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Highlights • Orthokeratology changes the relative peripheral astigmatic components in patients with early-adult onset myopia. • Despite their ages, the early-adult onset myopes presented in this case series experienced a significant myopia progression before they were treated with orthokeratology. • After starting orthokeratology treatment these patients showed slower progression or no progression of their refractive error. • Axial length remained stable during orthokeratology treatment in early-adult onset myopia.