This article provides an updated literature review on the orthkeratology effect on myopia progression considering outcome measures, potential effect modifiers, mechanisms and current prescription concerns. The discussion centres on the extent of slowed myopia progression, mechanisms, safety concerns and comparisons to other therapies. Orthokeratology consists of contact lenses worn overnight to reshape the cornea. Corneal reshaping appears to decrease peripheral hyperopia defocus and therefore increases peripheral myopia defocus which may reduce the stimuli for axial elongation and subsequent development of myopia. There is a potential risk for corneal infection through overnight wear of the contact lenses.