Background To evaluate the relationship between amount of corneal refractive change (CRC) after wearing orthokeratology (Ortho-K) lenses and axial length (AL) growth.Methods We retrospectively enrolled 77 patients (77 eyes) aged 8-14 years who wore Ortho-K lenses more than 12 months. We divided the patients into 2 subgroups: spherical equivalent (SE) <= -3.0 D and SE > -3.0 D subgroup. The sagittal and tangential curvature maps and corneal topographic data within the 8-mm diameter ring at the baseline and during follow-up visits after wearing Ortho-K lens were recorded in addition to the area, height, and volume of the CRC region. The AL data were recorded at the baseline and during follow-up visits. Multivariate linear regression was conducted to analyze associations between the area, height, and volume of the CRC region, AL elongation, and SE.Results The average change in the CRC region was 9.77 +/- 0.60 D in height, 16.66 +/- 3.61 mm(2) in area, and 87.47 +/- 8.96 D*mm(2) in volume on the tangential diagram after wearing Ortho-K lenses for 3 months. The AL showed a change of 0.19 +/- 0.14 mm after 1 year of Ortho-K lens wear (P < 0.05). At 1 year, AL elongation was negatively correlated with the area (P = 0.019) and volume (P < 0.001) of the CRC region. At 1 year, for every 1-mm(2) increase in the area and every 1-D*mm(2) increase in the volume of the CRC region, the average AL elongation decreased by 0.01 mm and 0.002 mm, respectively, in the multivariate analysis. In patients with SE <= -3.0 D, AL elongation was negatively correlated with the CRC-region volume (beta = -0.002, P = 0.018), and in patients with SE > -3.0 D, AL elongation was negatively correlated with the CRC-region area (beta = -0.017, P = 0.016).Conclusions The AL elongation-control efficacy of Ortho-K lenses may be related to the area and volume of the CRC region.