Efficacy of Toric Orthokeratology for Managing Myopia in Adolescents

Introduction to Myopia and Its Impact on Adolescents

Myopia, commonly known as nearsightedness, is a prevalent refractive error that significantly affects adolescents worldwide. The increasing prevalence of myopia, particularly among school-age children, has become a public health concern due to its implications on visual health and quality of life. According to recent studies, the global prevalence of myopia among children is rising alarmingly, with estimates suggesting that by 2050, nearly half of the world’s population will be myopic (Huang et al., 2024). This surge in myopia incidence can be attributed to multiple factors, including prolonged near work activities, reduced outdoor time, and genetic predispositions (Grzybowski et al., 2020).

The progression of myopia during childhood can lead to severe complications later in life, including an increased risk of conditions such as retinal detachment, glaucoma, and myopic maculopathy (Wang et al., 2024). Adolescents with myopia often experience a decline in academic performance due to blurred vision while reading or participating in activities that require distance vision. Therefore, early intervention strategies that effectively manage myopia progression in adolescents are essential for preserving visual health and enhancing overall quality of life.

Overview of Toric Orthokeratology Lenses

Orthokeratology (ortho-K) involves the use of specially designed rigid gas permeable (GP) contact lenses that reshape the cornea overnight to temporarily correct refractive errors, allowing clear vision during the day without the need for glasses or contact lenses. Toric orthokeratology lenses are specifically designed to address astigmatism, a common complication associated with myopia that occurs when the cornea is not perfectly spherical, leading to distorted vision.

Traditional ortho-K lenses may not adequately correct higher levels of astigmatism. However, toric ortho-K lenses are engineered to fit the unique curvature of the astigmatic cornea, providing improved visual outcomes for patients with moderate to high astigmatism (Hong et al., 2025). By wearing these lenses overnight, patients can achieve significant improvements in uncorrected visual acuity and control myopia progression during the day.

Table 1: Differences Between Spherical and Toric Orthokeratology Lenses

Comparative Effectiveness of Toric vs. Spherical Orthokeratology

Recent studies have highlighted the comparative effectiveness of toric orthokeratology lenses against traditional spherical lenses in managing moderate to high astigmatic myopia. A study conducted by Hong et al. (2025) evaluated 100 adolescent patients with astigmatism, comparing those treated with toric lenses to a control group using spherical lenses. The results indicated that the toric lens group showed significantly greater improvements in uncorrected visual acuity, spherical equivalent refraction, and overall eye health metrics.

The toric lens group experienced a mean spherical equivalent progression of only 2.0 ± 2.0 diopters (D) compared to 3.2 ± 1.9 D in the spherical lens group (p = 0.01). Additionally, the axial elongation in the toric group was significantly lower, further establishing the effectiveness of toric orthokeratology in controlling myopia progression in astigmatic adolescents (Hong et al., 2025).

Table 2: Comparative Results of Toric and Spherical Orthokeratology

Factors Influencing Treatment Outcomes in Myopic Patients

The effectiveness of toric orthokeratology lenses is influenced by multiple factors, including age, baseline spherical equivalent, and axial length. Logistic regression analysis performed in the study revealed that older participants, those with more severe myopia, and individuals with longer baseline axial lengths demonstrated significantly better myopia control (Hong et al., 2025).

It is essential to consider patient compliance, lens fit, and environmental conditions as additional factors influencing treatment outcomes. For instance, the quality of the lens fit is crucial for ensuring optimal vision correction and minimizing complications. Factors such as humidity, temperature, and lens care routines can also impact the effectiveness of orthokeratology lenses (Hong et al., 2025).

Table 3: Factors Influencing Treatment Outcomes

Long-Term Benefits of 0.01% Atropine in High Myopia Management

Recent research has demonstrated the long-term efficacy of low-dose atropine (0.01%) in managing high myopia progression in children. The RAMCOM-II study investigated the continuous administration of 0.01% atropine over five years, highlighting its potential as a safe and effective strategy for controlling myopia progression.

At the 5-year follow-up, the intervention group demonstrated a significant reduction in myopia progression, with a mean progression of 2.2 ± 2.0 D compared to 3.4 ± 1.9 D in the control group (Agarwal et al., 2025). Additionally, axial elongation was lower in the atropine-treated group, emphasizing the long-term benefits of this intervention in high myopic children.

Table 4: Long-Term Efficacy of 0.01% Atropine

Conclusion and Future Directions in Myopia Treatment

The use of toric orthokeratology lenses represents a promising approach for managing moderate to high astigmatic myopia in adolescents. The significant improvements in visual acuity and the control of myopia progression underscore the importance of tailored treatment strategies that address the unique needs of astigmatic patients. Furthermore, the long-term benefits of 0.01% atropine in high myopic children highlight the potential for pharmacological interventions to complement optical methods in myopia management.

As myopia prevalence continues to rise, the integration of innovative technologies, including toric lenses and low-dose atropine, will be crucial in developing effective strategies to mitigate the risks associated with myopia and improve ocular health outcomes in adolescents. Future research should aim to explore the underlying mechanisms of myopia progression, refine treatment protocols, and evaluate the long-term safety and efficacy of these interventions in diverse populations.

FAQ

What are toric orthokeratology lenses?

Toric orthokeratology lenses are specially designed contact lenses that correct both myopia and astigmatism by reshaping the cornea while worn overnight.

How do toric lenses differ from spherical lenses?

Toric lenses have an asymmetric curvature tailored to correct astigmatism, while spherical lenses have a uniform curvature meant for myopia correction only.

Can atropine be used with orthokeratology?

Yes, atropine can be used alongside orthokeratology lenses to help control myopia progression, particularly in children.

What are the side effects of using 0.01% atropine?

The side effects are generally mild and may include blurred vision, light sensitivity, and a temporary decrease in accommodation.

How effective are toric orthokeratology lenses?

Studies show that toric orthokeratology lenses significantly improve uncorrected visual acuity and slow the progression of myopia in adolescents with astigmatism.

References

1. Agarwal, P., Maan, V., Khurana, A., & Sutar, S. (2025). A Longitudinal Study Evaluating the Impact of 0.01% Atropine in High Myopic Children (RAMCOM-II Study). Journal of Current Ophthalmology. Retrieved from https://pubmed.ncbi.nlm.nih.gov/12184860/

2. Grzybowski, A., Kanclerz, P., & Tsubota, K. (2020). A review on the epidemiology of myopia in school children worldwide. BMC Ophthalmology, 20, 27. Retrieved from https://pubmed.ncbi.nlm.nih.gov/12184797/

3. Huang, Z., Song, D., & Tian, Z. (2024). Prevalence and associated factors of myopia among adolescents aged 12-15 in Shandong Province, China: a cross-sectional study. Scientific Reports, 14, 17289. Retrieved from https://pubmed.ncbi.nlm.nih.gov/12184966/

4. Wang, J., Li, S., & He, S. (2024). Regional disparities in the prevalence and correlated factors of myopia in children and adolescents in Gansu, China. Frontiers in Medicine, 11, 137508. Retrieved from https://pubmed.ncbi.nlm.nih.gov/12184867/

5. Hong, H., Dhuabairong, L., Long, Y., & Lin, E. (2025). Efficacy and factors influencing toric orthokeratology lenses in managing moderate to high astigmatic myopia. Optometry and Vision Science. Retrieved from https://pubmed.ncbi.nlm.nih.gov/12184860/