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Thirty subjects (60 eyes) completed the 1-year follow-up period. The subjects were randomly fitted with a 5-mm BOZD (5BOZD) lens in one eye and a 6-mm BOZD (6BOZD) lens in the fellow eye. Corneal biomechanics were measured using Corvis ST at baseline and at 1\u00a0day, 7\u00a0days, 1\u00a0month, 6\u00a0months, and 12\u00a0months after ortho-k wear. Axial length (AL) was measured at baseline, 6\u00a0months, and 12\u00a0months after ortho-k wear, and AL elongation (\u0394AL) was calculated relative to baseline. Statistical analyses were performed to compare intergroup differences and examine the correlations between \u0394AL and changes in biomechanical parameters.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      \u0394AL was significantly smaller in the 5BOZD groups compared to the 6BOZD groups at both 6 and 12\u00a0months (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.05). The stiffness parameter at first applanation (SP-A1) significantly increased at 6\u00a0months in both groups (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.05). At 12\u00a0months, the first applanation time (A1 time) and integrated radius significantly increased, while the first applanation velocity (A1 velocity) and stress\u2013strain index (SSI) significantly decreased in both groups (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.05). In the 6BOZD group, \u0394AL showed a significant positive correlation with \u0394A1 time at 6 and 12\u00a0months (r\n                      <jats:sub>6m<\/jats:sub>\n                      \u2009=\u20090.385, r\n                      <jats:sub>12m<\/jats:sub>\n                      \u2009=\u20090.424,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Long-term ortho-k therapy increased SP-A1, A1 time, integrated radius, and decreased A1 velocity, reflecting enhanced corneal resistance and elasticity. Compared to the 5BOZD lens, the traditional 6BOZD lens demonstrated relatively greater corneal elasticity, possibly reducing myopia control efficacy. A smaller BOZD may offset these corneal biomechanical changes and improve the management of myopia.<\/jats:p>\n                    <jats:p>\n                      <jats:italic>Trial registration<\/jats:italic>\n                      Chinese Clinical Trial Registry (ChiCTR2200061048).\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s40662-026-00503-2","type":"journal-article","created":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T06:08:09Z","timestamp":1784614089000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Effects of orthokeratology with different back optic zone diameters on corneal biomechanics and myopia control: a 1-year randomized, double-blind, self-controlled study"],"prefix":"10.1186","volume":"13","author":[{"given":"Ruisi","family":"Xie","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Huo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoqin","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaorui","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying","family":"Guo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhengyuan","family":"Qu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yutong","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoyu","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haohan","family":"Zou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guoxing","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1257-6635","authenticated-orcid":false,"given":"Yan","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,21]]},"reference":[{"issue":"5","key":"503_CR1","doi-asserted-by":"publisher","first-page":"1036","DOI":"10.1016\/j.ophtha.2016.01.006","volume":"123","author":"BA Holden","year":"2016","unstructured":"Holden BA, Fricke TR, Wilson DA, Jong M, Naidoo KS, Sankaridurg P, et al. 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