The application of hyaluronic acid-containing artificial tears on the ocular surface of children receiving orthokeratology contact lens treatment

Purpose: The purpose of this study was to compare the effects of the application of hyaluronic acid (HA)-containing artificial tears and non-HA artificial tears on the ocular surface of children receiving orthokeratology contact lens treatment. Method: Charts of patients fitted with orthokeratology contact lenses in any of 20 local clinics were reviewed in this retrospective cohort study. The patients were then categorized according to the artificial tear type used, resulting in 85 and 95 patients being placed into the non-HA and HA groups, respectively. The primary outcomes include fluorescein ocular surface staining and dry eye disease (DED)-related symptoms which were measured at 1, 3 and 6 months after orthokeratology contact lens treatment. An independent t test and Chi-square test were used for statistical analysis. Results: At one month, there was a statistically significant greater number of non-HA patients with staining (14 non-HA, 4 HA, P=0.017). In the final visit, the incidence of ocular surface stain was also significantly lower in the HA group (12 non-HA, 2 HA, P = 0.010). At one month, there was a statistically significant greater number of non-HA patients with DED-related symptoms (24 non-HA, 12 HA, P = 0.029). Finally, the number of DED-related symptoms was significantly lower in the HA group (P = 0.005). After a 6-month follow-up, the spherical equivalent refraction (SER) and axial length (AXL) values between the two groups showed no significant difference (all P > 0.05). Conclusions: The application of HA-containing artificial tears resulted in less ocular surface staining and fewer DED-related symptoms in children wearing overnight orthokeratology contact lenses.