How much orthokeratology over-correction is too much?

PC posed a question regarding the acceptable amount of over-correction to incorporate in an OrthoK prescription to allow for good end-of-day vision in this post. Here’s what the community said:

OrthoK over correction

What are the considerations?

Reasons for over-correcting:

  • General consensus was to over-correct by 0.50D to 1.00D. However, this number may vary between patients, depending on how fast a cornea ‘rebounds’.
  • Sometimes, over-correcting may help in a person with high exophoria or AC/A ratio
  • One can consider measuring over-refraction after 4 weeks of wear in the morning and evening to work out the perfect over-correction
  • Some kids may prefer to wear the lenses every 2nd night but that may mean significant over-correction
  • Some may be more sensitive to blur than others so over-correction will help guarantee clear end-of-day vision.

Reasons for not over-correcting:

  • May not be particularly necessary as any blur at the end of the day is minimal, especially since younger kids will tend to have shorter waking hours (earlier bedtimes) than for the same consideration in adults
  • A plano over-refraction may be ideal, in the case that too much over-correction (manifest hyperopia) could potentially reduce the relative peripheral myopia desired from OrthoK treatment.

What the research tells us:

  • Mountford et al1 showed that the degree of regression during day-time hours is about 0.50-0.75D on average after 90 days of wear.
  • However, Chan et al2 showed that the conventional 0.75D over-correction was insufficient for full myopia correction to last through the day for some patients.
  • Gardiner et al3 showed that the amount of regression increases with higher amounts of baseline myopia. For example, a -4.00D myope regresses by about 1.00D at the end of the day on average.
  • Lau et al4 hypothesised that a higher amount of over-correction (study was up to 1.75D) may actually potentially improve the myopia control effect due to increased amounts of high order aberrations (HOAs) that have been suggested to play a part in reduction of axial elongation5. However, increased HOAs may lead to poor low-light visual performance.
  • There have been no studies equating the amount of over-correction in OrthoK with the shift in peripheral refraction, and how this relates to myopia control efficacy. While it makes logical sense that too much over-correction could influence the optics of OrthoK, the main concern for the patient is to ensure good vision, at the start and the end of the day. This includes good vision at near, which could potentially be influenced by too much over-correction (manifest hyperopia).

Take home messages:

  • Most contact lens companies already include approximately 0.50-0.75D of over-correction to account for regression during the day and this may be sufficient for most patients.
  • It is prudent to check the patient’s end-of-day over-refraction after 4 weeks of wear, as it will give you a better idea of the patient’s level of vision at that time and adjustments can be made if they are bothered by poor end-of-day vision.
  • Incorporating a larger amount of over-correction than the lab’s standard 0.50-0.75D still remains a valid option to ensure good end-of-day acuity, provided it isn't too much to affect comfortable near vision.
  • The relationship between over-correction and OrthoK's myopia control effect has not yet been established.
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About Kimberley

Kimberley Ngu is a clinical optometrist from Perth, Australia, with experience in patient education programs, having practiced in both Australia and Singapore.

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About Connie

Connie Gan is a clinical optometrist from Kedah, Malaysia, who provides comprehensive vision care for children and runs the myopia management service in her clinical practice.

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