of data from three prospective studies that compared overnight orthokeratology contact lens wearers with a control group of single-vision spectacle lens wearers over a 2-year period.
The study analyzed data from 101 children wearing orthokeratology lenses and 88 children wearing single-vision spectacles who completed the study. There were no significant differences in dropout rates between the two groups. A total of 19 orthokeratology lens wearers experienced adverse events, six of which were considered significant; in contrast, only one adverse event was reported in the control group. Notably, fewer adverse effects were observed in Hong Kong Chinese patients than in White European patients. The authors offer possible explanations, such as improved compliance through familiarity with orthokeratology in Hong Kong and differences in the methods used by each clinic to assess adverse events.
The authors concluded that approximately 13% of eyes wearing overnight orthokeratology contact lenses are likely to experience an adverse event over a 1-year period. They noted that the figure is lower when considering events directly related to the contact lens; it is also important to note that the events categorized as significant were not deemed serious. There was no loss of best-corrected visual acuity as a result of an adverse event. The authors concluded that 10% to 20% of eyes wearing overnight orthokeratology contact lenses are likely to experience adverse events over 1 year, with this figure below 10% when considering lens-related adverse events alone, supporting overnight orthokeratology as a safe option for myopia management in children.
I found the frequency of adverse events in this study to be higher than what I encounter in my clinical practice. The safety of overnight orthokeratology can revolve around two key factors: the experience of the eye professional fitting the lens and the compliance of the family interested in myopia management through contact lenses. An explanation for the discrepancy can be the limitation of using one type of orthokeratology lens design (Menicon Z Night) in all three studies, as well as the experience of the clinic fitting the lens. This is particularly relevant given that children in Hong Kong had fewer adverse events where orthokeratology has long been used as a form of myopia management, which would enhance both clinical familiarity with the technique and patient compliance.