Research Article| Volume 40, ISSUE 3, P184-189, June 2017

Near binocular visual function in young adult orthokeratology versus soft contact lens wearers

  • Kate Gifford
    Corresponding author.
    School of Optometry and Vision Science, Faculty of Health, Institute of Health and Biomedical Innovation, Queensland University of Technology,60 Musk Avenue, Kelvin Grove, QLD 4059 Australia
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  • Paul Gifford
    School of Optometry and Vision Science, Faculty of Science, Rupert Myers Building, Barker Street, Kensington, NSW 2033 Australia
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  • Peter L. Hendicott
    School of Optometry and Vision Science, Faculty of Health, Institute of Health and Biomedical Innovation, Queensland University of Technology,60 Musk Avenue, Kelvin Grove, QLD 4059 Australia
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  • Katrina L. Schmid
    School of Optometry and Vision Science, Faculty of Health, Institute of Health and Biomedical Innovation, Queensland University of Technology,60 Musk Avenue, Kelvin Grove, QLD 4059 Australia
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Published:February 15, 2017DOI:


      • Young myopic adults wearing OK show more exophoria than matched SCL wearers.
      • These long term OK wearers also show a lower accommodative lag than SCL wearers.
      • These findings have relevance to visual acceptance and myopia management.



      To compare near point binocular vision function of young adult myopes wearing orthokeratology (OK) lenses to matched single vision soft disposable contact lens (SCL) wearers.


      A retrospective clinical record analysis of all OK wearers (18–30 years) presenting over an 18 month period was undertaken. Data was extracted for 17 OK wearers, with 17 SCL wearers matched for age, refractive error and duration of contact lens wear. Binocular vision data included horizontal phoria (phoria), horizontal base-in (BIFR) and base-out fusional reserves (BOFR) and accommodation accuracy (AA).


      The OK group was 25.8 ± 3.2 years, with a duration of wear of 45.7 ± 25 months and refractive error of R −2.09 ± 1.23D, L −2.00 ± 1.35D. Compared to matched SCL wearers the OK group were significantly more exophoric (OK −2.05 ± 2.38Δ; SCL 0.00 ± 1.46Δ, p = 0.005) and had better accommodation accuracy (OK 0.97 ± 0.33D; SCL 1.28 ± 0.32D, p = 0.009). BIFR and BOFR were not different in the two groups. Frequency histograms showed that more SCL wearers had high lags of accommodation (AA ≥ 1.50D: 8 SCL,2 OK) and esophoria (≥1Δ: 5 SCL,1 OK) than OK wearers. A positive correlation was found between refraction and phoria in the SCL group (r = 0.521, p = 0.032).


      Young adult myopes wearing OK lenses display more exophoria and lower accommodative lags at near compared to matched single vision SCL wearers. Young adult myopes with specific binocular vision disorders may benefit from OK wear in comparison to single vision SCL wear. This has relevance to both the visual acceptance of OK lenses and in managing risk factors for myopia progression.


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        • Nichols J.J.
        • Marsich M.M.
        • Nguyen M.
        • Barr J.T.
        • Bullimore M.A.
        Overnight orthokeratology.
        Optom. Vis. Sci. 2000; 77: 252-259
        • Sun Y.
        • Xu F.
        • Zhang T.
        • Liu M.
        • Wang D.
        • Chen Y.
        • Liu Q.
        Orthokeratology to control myopia progression: a meta-analysis.
        PLoS One. 2015; 10: e0124535
        • Si J.K.
        • Tang K.
        • Bi H.S.
        • Guo D.D.
        • Guo J.G.
        • Wang X.R.
        Orthokeratology for myopia control: a meta-analysis.
        Optom. Vis. Sci. 2015; 92: 252-257
        • Efron N.
        • Morgan P.B.
        • Woods C.A.
        • C. International Contact Lens Prescribing Survey
        Survey of contact lens prescribing to infants children, and teenagers.
        Optom. Vis. Sci. 2011; 88: 461-468
        • Bennett A.G.
        • Rabbetts R.B.
        Clinical Visual Optics.
        2 ed. Butterworths, London; Boston1989
        • Hunt O.A.
        • Wolffsohn J.S.
        • Garcia-Resua C.
        Ocular motor triad with single vision contact lenses compared to spectacle lenses.
        Contact Lens Anterior Eye. 2006; 29: 239-245
        • Evans B.J.W.
        Detecting binocular vision anomalies in primary eyecare practice.
        Pickwell's Binocular Vision Anomalies. Fifth Edition. Butterworth-Heinemann, Edinburgh2007: 12-38
        • Drobe B.
        • de Saint-André R.
        The pre-myopic syndrome.
        Ophthalmic Physiol. Opt. 1995; 15: 375-378
        • Abbott M.L.
        • Schmid K.L.
        • Strang N.C.
        Differences in the accommodation stimulus response curves of adult myopes and emmetropes.
        Ophthalmic Physiol. Opt. 1998; 18: 13-20
        • Harb E.
        • Thorn F.
        • Troilo D.
        Characteristics of accommodative behavior during sustained reading in emmetropes and myopes.
        Vis. Res. 2006; 46: 2581-2592
        • Zhu M.
        • Feng H.
        • Zhu J.
        • Qu X.
        The impact of amplitude of accommodation on controlling the development of myopia in orthokeratology.
        Chin. J. Ophthalmol. 2014; 50: 14-19
        • Scheiman M.
        • Wick B.
        Clinical Management of Binocular Vision: Heterophoric, Accommodative and Eye Movement Disorders.
        Lippincott Williams & Wilkins, Philadephia, USA1994
        • Tarrant J.
        • Liu Y.
        • Wildsoet C.F.
        Orthokeratology can decrease the accommodative lag in myopes.
        Invest. Ophthalmol. Vis. Sci. 2009; 50: 4294
        • Felipe-Marquez G.
        • Nombela-Palomo M.
        • Cacho I.
        • Nieto-Bona A.
        Accommodative changes produced in response to overnight orthokeratology.
        Graefes Arch. Clin. Exp. Ophthalmol. 2015; 253: 619-626
        • Mountford J.
        An analysis of the changes in corneal shape and refractive error induced by accelerated orthokeratology.
        Int. Contact Lens Clin. 1997; 24: 128-144
        • Mountford J.
        Chapter 6-trial lens fitting.
        Orthokeratology. Butterworth-Heinemann, London2004: 139-173
        • Rainey B.B.
        • Schroeder T.L.
        • Goss D.A.
        • Grosvenor T.P.
        Inter-examiner repeatability of heterophoria tests.
        Optom. Vis. Sci. 1998; 75: 719-726
        • Calvin H.
        • Rupnow P.
        • Grosvenor T.
        How good is the estimated cover test at predicting the von Graefe Phoria measurement?.
        Optom. Vis. Sci. 1996; 73: 701-706
        • Goss D.A.
        • Rana S.
        • Ramolia J.
        Accommodative response/stimulus by dynamic retinoscopy: near add guidelines.
        Optom. Vis. Sci. 2012; 89: 1497-1506
        • Antona B.
        • Barrio A.
        • Barra F.
        • Gonzalez E.
        • Sanchez I.
        Repeatability and agreement in the measurement of horizontal fusional vergences.
        Ophthalmic Physiol. Opt. 2008; 28: 475-491
        • Antona B.
        • Sanchez I.
        • Barrio A.
        • Barra F.
        • Gonzalez E.
        Intra-examiner repeatability and agreement in accommodative response measurements.
        Ophthalmic Physiol. Opt. 2009; 29: 606-614
        • Tarczy-Hornoch K.
        Modified bell retinoscopy: measuring accommodative lag in children.
        Optom. Vis. Sci. 2009; 86: 1337-1345
        • Armstrong R.A.
        When to use the Bonferroni correction.
        Ophthalmic Physiol. Opt. 2014; 34: 502-508
        • Goss D.A.
        • Jackson T.W.
        Clinical findings before the onset of myopia in youth: 3. Heterophoria.
        Optom. Vis. Sci. 1996; 73: 269-278
        • Gwiazda J.
        • Thorn F.
        • Held R.
        Accommodation accommodative convergence, and response AC/A ratios before and at the onset of myopia in children.
        Optom. Vis. Sci. 2005; 82: 273-278
        • Evans B.J.W.
        Nature of binocular vision anomalies.
        Pickwell's Binocular Vision Anomalies. Fifth Edition. Butterworth-Heinemann, Edinburgh2007: 2-11
        • Narayanasamy S.
        • Vincent S.J.
        • Sampson G.P.
        • Wood J.M.
        Impact of simulated hyperopia on academic-related performance in children.
        Optom. Vis. Sci. 2015; 92: 227-236
        • Gwiazda J.
        • Bauer J.
        • Thorn F.
        • Held R.
        A dynamic relationship between myopia and blur-driven accommodation in school-aged children.
        Vis. Res. 1995; 35: 1299-1304
        • Nakatsuka C.
        • Hasebe S.
        • Nonaka F.
        • Ohtsuki H.
        Accommodative lag under habitual seeing conditions: comparison between myopic and emmetropic children.
        Jpn. J. Ophthalmol. 2005; 49: 189-194
        • Walline J.J.
        • Jones L.A.
        • Sinnott L.
        • Manny R.E.
        • Gaume A.
        • Rah M.J.
        • Chitkara M.
        • Lyons S.
        • on behalf of the ACHIEVE Study Group
        A randomized trial of the effect of soft contact lenses on myopia progression in children.
        Invest. Ophthalmol. Vis. Sci. 2008; 49: 4702-4706
        • Bullimore M.A.
        • Jones L.A.
        • Moeschberger M.L.
        • Zadnik K.
        • Payor R.E.
        A retrospective study of myopia progression in adult contact lens wearers.
        Invest. Ophthalmol. Vis. Sci. 2002; 43: 2110-2113
        • Jorge J.
        • Braga A.
        • Queiros A.
        Changes in myopia prevalence among first-year university students in 12 years.
        Optom. Vis. Sci. 2016; 93: 1262-1267
        • Charman W.N.
        • Mountford J.
        • Atchison D.A.
        • Markwell E.L.
        Peripheral refraction in orthokeratology patients.
        Optom. Vis. Sci. 2006; 83: 641-648
        • Queirós A.
        • González-Méijome J.M.
        • Jorge J.
        • Villa-Collar C.
        • Gutiérrez A.R.
        Peripheral refraction in myopic patients after orthokeratology.
        Optom. Vis. Sci. 2010; 87: 323-329
        • Kang P.
        • Fan Y.
        • Oh K.
        • Trac K.
        • Zhang F.
        • Swarbrick H.
        Effect of single vision soft contact lenses on peripheral refraction.
        Optom. Vis. Sci. 2012; 89: 1014-1021
        • Schor C.
        The influence of interactions between accommodation and convergence on the lag of accommodation.
        Ophthalmic Physiol. Opt. 1999; 19: 134-150
        • Davies L.N.
        • Mallen E.A.H.
        Influence of accommodation and refractive status on the peripheral refractive profile.
        Br. J. Ophthalmol. 2009; 93: 1186-1190
        • Atchison D.A.
        • Collins M.J.
        • Wildsoet C.F.
        • Christensen J.
        • Waterworth M.D.
        Measurement of monochromatic ocular aberrations of human eyes as a function of accommodation by the howland aberroscope technique.
        Vis. Res. 1995; 35: 313-323
        • Cheng H.
        • Barnett J.K.
        • Vilupuru A.S.
        • Marsack J.D.
        • Kasthurirangan S.
        • Applegate R.A.
        • Roorda A.
        A population study on changes in wave aberrations with accomodation.
        J. Vis. 2004; 4: 272-280
        • Hough A.
        Soft bifocal contact lenses: the limits of performance.
        Contact Lens Anterior Eye. 2002; 25: 161-175
        • Gifford P.
        • Li M.
        • Lu H.
        • Miu J.
        • Panjaya M.
        • Swarbrick H.A.
        Corneal versus ocular aberrations after overnight orthokeratology.
        Optom. Vis. Sci. 2013; 90: 439-447
        • Joslin C.E.
        • Wu S.M.
        • McMahon T.T.
        • Shahidi M.
        Higher-order wavefront aberrations in corneal refractive therapy.
        Optom. Vis. Sci. 2003; 80: 805-811
        • He J.C.
        • Burns S.A.
        • Marcos S.
        Monochromatic aberrations in the accommodated human eye.
        Vis. Res. 2000; 40: 41-48
        • Collins M.J.
        • Wildsoet C.F.
        • Atchison D.A.
        Monochromatic aberrations and myopia.
        Vis. Res. 1995; 35: 1157-1163
        • Collins M.J.
        • Buehren T.
        • Iskander D.R.
        Retinal image quality, reading and myopia.
        Vis. Res. 2006; 46: 196-215
        • He J.C.
        • Gwiazda J.
        • Thorn F.
        • Held R.
        • Vera-Diaz F.A.
        The association of wavefront aberration and accommodative lag in myopes.
        Vis. Res. 2005; 45: 285-290
        • Gwiazda J.
        • Hyman L.
        • Dong L.M.
        • Everett D.
        • Norton T.
        • Kurtz D.
        • Manny R.
        • Marsh-Tootle W.
        • Scheiman M.
        Factors associated with high myopia after 7 years of follow-up in the Correction of Myopia Evaluation Trial (COMET) cohort.
        Ophthalmic Epidemiol. 2007; 14: 230-237
        • McBrien N.A.
        • Millodot M.
        Differences in adaptation of tonic accommodation with refractive state.
        Invest. Ophthalmol. Vis. Sci. 1988; 29: 460-469
        • Evans B.J.W.
        Esophoric conditions.
        Pickwell's Binocular Vision Anomalies. Fifth Edition. Butterworth-Heinemann, Edinburgh2007: 109-116
        • Chen A.H.
        • Aziz A.
        Heterophoria in young adults with emmetropia and myopia.
        Malaysian J. Med. Sci. 2003; 10: 90-94
        • Mountford J.
        Retention and regression of orthokeratology with time.
        Int. Contact Lens Clin. 1998; 25: 59-64
        • Stillitano I.
        • Schor P.
        • Lipener C.
        • Hofling-Lima A.L.
        Long-term follow-up of orthokeratology corneal reshaping using wavefront aberrometry and contrast sensitivity.
        Eye Contact Lens. 2008; 34: 140-145