Effect of Optical Zone Diameter in Orthokeratology on Myopia Control: A Meta-Analysis and Systematic Review

OBJECTIVES: To analyze the literature comparing the efficacy of orthokeratology lenses (OKLs) with small (≤5.5 mm) and large (≥6.0 mm) optical zone diameter (OZD) on myopia control. METHODS: A systematic review was conducted using PubMed and Scopus databases identifying seven articles that met the eligibility criterion. The quality assessment was checked using the Critical Appraisal Skills Programme standard checklist. A meta-analysis focused on the axial length (AL) growth was conducted. RESULTS: Six clinical trials and one pseudo experimental pre-post study were evaluated. All articles found a significantly slower AL increase in wearers with small OZD, which was confirmed through the meta-analysis (mean difference = -0.13, 95% confidence interval [-0.18/-0.10], P < 0.001). In four articles, the use of smaller OZD resulted in an increase in higher-order aberrations. The quality analysis revealed a low level of bias in six out of the seven articles. Common strengths included a clearly defined research question, random OKLs assignment, comparable baseline groups, and consistent care levels. Common weaknesses were the absence of cost-effectiveness analysis and lack of blinding for data analysts. CONCLUSIONS: There is consistent evidence supporting that OKLs with OZD of 5.0 mm provide a better control of myopia progression compared with those with an OZD of ≥6.0 mm.