Perceived Challenges, Barriers, and Strategies for Orthokeratology Practice: Insights From Eye Care Practitioners in India

Objectives: This study aimed to evaluate the perceived challenges, barriers, and strategies associated with orthokeratology (Ortho-K) practice among eye care practitioners in India. Methods: A cross-sectional questionnaire-based survey was conducted among eye care practitioners across India between November 2025 and February 2026. The survey assessed perceived challenges, barriers, and strategies related to Ortho-K practice using a five-point Likert scale. Responses were summarized using frequencies, percentages, and medians with interquartile ranges (IQRs). Differences in domain scores according to Ortho-K exposure were analyzed using the Kruskal–Wallis test, whereas correlations between domains were evaluated using Spearman rank correlation. Multivariable logistic regression was performed to identify factors associated with current Ortho-K practice. Results: A total of 465 eye care practitioners were invited, of whom 343 completed the survey and were included in the analysis, yielding a response rate of 73.8%. Among the respondents, 20.4% reported currently practicing Ortho-K. Fellowship qualification (AOR: 3.62; 95% CI: 1.38–9.47; P =0.009) and ≥31 years of clinical experience (AOR: 7.24; 95% CI: 2.14–24.54; P =0.002) were associated with higher odds of current Ortho-K practice, whereas university-based practice was associated with lower odds (AOR: 0.24; 95% CI: 0.09–0.62; P =0.003). Patient education and motivation during consultations received the highest median agreement score among the listed challenges (median 4/5; IQR: 3–5), whereas high treatment cost received the highest median agreement score among the listed barriers (median 4/5; IQR: 3–4). Respondents expressed high levels of agreement with strategies aimed at increasing patient awareness and providing advanced hands-on training workshops (median 4/5; IQR: 3–5). No significant association was observed between Ortho-K exposure and domain scores ( P >0.05). Strong positive correlations were identified between challenges and barriers (ρ=0.74, P <0.001). Conclusions: The clinical adoption of Ortho-K among practitioners in India remains limited, with educational, infrastructural, and economic factors perceived as barriers to its wider integration. Targeted training initiatives, improved access to diagnostic resources, and enhanced patient awareness may facilitate wider integration of Ortho-K into contemporary myopia management.