Objective To use vector analysis to evaluate the effectiveness of general and toric orthokeratology lenses for changes in corneal astigmatism in myopic children with moderate-to-high astigmatism. Methods This was a prospective study. Fourteen patients, 27 eyes (Spherical group), were fitted with spherical orthokeratology lenses and 10 patients, 20 eyes (Toric group), were fitted with toric orthokeratology lenses. Data collection was performed 1 day, 1week, 1 month, 3 months after orthokeratology fitted and included visual acuity, corneal topography, axial length and biomicroscopy examinations. Changes in corneal toricity were evaluated using vector analysis. Data were compared between the two groups using independent t test. Results The median subjective myopia of Spherical group and Toric group at base line was -3.80±1.43 D and -3.98±1.53 D (P>0.05). The corneal J0 vector values were -1.11±0.23 D and -1.18±0.29 D (P>0.05) and the J45 vector values were 0.11±0.21 D and 0.05±0.51 D (P>0.05), respectively. After wearing orthokeratology lenses for 1 day, 1 week, 1 month and 3 months, the UCVAs improved steadily in both groups, the differences between the two groups were insignificant in 1 day, 1 week, 1 month, but with significant difference in 3 months (4.93±0.05 vs. 5.05±0.06). The differences of corneal J0 vector values between the two groups were significant for all the time ponits (t=-4.83, -1.56, -2.38, -1.03, P<0.05). The differences of corneal J45 vector values between the two groups were insignificant. There were 4 and zero patients in Spherical group and Toric group who reported visual disturbance symptoms. Conclusion Both spherical and toric orthokeratology lenses can improve UCVA in myopic children with moderate-to-high astigmatism. However, the toric design can be effective for improving contact lens fitting and enhancing the effect of corneal reshaping.