ArticleBMC ophthalmology2026
Corneal morphological changes after discontinuation of long-term orthokeratology and SMILE surgery outcomes: a retrospective comparative study.
Article in BMC ophthalmology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundOrthokeratology (OK) has been widely adopted as a non-surgical intervention to slow myopia progression in children and adolescents. In China, where myopia prevalence is exceptionally high, OK lenses are commonly prescribed to school-aged children as an early intervention strategy. As these individuals reach adulthood, many pursue permanent refractive correction-such as small-incision lenticule extraction (SMILE)-to meet unaided visual acuity standards required for university entrance, military service, or certain occupations. However, the long-term morphological effects of OK wear and their potential impact on SMILE outcomes remain inadequately understood. This study aimed to evaluate ocular biometric and corneal morphological changes following long-term OK lens discontinuation and to compare the visual and surgical outcomes of SMILE between former OK users and spectacle-wearing controls.
methodsThis retrospective comparative study included 44 myopic eyes-22 from patients with a history of OK lens wear (average duration: 64.8 ± 22.6 months; discontinuation ≥ 3 months) and 22 from age- and refractive error-matched controls. Examinations were conducted pre-OK (baseline), pre-SMILE, and at 1 month, 6 months, and final follow-up. Parameters included uncorrected and corrected distance visual acuity (UDVA, CDVA), corneal topography, pachymetry, volume, curvature, and higher-order aberrations. Astigmatic outcomes were evaluated using Alpins vector analysis.
resultsAfter OK discontinuation, the OK group exhibited increased corneal astigmatism (P = 0.030), spherical aberration (P = 0.036), and total aberrations (P = 0.034), as well as decreased vertical coma (P = 0.004), central corneal thickness (P < 0.001), and corneal volume (P = 0.001). Posterior corneal curvature steepened significantly (P < 0.001), while anterior curvature remained stable. Further correlation analysis showed that a younger age at initial OK lens wear was significantly associated with greater posterior steepening after discontinuation at the 3 mm, 5 mm, and 7 mm zones (all P < 0.050). There was also a borderline negative correlation between the duration of OK lens wear and changes in posterior steep K value, suggesting longer wear may result in more pronounced steepening. At 6 months and final follow-up, both groups demonstrated comparable UDVA, CDVA, corneal shape, and higher-order aberrations (all P > 0.050). Vector analysis revealed no significant group differences in astigmatic correction.
conclusionsSMILE remains a viable option for former OK users; the observed reduction in CCT after lens discontinuation has minimal impact on refractive surgery selection.
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