Aims/Purpose: This study aims to determine the impact of orthokeratology lenses on relative peripheral defocus (RPD) in children and adolescents through a systematic review and meta‐analysis.Methods: A thorough literature search was conducted using PubMed and Web‐of‐Science databases, focusing on randomized controlled trials (RCTs) and cohort studies investigating the effects of orthokeratology on peripheral refraction. The search employed the keywords "peripheral refraction" AND "orthokeratology." The inclusion criteria required studies to report spherical equivalent (M) peripheral refraction at 25° and/or 30°, including standard deviation or standard error of the mean, and present data graphically or in tables for horizontal meridian measurements before and after orthokeratology treatment. Relative peripheral refraction (RPR) was computed. From an initial pool of 133 studies, 124 were excluded for various reasons, resulting in a final sample of 9 studies. Four studies included data up to 12 months, while five provided data for less than three months, allowing separate analyses before pooling for an overall effect.Results: The 9 studies included 3 RCTs and 6 cohort studies with 239 participants aged 6 to 30 years. The pre‐treatment refractive error was M=‐2.48 ± 0.29D, with follow‐up periods ranging from 14 days to 1 year. All studies indicated a myopic shift at 30° Nasal (‐2.13 ± 1.05 D) and 30° Temporal (‐2.40 ± 0.47 D), averaging ‐2.27 ± 0.83D. The meta‐analysis yielded an overall myopic defocus effect size of M=‐2.29 (95% CI ‐1.94 to ‐2.64, Z=12.84, p < 0.001) using a random effects model due to observed heterogeneity (I2=63%; p < 0.001). Myopic blur induction was greater at 1 year (M=‐2.64, 95% CI ‐2.42 to ‐2.85, Z=24.52, p < 0.001; I2=0%; p = 0.84) compared to treatments under 3 months (M=‐1.98, 95% CI ‐1.94 to ‐2.64, Z=7.37, p < 0.001; I2=63%; p < 0.001).Conclusions: The results suggest a more consistent effect with longer treatment durations, highlighting the necessity for extended follow‐up periods to achieve a reliable effect size estimate. Orthokeratology effectively induces myopic defocus at 30° eccentricity in children and adolescents over both short and long‐term treatments.
Read full abstract