Objective To investigate an improved orthokeratology fitting method for myopic adolescents with moderate-to-high astigmatism； to analyze successful fitting factors. Methods This was a retrospective analysis of 33 patients （60 eyes） ranging in age from 6 to 18 years with 0.5 to 6.25 diopters （D） of myopia and with-the-rule corneal astigmatism of 1.76 to 3.02 D who were fitted with orthokeratology lenses with a spherical design. Treatment outcomes were evaluated by comparing eyes before lens wear and after wearing the lenses for 1 day， 1 week， 1 month， 3 months， 6 months and 12 months. The results were graded on corneal topography and visual acuity. Orthokeratology central-fitting factors were analyzed in patients with moderate-to-high astigmatism using logistic regression. Results The uncorrected visual acuity （UCVA） of patients before wearing the orthokeratology lenses was 4.15±0.23， and was 4.59±0.23 after 1 night of wear， 4.90±0.11 after 1 week， 4.96±0.07 after 1 month， 4.86±0.25 after 3 months， 4.93±0.10 after 6 months and 4.93±0.11 after 12 months. Visual acuity improved significantly after lens wear （F=148.08， P<0.05）. Four grades were defined as a result of wearing orthokeratology lenses for 1 month. Eyes were graded as follows： grade Ⅰ， 35 eyes （58%）， grade Ⅱ， 15 eyes （25%）， grade Ⅲ， 8 eyes （13%）， grade Ⅳ， 2 eyes （3%）. No statistically significant effect was found on baseline factors in the results. Factors included myopia， corneal astigmatism， steep keratometry （SK）， corneal eccentricities （e）， and inferior-superior value （I-S）. Conclusion With this modified method， spherical orthokeratology lenses can be central-fitted on some myopic patients with moderate-to-high corneal astigmatism.