History of Orthokeratology: From 1960s PMMA to Modern Myopia Control

Article Title: History of Orthokeratology: From 1960s PMMA to Modern Myopia Control

ARTICLE: As an optometrist who has dedicated my career to the field of myopia control, I often get asked about the origins of the technologies I use. It’s a question that always brings a smile to my face, because the story of orthokeratology, or ortho-k, is a fascinating journey of innovation, persistence, and a little bit of accidental genius. It’s a story that starts long before I opened my practice here in Fayetteville, North Carolina, and it’s a story that continues to unfold with exciting new developments.

Many of my patients, from military families at Fort Liberty to long-time residents of Cumberland County, are surprised to learn that the concept of reshaping the cornea to improve vision isn’t a new one. In fact, the idea has been around for over half a century! But how did we get from the early, unpredictable methods of the 1960s to the precise, FDA-cleared sleepSEE® lenses we use for myopia control today? Let’s take a look back at the remarkable history of orthokeratology.

The story of modern orthokeratology begins in the 1960s with an optometrist named George Jessen. At the time, contact lenses were made from a hard, non-breathable plastic called polymethylmethacrylate (PMMA). Dr. Jessen noticed something interesting: when his patients wore these PMMA lenses, their corneas would sometimes temporarily change shape, leading to a slight improvement in their natural vision after taking the lenses out. This was an unintended side effect, but it sparked an idea. What if this corneal reshaping could be done on purpose?

Dr. Jessen developed a technique he called "Orthofocus," where he would intentionally fit PMMA lenses flatter than the cornea to gently mold it into a new shape. The goal was to reduce myopia, and while the concept was revolutionary, the results were often unpredictable. The PMMA material didn’t allow oxygen to reach the cornea, which limited wearing time and caused swelling. The lens designs were simple, and without advanced tools to measure the cornea’s shape, it was more of an art than a science. Still, the seed was planted. The idea that we could actively reshape the eye’s surface to correct vision was born.

The RGP Revolution and Reverse Geometry Designs

The next major leap forward came with the development of rigid gas permeable (RGP) materials in the 1970s and 80s. Unlike PMMA, RGP lenses allowed oxygen to pass through to the cornea, making them much healthier for the eye and allowing for longer wear. This was a game-changer for all contact lens wearers, but it was especially important for the advancement of orthokeratology.

Around the same time, pioneers like Dr. Richard Wlodyga and Nick Stoyan began experimenting with more sophisticated lens designs. They are largely credited with developing the first "reverse geometry" lens. This might sound complicated, but the concept is quite elegant. A traditional contact lens has a single curve on the back surface that roughly matches the curve of the cornea. A reverse geometry lens, however, has a central curve that is flatter than the cornea (to do the reshaping), surrounded by a steeper "reverse curve." This secondary curve helps to center the lens on the eye and creates a space for the corneal tissue to move into. This design was a major breakthrough, leading to more predictable results and better lens stability on the eye.

*Modern ortho-k lenses are manufactured using incredibly precise, computer-controlled lathes, a world away from the early days of lens making.*

The Digital Age: Corneal Topography and Precision Manufacturing

Despite the advances in materials and design, orthokeratology in the 1980s was still limited by the tools available to practitioners. We could measure the central curvature of the cornea with a keratometer, but we couldn’t see the whole picture. That all changed in the 1990s with the advent of computerized corneal topography.

For the first time, we could create a detailed, color-coded map of the entire corneal surface, much like a topographic map of a mountain. This technology was revolutionary. It allowed us to see exactly how the ortho-k lens was interacting with the cornea and to design lenses with an unprecedented level of precision. Here in my Fayetteville practice, the corneal topographer is one of the most important tools I use, allowing me to customize sleepSEE® lenses for each individual patient’s unique eye shape. You can learn more about this process on our how it works [blocked] page.

Combined with the development of computer-controlled lathes that could manufacture these complex lens designs with incredible accuracy, the digital age transformed orthokeratology from an art into a highly predictable science.

*This timeline illustrates the key milestones in the development of orthokeratology, from early concepts to modern myopia control.*

A New Millennium: FDA Approval and the Rise of Overnight Ortho-K

The early 2000s marked a major turning point for orthokeratology. In 2002, the U.S. Food and Drug Administration (FDA) granted approval for the first reverse geometry lens design to be worn overnight. This was a landmark achievement, validating the safety and effectiveness of the procedure. The ability to wear the lenses while sleeping and enjoy clear vision all day without glasses or contacts was a huge benefit for patients.

This FDA approval, for a procedure called "Corneal Refractive Therapy" (CRT), opened the floodgates. More companies began to develop and market their own overnight ortho-k lenses, and the procedure became a mainstream option for vision correction. It was no longer a niche specialty but a widely recognized and trusted method for temporarily reducing myopia.

The Modern Era: Ortho-K for Myopia Control

Which brings us to today. While ortho-k is still an excellent option for adults who want freedom from glasses and daytime contacts, the most exciting application of this technology is now in the field of myopia management for children. A growing body of research from respected institutions like the American Academy of Ophthalmology (AAO) and the National Eye Institute (NIH) has shown that ortho-k can significantly slow down the progression of nearsightedness in children by approximately 40-55%. [1] [2]

This is the part of my job that I’m most passionate about. Here in Cumberland County, we’re seeing more and more children developing myopia at a young age. By using sleepSEE® lenses, we can not only give these kids clear vision during the day but also help protect their eyes for the future by slowing down the stretching of the eye that causes myopia to worsen. It’s a proactive approach to eye health that can have a lifelong impact. If you’re wondering if your child might be a candidate, I encourage you to take our candidacy quiz [blocked].

*The global adoption of orthokeratology has seen a dramatic increase, particularly with its proven effectiveness in myopia management.*

Ortho-K Technology: A Journey Through Time

It's truly remarkable to see how far we've come. This table provides a snapshot of the evolution of ortho-k technology over the decades: