December 14, 2021

High Rate of Noncompliance in Orthokeratology Patients           

Naveed Saleh, MD, MS

Compliance rates for orthokeratology (ortho-k) patients are low and plummeted after a year of wear, according to a study published in BMC Ophthalmology.

Researchers assessed 238 participants with ortho-k lenses and analyzed wear and care behaviors through a survey. They reported that adherence with wear and care behaviors was 19.7%, with patients self-reporting an adherence rate of 96.6%. Higher compliance was noted in those wearing the lenses for fewer than 12 months (P <.001).

The average age of participants was 11.3 years with a range of 7 to 25 years. No associations between adherence and age, sex, or lens care operator were observed.

Researchers find poor compliance behaviors in contact lens wear and care for orthokeratology patients. Credit: Getty Images

Investigators examined adherence rates at different time periods during the first year of use and found no significant differences indicating that adherence to wear and care behaviors is consistently low, despite 96.6% of patients claiming to practice compliance.

Categories showing the poorest adherence during the first year of wear included  “lens case replacement according to ECPs’ recommendation” and “removal of lens deposition interval according to ECPs’ recommendation.” Adherence with regard to “avoiding exposure of lenses to non sterile solutions” decreased dramatically after 1 year.

“While some noncompliance was unintentional, some patients were intentionally noncompliant,” according to the researchers. “Therefore, it is important to re-examine ortho-k lenses patients’ wear and care practices to identify the wear and care behaviors that wearers are not following.”

Study limitations include convenience sampling, a single center design, and the inability to pinpoint specific reasons for the decline in compliance.


Bian Z, Xu X, Chen D, Ni H. Assessment of patient compliance in Orthokeratology and analysis of influencing factors: A cross-sectional study. BMC Ophthalmology. Published online November 16, 2021. doi:10.1186/s12886-021-02148-2

The results of the study in this post are alarming. As a fellowship-trained Orthokeratologist with hundreds of patients in ortho-k, I take patient compliance very seriously.

Only this week, did I take away the option for a patient to continue treatment. This patient, mind you came in seeing 20/20 with each eye and did not have any complaints. However, not following our agreed-upon "contract" on how to care for the molds forced me to remove the option of continuing treatment, for the health and safety of the patient. In addition to the patient causing harm to themselves, they may very easily give Orthokeratology a black eye in the event they suffered any sight loss due to their abuse of the service.

Orthokeratology is very safe and extremely effective at slowing down Myopia progression and the risks associated with high myopia. However, any product (including 1-day disposable contact lenses) may contribute to eye infections if not used properly.

Doctors must stay engaged with each patient and always confirm good compliance. I review what to do and how to do it on each visit. We are also very strict on what patients use and do not allow for substitutions for routine care.

Posted in Myopia Prevention.