Long-Term Axial Length Shortening in Myopic Orthokeratology: Incident Probability, Time Course, and Influencing Factors.

Purpose: Long-term axial length (AL) shortening in myopia is uncommon but noteworthy. Current understanding on the condition is limited due to difficulties in case collection. The study reported percentage, probability, and time course of long-term AL shortening in myopic orthokeratology based on a large database. Methods: This study reviewed 142,091 medical records from 29,825 subjects in a single-hospital orthokeratology database that were collected over 10 years. Long-term AL shortening was defined as a change in AL of -0.1 mm or less at any follow-up beyond 1 year. Incident probability was calculated based on multivariate logistic regression. Time course was estimated using mixed-effect regression model. Results: A total of 10,093 subjects (mean initial age, 11.70 ± 2.52 years; 58.8% female) with 80,778 visits were included. The number of subjects experienced long-term AL shortening was 1,662 (16.47%; 95% confidence interval, 15.75%-17.21%). Initial age showed significant impact on the incident occurrence (OR, 1.37; 95% confidence interval, 1.34-1.40; P < 0.001). The estimated probability of AL shortening was approximately 2% for subjects with initial age of 6 years and 50% for those aged 18. Among the 1662 AL shortening cases, the median magnitude of the maximum AL reduction was 0.19 mm. The shortening process mostly occurred within the initial 2 years. Subject characteristics had limited associations with the shortening rate. Conclusions: Long-term AL shortening is possible in subjects receiving myopic orthokeratology. Although age notably affect the incident probability, the time course seems to not vary significantly.

Development and validation of a prediction model for axial length elongation in myopic children treated with overnight orthokeratology.

PURPOSE: To develop and validate a standardized prediction model aiming at 1-year axial length elongation and to guide the orthokeratology lens practice. METHODS: This retrospective study was based on medical records of myopic children treated with orthokeratology. Individuals aged 8-15 years (n = 1261) were included and divided into the primary cohort (n = 757) and validation cohort (n = 504). Feature selection was primarily performed to sort out influential predictors by high-throughput extraction. Then, the prediction model was developed using multivariable linear regression analysis completed by backward stepwise selection. Finally, the validation of the prediction model was performed by evaluation metrics (mean-square error, root-mean-square error, mean absolute error and R ad 2 ). RESULTS: No significant difference was found between primary and validation cohort (all p > 0.05). After the feature selection, the crude model was adjusted by demographic information in multivariable linear regression analysis, and five final predictors were identified (all p < 0.01). The interaction effect of age with 1-month change of zone-3 mm flat K was detected (p < 0.01); hence, two final prediction models were developed based on two age subgroups. The validation proved an acceptable performance. CONCLUSION: An effective multivariable prediction model aiming at 1-year axial length elongation was developed and validated. It can potentially help clinicians to predict orthokeratology efficacy and make valid adjustments. The influential variables revealed in this model can also provide designers directions to optimize the design of lens to improve the efficacy of myopia control.