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To assess the correlation between changes in corneal aberrations and the 2-year change in axial length in children fitted with orthokeratology (OK) contact lenses.Thirty-one subjects 6 to 12 years of age and with myopia −0.75 to −4.00DS and astigmatism ≤1.00DC were fitted with OK. Measurements of axial length and corneal topography were taken at regular intervals over a 2-year period. Corneal topography at baseline and after 3 and 24 months of OK lens wear was used to derive higher-order corneal aberrations (HOA) that were correlated with OK-induced axial length changes at 2 years.Significant changes in root mean square (RMS) secondary astigmatism and fourth and total HOA were found with both 3 and 24 months of OK lens wear in comparison with baseline (all P<0.05). Additionally, significant changes in and RMS tetrafoil were found at 3 months and in second-order RMS at 24 months of OK lens wear in comparison with baseline (all P<0.05). However, none of the changes in corneal aberrations were significantly correlated with the 2-year change in axial elongation (all P>0.05). Coma angle of orientation changed significantly pre-OK in comparison with 3 and 24 months post-OK as well as secondary astigmatism angle of orientation pre-OK in comparison with 24 months post-OK (all P<0.05). However, coma, trefoil, secondary astigmatism, and tetrafoil angles of orientation pre-OK or post-OK were not significantly correlated with the 2-year change in axial elongation (all P>0.05).Short-term and long-term OK lens wear induces significant changes in corneal aberrations that are not significantly correlated with changes in axial elongation after 2-years.