Orthokeratology rated best for active myopes

Paper title: Patient and parent perceptions of myopia modalities

Authors: Lattery LJ (1), Chao C (2), Walline JJ (3), Bullimore MA (1), Ritchey ER (1), Skidmore K (1), Richdale K (4)

1. University of Houston College of Optometry, Houston, TX, United States
2. University of Houston College of Optometry, Houston, TX, United States; School of Optometry and Vision Science, University of New South Wales Sydney, Australia
3. The Ohio State University College of Optometry, Columbus, OH, United States
4. University of Houston College of Optometry, Houston, TX, United States

Date: Published online October 27, 2022

Reference: Lattery LJ, Chao C, Walline JJ, Bullimore MA, Ritchey ER, Skidmore K, Richdale K. Patient and parent perceptions of myopia modalities. Cont Lens Anterior Eye. 2023 Apr;46(2):101772.

[Link to paper abstract]

Quality of life (QoL) can help guide clinical decision-making for myopia correction in children, particularly as myopia treatment options become more diverse. Past research has shown that both soft contact lenses and orthokeratology may offer psychosocial and functional benefits over spectacles.1 However, few studies have directly compared the QoL experiences of children and adults across multiple modalities, or examined parent proxy responses alongside children's self-reports.2

This study used the Pediatric Refractive Error Profile 2 (PREP2) survey to compare QoL between adults and children who had long-term experience with spectacles, soft contact lenses (SCL), or orthokeratology (OK), and investigated how closely parental perceptions aligned with children’s own experiences. 

This was a cross-sectional survey study involving 48 myopic adults (aged 18–26), 49 myopic children (aged 9–17), and one parent for each child participant. All participants had worn their current correction modality for at least three years. Participants completed the PREP2 online, which includes seven QoL subscales. Scores were compared between age groups, correction types, and between children and their parents.

Key findings were as follows.

• Adult OK wearers were more satisfied with vision (+20 points) and activities (+23 points) than spectacle wearers.
• Among children, only the activities score was significantly different among the different modalities. Children wearing OK and SCL were more satisfied with activities compared to spectacle wearers (OK +33 points, SCL +19 points).
• Parents of children wearing contact lenses perceived greater QoL than parents of spectacle wearers, especially for activities (OK +25 points, SCL +14 points) and handling (OK +17 points, SCL +13 points). 
• Children and parents’ responses did not align, with parents recording more negative perception across multiple factors. However, children themselves were generally satisfied with their own correction, regardless of modality.

This study highlights that ortho-k is particularly well-received by both children and adults who lead active lifestyles, with higher activity-related QoL scores compared to spectacles or soft contact lenses. 

Children rated ortho-k the most favourably, suggesting that the freedom from daytime correction may be especially beneficial during play and sports. Adults also preferred orthokeratology for both vision and overall satisfaction, supporting its utility across age groups.

The findings also suggest that parents tend to favour contact lenses over spectacles for their children, even more strongly than their children do. Children themselves were generally satisfied with their correction, regardless of modality. This suggests that parents may drive decision-making on their child’s correction based on their own poor perception of spectacles. 

Practitioners may need to be mindful of how parents’ perceptions influence the uptake and long-term continuation of myopia control, particularly if considering spectacle-based strategies. 

This study used a cross-sectional design with long-term wearers, meaning participants self-selected their correction modality. As such, it should be noted that the results reflect existing satisfaction rather than outcomes in new wearers. 

The study did not specify the regions of the respondents. As practitioners’ perceived effectiveness of myopia management options and prescribing patterns differ by region,3 this may have a ripple effect on parental attitudes towards specific modes of correction. Parents’ own correction history was also not collected, which may have shaped their perceptions of their child’s experience.

In addition, the baseline refractive error of respondents was not quantified – most likely as the survey was distributed online. Individuals with higher myopia are likely to have poorer QoL,4 and have higher QoL concerns regarding appearance, and functional status in daily life.5 It is possible that high myopes may score differently among the different QoL subscales, and among the different correction modalities, than low myopes. Without stratifying by refractive error, it's unclear whether the findings apply consistently across the spectrum of low to high myopia. 

Purpose: This study compared quality of life (QoL) of myopic adults and children who were established spectacle, soft contact lens (SCL), or orthokeratology (OK) wearers as well as parent/child responses using Pediatric Refractive Error Profile 2 (PREP2).

Methods: Forty-eight adults (aged 18–26 years), 49 children (aged 9–17 years), and the children’s parent, completed PREP2, with 7 subscales (symptoms, vision, activities, appearance, peer perception, handling, and overall). Adults and children must have worn their correction for at least three years. Parents were asked to answer how they thought their child would answer. Scores were compared between age groups, among correction groups, and between children and their parents using non-parametric ANOVA, Mann-Whitney U and Wilcoxon Signed-Rank tests, as appropriate. Post-hoc pairwise comparisons among correction groups were conducted with Bonferroni adjustment.

Results: Adult OK wearers were more satisfied with vision (p = 0.04), activities (p < 0.001) and overall (p = 0.03) compared to spectacle wearers. Children OK wearers reported higher scores for activities than SCL (p = 0.048) and spectacle wearers (p < 0.001). Parents of contact lens wearers reported higher perceived QoL for activities (OK p < 0.001; SCL p = 0.02), handling (OK p = 0.02; SCL p < 0.001), appearance (SCL p = 0.001), and overall (OK p = 0.001; SCL p < 0.001) subscales than parents of child spectacle wearers.

Conclusions: Activity-driven children and adults perceive significant benefits from OK over spectacles. Parents’ perceptions did not align with their children’s perceptions of their correction.

[Link to paper abstract]