Objective To evaluate the corneal aberration and Q value on controlling the development of myopia in orthokeratology. Methods This was a prospective clinical study. Eighty-five children aged 8-16 years with low and moderate myopia were enrolled in this study. The ocular axis and aberrations of the cornea, corneal anterior surface Q measurements were measured before and after wearing 1 year. The ocular axis was measured by IOLMaster, the corneal aberrations and Q value were measured by corneal topography, and the corneal aberrations were measured under 6 mm pupil diameter. The data were analyzed by binary logistic regression, independent samples t test. Results Seventy-three subjects completed the 1-year follow-up. The mean axial length significantly increased from 25.17±0.88 mm at baseline to 25.42±0.83 mm 1 year after treatment. There were significant differences in age, the difference of anterior corneal surface Q value, the corneal spherical aberration, the horizontal corneal coma and the degree of myopia between two different axial length growth groups. The main factors of controlling axial length elongation in orthokeratology were the difference of anterior corneal surface Q value (?茁=-4.349, P<0.01), the corneal spherical aberration (?茁=-12.881, P<0.01) and the degree of myopia (?茁=3.709, P<0.01) using logistic regression analysis. The factors of myopia included age (?茁=0.441, P<0.05) and the corneal spherical aberration (?茁=8.762, P<0.05). Conclusion Age and corneal spherical aberration have an impact on myopia progression. After one-year follow-up, the impact of orthokeratology on controlling of the axial elongation is better in moderate myopia than in low myopia. Orthokeratology have a considerable effect on slowing axial length elongation through changing anterior corneal surface Q values and corneal spherical aberration.