COLLEGE OF MEDICINE AND HEALTH SCIENCE

DEPARTMENT OF OPTOMETRY
Article review on; multifocal orthokeratology versus
conventional orthokeratology for myopia control
Presenter by Dessie T .
Modulator: Mr. Haile W. (BSc, MSc, F-LVPEI, Ass’t prof)

1
 Outline

 Introduction
 Methods
 Result

 Discussion & Conclusion

 Reference

2
 Introduction

• Progressive myopia is nearsightedness that continues to

worsen year after year, which results in severe myopia with
potentially serious side effects. (1)
• Children tend to become myopic between 8 and 10 years of
age and to progress through age 15 or 16 years. (2 )
• Over that time, the typical progression of myopia is about
0.50D per year, although it slows with age. (2)
• Axial elongation the main ‘vehicle’ of myopia progression.
• Under-correction of myopia by approximately 0.50D to 0.75D
does not slow myopia progression.
• Fully corrected myopes have more progression than
uncorrected myopes 

4
 Method management of myopia control

– Center-distance soft multifocal contact lenses

– Orthokeratology contact lenses
– Low-concentration atropine.
– defocus incorporated (DIMS) spectacle

5
Defocus incorporated (DIMS) spectacle

6
Center-distance soft multifocal contact lenses

7
Cont…

8
 Cont…
• Orthokeratology (ortho-k) is a special rigid contact lens worn
at night to achieve myopic reduction and control.
• A basic standard ortho-k lens, or reverse geometry lens, has
three curves, from center to periphery: a BOZR, a reverse
curve, and a peripheral curve.
• In order to improve lens centration, the lens is further
modified to multicurve design.

9
 The tear exchange is maintained by adequate edge lift under
the peripheral curve.
 ortho-k lens shows bearing at the corneal apex because the
thickness of tear layer is ~5 µm
 Bearing is also found at the alignment curve
 Any tear layer thickness >20 µm is visible in green when
fluorescein is applied.

10
Cont…

11
 Mechanism

• The positive force is exerted to flatten the central cornea, and

the negative force is extracted against the mid-peripheral
cornea.
• With these two forces, the epithelial cells are driven from
center to mid-peripheral cornea.

12
• Multifocal Orthokeratology is  Special lenses are worn to
sleep that re-shape your eye so you can see at distance and at
near all day, without having to use contact lenses during the
day at all.
• Multifocal Orthokeratology is a new advance in Ortho-K
treatment.  
• It enables adults who now need different powers to see at
distance and at near, to see both distances (i.e. driving) and
near (i.e. reading) without having to wear eyeglasses.  

13
 Cont….
• Beginning at about 40, people find they can see at distance
through their eyeglasses or contact lenses, but have difficulty
at near, for example reading or working on the computer
•  Multifocal Ortho-K enables people to wear special lenses at
night while sleeping, and they are then able to see clearly at
distance and near.

14
 The mechanisms of orthokeratology and use of soft multifocal
contact lenses are attributed to optically decreasing the
peripheral hyperopic defocus or increasing peripheral myopic
blur.
 center-distance multifocal lenses, as this optical design
provides an increase in peripheral myopic defocus

15
16
 A)  Conventionalorthokeratology induces peripheral myopic defocus while
correcting on-axis refractive error.
(b) Dual focus optics creates simultaneous, on-axis myopic retinal defocus.
(c) The multifocal treatment zone is molded onto the corneal surface. The
MOK lens combines both optical concepts.

17
18
19
 myopia reduction, a change in corneal thickness at the
epithelium (thinning at the central epithelium, but thickening
at the mid-peripheral epithelium).
 In hyperopic ortho-k, the central epithelium remains the same,
whereas the mid-peripheral epithelium was thinned by of lens
wear.

20
 spherical or toric ortho-k lens is prescribed based on corneal
profile and refractive errors.
 A spherical lens can only correct slight astigmatism.
 When corneal astigmatism is ≥1.50 D,
 fitting a spherical lens leads to induced astigmatism or lens
decentration and results in poor vision.
 A toric lens is suggested under these conditions.

21
 Cont…

 Myopic ortho-k effect results from a central corneal

flattening and a paracentral corneal steepening.
 A hyperopic ortho-k effect results from a central corneal
steepening and a paracentral corneal flattening.

22
 Candidates of Ortho-k

• Myopia of –0.50 to –4.00 D Sph

• Mild to moderate hyperopia
• Astigmatism < 1.50 D of corneal
• Central K-flat readings ≥42.00D
• Corneas that flatten in the periphery
• Motivated patients.
• Previous contact lens wear

23
 CONTRAINDICATIONS

• Previous failure(s) with RGP lens wear

• Diseases of the cornea, conjunctiva, or adnexa
e.g. dry eye
• Systemic disease that affect the eye that can exacerbated by lens
wear e.g. diabetes
• Keratoconus
• Older patients & long-term CL wearers
– cornea less likely to respond well
• Against the rule astig > 0.75 D Cyl

24
 Contraindications…

• Low sphere power with high cylinder

• Limbus to limbus astigmatism
• When the cornea is spherical (i.e. e=0)
• Deep-set eyes

• Very loose/flaccid lids

25
 Ortho-k…

Complications
• Overnight lens adherence is common
• Some mild corneal punctate staining
• Corneal infections
 Methods
• Visual acuity.

• Subjective & Objective refraction

• Ocular biometry; For VCD and AL measurement. (mm/yr)

• Corneal topography

27
 Cont.….…

 A prospective study on the thirty participants were pseudo-

randomly assigned to two groups
 We have tested its efficacy in paired-eye study in which the
MOK lens is worn in one eye and a conventional OK lens is
worn in the other nightly for 18 months

28
Baseline measures parameter

29
Comparison of the effects of 18 months of MOK and OK lens
wear on ocular structures

30
• Changes over 18 months for eyes wearing MOK lenses and
those wearing OK lenses.
• There was significantly less elongation of axial length,
vitreous chamber depth, and inner axial length in MOK eyes
than OK eyes.
• The central corneal thickness thinned significantly less in
MOK eyes,
• but choroidal thickness increased significantly more in MOK
eyes than in OK eyes.

31
 Results

 significantly less AL elongation in MOK-treated eyes

compared to OK-treated eyes at 18 months (−0.097±0.15 mm,
p = 0.013), although the differences at
6months(−0.033±0.11mm,p=0.116)and12months(−0.050±0.13
mm,p=0.132)were not significant.

32
Correlation between the change axial length 18 over month and
myopic progression prior to enrolment

33
 Conclusion

This study showed that MOK lens wear is significantly more effective at slowing
myopic eye growth in children than conventional OK over 18 months.
In addition, MOK lenses appeared to slow the progression independently of the
progression rate before the study period.
Moreover, no additional negative side effects were found with MOK lenses apart
from a slight reduction in VA equivalent to a loss of 2.3 Snellen letters.

34
 Limitations & critics

 Lack of a control group which would indicate the natural

degree of slowing that would be expected over the treatment
period.
 It was better if the above limitations are managed and also
performed on sample size enough for generalizability
 It was good, on same person, If possible

35
 Reference

1,Beth Longware Duff; What is Progressive Myopia?,

September 2018
2, JEFFREY J. WALLINE; Clinically applicable myopia control;
March 1, 2019
3 ,JEFFREY J. WALLINE; Clinically applicable myopia control;
March 1, 2019
4,IACLE Contact Lens Course Module 8: First Edition , p- 411

36
THANK YOU

37