Objective  To observe the changes in corneal astigmatism after patients are fitted with different ortho-k contact lens （CL） designs and the influence of these lenses on visual quality. Methods  In a case-control study， corneal astigmatism， corneal topography， wavefront aberrations （Pentacam）， visual acuity and visual disturbance symptoms were observed in three groups （groups A， B， C） before and after CL wear. Group A（30 eyes） had lower corneal astigmatism and wore a general ortho-k contact lens design that fit quite well； group B（30 eyes） had lower corneal astigmatism and wore a general ortho-k contact lens design that did not fit well and was obviously decentered； group C （31 eyes） had higher corneal astigmatism and wore toric ortho-k contact lenses with an acceptable fit. SPSS 16.0 statistical software was used to analyze the data. Results  Changes in corneal astigmatism after fitting with the ortho-k CL： astigmatism increased in group B but was lower in groups A and C. Fourier analysis from corneal topography： increases in asymmetry for all three groups at 3 mm were （-0.393±0.329）D， （-4.050±2.084）D， and （-0.494±0.522）D， respectively， all at P<0.001. Higher order aberrations in the three groups increased at 3 mm and were （-0.011±0.055）D （P>0.05）， （-0.635±0.441）D （P<0.001） and （-0.055±0.082）D （P<0.01）. The three groups at 3 mm regular：differences in the comparison of astigmatism， asymmetry and higher order aberrations were statistically significant， F=79.862， F=83.882， F=54.265， respectively， all at P<0.01. After fitting with ortho-k CLs， the total aberrations and total higher order aberrations for the three groups increased in varying degrees， with group B as the most significant. A comparison of the difference in aberrations： only the anterior surface of the spherical aberration had a statistically significant difference （F=18.048， P<0.01）. After the CLs were removed： in group A 36.7 % achieved a UVA of 1.2， 50.0% achieved 1.0 and 13.3% achieved 0.8； in group B 36.7% achieved 1.0， 46.7% achieved 0.9-0.8， 13.3% achieved 0.6-0.5， and 3.3% achieved 0.4； in group C 9.7% achieved 1.2， 51.6% achieved 1.0， 16.1% achieved 0.9~0.8 and 22.6% achieved 0.6. There were statistically significant differences in UVA between the three groups （χ2=20.252， P<0.01）. Patients reported a variety of visual disturbance symptoms such as ghost， fringe， glare， etc. In group A， 0% reported visual disturbance symptoms， with 16% in group C and 47% in group B. Conclusion  Ortho-k contact lens design and fitting significantly impact corneal astigmatism and visual quality. Appropriate ortho-k CL toric designs can be highly effective for improving the CL fitting and enhancing the corneal reshaping effect for some higher order corneal astigmatisms.