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

Modern Ortho-K depends on three things that took decades to develop: lenses that let oxygen through, designs that reshape the cornea more predictably and instruments that map the eye’s surface. The early versions were very different from the overnight lenses fitted today. Looking at that history helps explain why measurement, lens design and follow-up are so central to the process.

The idea of changing corneal shape with a contact lens dates back more than half a century. The sections below follow the changes from early PMMA lenses to modern materials and FDA device approvals. They also explain how a technique developed for temporary vision correction became part of childhood myopia management.

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 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. For Ortho-K, that material change opened the way to further development of overnight lens designs.

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. The name describes the curves on the back of the lens. 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.

Corneal topography gives the doctor a detailed, color-coded map of the eye’s front surface. Comparing maps before and after wear helps show where the cornea has changed and whether the treatment area is centered. It also helps guide changes to the lens fit. At a sleepSEE® evaluation, those measurements inform the design for the individual eye; follow-up maps help assess the response. Our how it works page shows where topography fits into the fitting process.

Computer-controlled lathes made it possible to manufacture more complex lens designs accurately. Used together with corneal maps, they gave practitioners better tools for planning and adjusting a fit. Individual eyes still need follow-up to check the response.

*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.

*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:

Historical review, review of optical and design changes, and the ROMIO trial provide the research behind these milestones.

The story continues through better measurements, fitting methods and long-term follow-up. Those developments help a provider explain both what the lenses can do and how care should be monitored.