Vision-related quality of life in highly myopic children undergoing orthokeratology treatment

Abstract

Purpose: To compare the vision-related quality of life (VRQoL) of highly myopic children before and after one-year orthokeratology (ortho-k) treatment, and between full and partial correction ortho-k groups. Methods: Chinese children aged 7 to 13 years, with myopia no less than −5.00 D and astigmatism no more than −2.00 D, were fitted with either a conventional ortho-k lens design targeted for −4.00 D or a dual RC design targeted for full correction. Participants were required to wear spectacles during the day if their residual spherical refraction was no less than −1.25 D or monocular unaided visual acuity was worse than 0.18 logMAR. VRQoL was evaluated before and after one-year ortho-k treatment using the traditional Chinese Paediatric Refractive Error Profile (PREP) questionnaire along with four additional questions regarding symptoms and their frequency after treatment. Participants were retrospectively classified into full and partial correction groups, based on their spectacle dependence at the one-year follow-up visit. The overall PREP score, calculated from the mean of 10 subscales, and the 10 subscales themselves, were compared pre- and post-ortho-k treatment, and between the full and partial correction groups. Results: Thirty-eight participants (full correction: 17, partial correction: 21) completed the study. At baseline, the partial correction group exhibited significantly greater spherical refraction and SER than the full correction group (p < 0.001), while unaided monocular visual acuity was comparable between the groups (p = 0.41). At the one-year follow-up, the full correction group had significantly lower residual spherical refraction and SER, and better unaided monocular visual acuity than the partial correction group (p < 0.001). No significant Group by Visit interactions were observed for any PREP subscales (p ≥ 0.13), indicating similar patterns of change over time in both groups. A significant improvement in the “Activities” subscale was found with ortho-k treatment compared to spectacle wear in both groups (main effect of Visit, p = 0.001). For the “Handling” subscale, when averaging across both time points, the full correction group reported consistently higher scores than the partial correction group (spectacle wear: 83 ± 3 vs 78 ± 3) and the one-year follow-up (ortho-k wear: 85 ± 2 vs 75 ± 3) (main effect of Group, p = 0.03). Although an improving trend in the “Appearance” subscale was noted in the full correction group following ortho-k (57 ± 6 vs 72 ± 4), compared to stable scores in the partial correction group (62 ± 5 vs 63 ± 3), this difference was not significant (Group by Visit interaction, p = 0.13). Regarding symptoms experienced during nighttime ortho-k lens wear, the most reported symptoms (∼18%) were “ocular discomfort” and “itchy/burning/dryness”, with ≤ 10% of participants reporting any symptom more than twice per week. No significant differences in ocular symptoms were found between the full and partial correction groups. Conclusion: After one year of ortho-k treatment, VRQoL in the “Activities” subscale significantly improved compared to baseline spectacle wear, for both full and partial correction. The full correction group demonstrated a trend towards improved “Appearance” scores over spectacles and achieved significantly higher overall scores in the “Handling” subscale than the partial correction group. Both correction strategies were well-tolerated with a comparable, low frequency of mild ocular symptoms.