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Learn more: PMC Disclaimer | PMC Copyright Notice BMC Med Educ . 2026 Mar 5;26:596. doi: 10.1186/s12909-026-08955-9 Search in PMC Search in PubMed View in NLM Catalog Add to search Preliminary exploration and evaluation of video-based feedback for orthokeratology lens fitting: a pilot study Feng’e Xu Feng’e Xu 1 Key Laboratory of Ocular Blindness and Diseases, Ningbo Eye Research Institute, Ningbo Eye Hospital, Affiliated to Wenzhou Medical University, Ningbo, 315040 China Find articles by Feng’e Xu 1 , Xiaolan Wu Xiaolan Wu 1 Key Laboratory of Ocular Blindness and Diseases, Ningbo Eye Research Institute, Ningbo Eye Hospital, Affiliated to Wenzhou Medical University, Ningbo, 315040 China Find articles by Xiaolan Wu 1 , Bilian Wang Bilian Wang 2 Ningbo Art Experimental School, Ningbo, 315040 China Find articles by Bilian Wang 2 , Xiaotian Liu Xiaotian Liu 1 Key Laboratory of Ocular Blindness and Diseases, Ningbo Eye Research Institute, Ningbo Eye Hospital, Affiliated to Wenzhou Medical University, Ningbo, 315040 China Find articles by Xiaotian Liu 1, ✉ Author information Article notes Copyright and License information 1 Key Laboratory of Ocular Blindness and Diseases, Ningbo Eye Research Institute, Ningbo Eye Hospital, Affiliated to Wenzhou Medical University, Ningbo, 315040 China 2 Ningbo Art Experimental School, Ningbo, 315040 China ✉ Corresponding author. Received 2026 Jan 4; Accepted 2026 Feb 27; Collection date 2026. © The Author(s) 2026 Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/ . PMC Copyright notice PMCID: PMC13072557 PMID: 41787419 Abstract Background To evaluate the application effect of the video-based feedback teaching method in the practical teaching of orthokeratology lens fitting. Methods Twenty-three optometry interns were assigned via stratified randomization to an experimental group (video-based feedback, n = 12) and a control group (traditional verbal feedback, n = 11). Both groups received identical theoretical lectures led by the same instructor. The experimental group’s practice sessions were video recorded with structured feedback provided. Assessments included theoretical examinations, practical skill assessments and questionnaires. Independent sample t-tests and Mann–Whitney U tests were used to compare theoretical examination scores, practical skill assessments, and questionnaire results between the two groups to evaluate the teaching effectiveness. Theoretical examinations tested cognitive understanding of orthokeratology principles. Practical skills were evaluated using standardized assessments focusing on fluorescence evaluation techniques. Students completed questionnaires assessing course experience and metacognitive awareness. Results Theoretical knowledge scores showed no significant difference between groups ( P = 0.060); however, the experimental group achieved a significantly higher pass rate (100.0% vs. 45.5%, Fisher’s exact test, P = 0.004). The experimental group achieved significantly higher practical skills scores (90.33 ± 6.29 vs. 81.91 ± 7.94; P = 0.010), particularly in static fluorescence evaluation (median 32, IQR: 29.5–36 vs. median 30, IQR: 21–32; P = 0.027) and dynamic fluorescence evaluation (median 14, IQR: 12–14 vs. median 10, IQR: 7–12; P = 0.004). The experimental group also demonstrated significantly higher satisfaction in self-awareness of performance ( P = 0.048), perceived course helpfulness ( P = 0.014), detail of practical demonstration ( P = 0.008), and timeliness of instructor guidance ( P = 0.019). Conclusion This pilot study provides preliminary evidence that video-based feedback effectively enhances orthokeratology fitting skills and promotes reflective learning, offering a practical approach for clinical skills education in optometry. Future studies with larger sample sizes and long-term follow-up are warranted. Keywords: video-based feedback, orthokeratology lens fitting, optometry education, fluorescein evaluation Background Myopia has reached epidemic proportions globally, with prevalence rates exceeding 80% among young adults in some Asian countries [ 1 ]. China faces particularly high myopia rates compared with Western nations [ 2 ]. Orthokeratology (OK lens) is a non-surgical technique using specially designed rigid lenses to temporarily reshape the cornea. It is now recognized as a safe and effective approach for myopia control [ 3 ]. For optometry students, OK lens fitting is an essential clinical skill that requires the ability to visualize and reflect on their own techniques while developing critical thinking and self-assessment abilities. Mastering OK lens fitting often demands repeated and extensive practice, making the learning process relatively long and challenging. The difficulty of fully mastering the fitting and evaluation skills of OK lenses has received increasing attention, and some studies have also attempted to explore methods for improvement [ 4 ]. Traditional teaching approaches for this complex procedure face significant limitations. Students typically receive theoretical instruction supplemented by limited clinical exposure, constrained by the scarcity of patient cases, inadequate facilities, and restricted hands-on opportunities [ 5 ]. These barriers extend the learning curve and hinder the development of clinical competence. Moreover, conventional teaching methods often fail to provide students with opportunities for objective self-assessment and specific, timely feedback—two key components essential for efficient skill acquisition. Video-based feedback offers a promising solution to these challenges. By recording students’ practice sessions and facilitating structured review, this pedagogical approach enables direct visualization of performance, accurate skill assessment and timely, specific feedback [ 6 – 8 ]. Evidence across multiple clinical disciplines demonstrates that video-based feedback significantly enhances both technical competency and learning engagement [ 9 – 12 ]. Despite its proven effectiveness in other domains, video-based feedback teaching remains underutilized in optometry education, particularly for OK lens training. As an initial exploration, this pilot study examines the feasibility of implementing video-based feedback in OK lens fitting education and assesses its potential impact on student learning outcomes. The findings aim to provide preliminary evidence and a practical framework to guide future investigations in optometry clinical skills education. Methods We implemented this video-based feedback approach at Ningbo Eye Hospital affiliated to Wenzhou Medical University between June 2024 and June 2025. The program included 23 fourth-year optometry interns completing their clinical rotations. Implementation in OK lens training When video-based feedback is applied to OK lens training, this approach enables students to observe their own OK lens fitting technique, identify specific areas for improvement and receive targeted feedback based on objective visual evidence. Our video-based feedback approach was designed with three core principles: the recording process should be unobtrusive and not interfere with the natural learning environment; feedback should be structured and systematic, focusing on specific observable behaviors; and the approach should promote active student engagement and self-reflection rather than passive reception of instructor comments. Study design and participant allocation Twenty-three optometry interns underwent stratified randomization based on recent standardized theoretical examination scores. Within each stratum, participants were randomly allocated to experimental or control groups (1:1 ratio) using computer-generated random numbers. The basic information of the two groups of students is shown in Table 1 . The experimental group ( n = 12) received video-based feedback, while the control group ( n = 11) received traditional verbal feedback .There were no significant differences in age, gender distribution and academic performance between groups, confirming good comparability for subsequent effectiveness evaluation. Table 1. Baseline Characteristics of Participants Characteristic Control Group ( n = 11) Experimental Group ( n = 12) P -value Age (years), mean ± SD 20.38 ± 1.06 20.25 ± 0.46 0.978 Gender (Male: Female) 2:9 3:9 0.500 Academic performance (score), mean ± SD 73.63 ± 8.70 74.88 ± 4.42 0.724 Open in a new tab Teaching interventions Both groups attended an identical 90-minute theoretical lecture delivered by the same instructor with over five years of experience in OK lens education, covering fundamental concepts including OK lens types and materials, fitting principles, and the complete fitting workflow. Subsequently, both groups participated in 180-minute practical training sessions with different pedagogical approaches, as illustrated in Fig. 1 . Fig. 1. Open in a new tab Teaching workflow comparing video-based feedback with traditional verbal feedback in OK lens fitting education. Both groups (control n=11, experimental n=12) received identical 90-minute theoretical lectures. Control group: instructor demonstration (30 min) plus group practice with real-time verbal feedback (150 min). Experimental group: instructor demonstration (30 min), recorded paired practice (100 min), immediate video review and structured feedback sessions (50 min) analyzing three fitting patterns. Both groups completed blinded assessments: theoretical examination, practical skills evaluation (standardized rubric, 100 points), and teaching feedback questionnaire The control group’s practical course consisted of instructor demonstration (30 min) followed by group training (150 min), with 2–3 students per group serving as subjects for each other in selecting trial OK lenses and conducting evaluation and adjustment. The instructor provided bedside teaching with verbal feedback on common errors in static assessment and challenges in dynamic assessment, without video recording. Pre-examination guidance (90 min) included theoretical review (30 min) and intensive practice (60 min). The experimental group received video-based feedback intervention during their 180-minute practical course. After instructor demonstration (30 min), students practiced in pairs (100 min) while being recorded using a smartphone positioned at a 45-degree angle 1.5 m away and the slit lamp imaging system capturing fluorescence images in a standardized fitting room. Students immediately reviewed their recordings for self-reflection and peer discussion, followed by instructor-led feedback sessions (50 min) analyzing common errors in static and dynamic assessment and OK lens selection judgment. Through systematic video review, students in the experimental group learned to identify three critical fitting patterns—loose fit, tight fit, and optimal fit (Fig. 2 )—by comparing their own fluorescein patterns with standard criteria and receiving targeted instructor feedback to develop visual discrimination skills. Feedback covered three dimensions: technical operations, clinical judgment, and professional competency, lasting 15–25 min per group (mean 18.3 ± 3.7 min). All videos were uploaded to the hospital’s internal platform for repeated viewing. Pre-examination guidance (90 min) incorporated video review (30 min) before targeted intensive practice (60 min). Fig. 2. Open in a new tab Fluorescein fitting patterns identified through video-based feedback. Representative images from experimental group students showing: ( A ) Loose fit: fluorescein leakage is visible inferiorly (arrow). B Tight fit: central fluorescein pooling with small air bubbles is visible (arrow). C Optimal fit demonstrating appropriate fluorescein distribution across all zones. Images were captured using the slit lamp's integrated imaging system under cobalt blue illumination with a yellow barrier filter during practical training sessions. Students used these video-recorded patterns for self-assessment and instructor-guided feedback to develop visual discrimination skills Theoretical and practical assessments The evaluation methods included a theoretical knowledge test, a practical skills assessment, and a questionnaire assessing course experience and metacognitive awareness.The theoretical knowledge test was administered as a closed-book written examination. Practical skills were assessed by blinded examiners who underwent standardized training and had no involvement in teaching either group. Students were randomly coded to ensure examiner blinding and objective evaluation. All assessments followed a standardized OK lens fitting evaluation rubric (maximum 100 points) encompassing six domains: basic information documentation, OK lens selection principles, fluorescence pattern evaluation, adjustment protocols, with each domain further subdivided into detailed scoring criteria to minimize subjective judgment. Questionnaire assessment This study utilized a self-developed Teaching Feedback Questionnaire for OK Lens Fitting to assess course experience and metacognitive awareness in both groups. The questionnaire was designed based on two validated instruments. Course experience was evaluated using four items adapted from the Course Experience Questionnaire (CEQ), originally developed by Ramsden [ 13 ] and subsequently validated by Wilson et al. [ 14 ]. These items assessed clarity of theoretical instruction, timeliness of instructor guidance, perceived course helpfulness, and comprehensiveness of practical demonstrations. Metacognitive awareness was measured using one item adapted from the knowledge of cognition dimension of the Metacognitive Awareness Inventory (MAI) developed by Schraw and Dennison [ 15 ], which evaluated students’ ability to recognize their own operational strengths and weaknesses. The questionnaire employed a five-point Likert scale (1 = strongly disagree to 5 = strongly agree) and was administered immediately following course completion. Participants completed the questionnaire anonymously, with on-site collection to ensure maximum response rate. All 23 distributed questionnaires were returned, yielding a 100% response rate with no missing data. Prior to implementation, the questionnaire underwent rigorous validation. Three expert faculty members in optometry education reviewed the items for content validity and relevance to the learning objectives. A pilot test was then conducted with five students to assess clarity and comprehension. Internal consistency reliability of the final instrument was evaluated using Cronbach’s alpha coefficient, which yielded a value of 0.858, indicating good internal consistency and acceptable reliability for research purposes. Statistical analysis Data were analyzed using SPSS version 26.0 (IBM Corp., Armonk, NY, USA). Baseline characteristics were compared using independent-samples t-test for continuous variables (age, academic performance) and Fisher’s exact test for gender distribution due to the small sample size. Fisher’s exact test was used to compare the theoretical examination pass rates between groups, with a two-tailed significance level set at α = 0.05.The total practical test scores followed a compound normal distribution and were compared between groups using the independent-samples t-test, with results expressed as mean ± standard deviation (SD). The remaining variables did not conform to normal distribution and were analyzed using the Mann–Whitney U test, with results presented as median (interquartile range, IQR). Statistical significance was defined as p < 0.05 (two-tailed). Results Theoretical knowledge assessment Table 2 presents the comparison of theoretical examination scores between the two groups. Although the experimental group achieved a higher median total score (93, IQR: 86-93.75) compared to the control group (86, IQR: 80–93), this difference did not reach statistical significance ( P = 0.060). No statistically significant differences were observed between groups for any question type (single-choice, multiple-answer, or true/false questions; all P > 0.05).However, a notable difference was observed in the pass rate: all students in the experimental group (100.0%, 12/12) achieved passing scores, compared to only 45.5% (5/11) in the control group, with this difference being statistically significant (Fisher’s exact test, P = 0.004). Table 2. Comparison of Theoretical Examination Scores between the Two Groups Assessment Component Control Group ( n = 11) [Median (IQR)] Experimental Group ( n = 12) [Median (IQR)] P -value Single-choice questions 60(48–60) 60(55.5–60) 0.259 Multiple-answer questions 21(14–21) 21(28 − 14) 0.117 True/false questions 12(12–12) 12(12–12) 0.852 Total score 86(80–93) 93(86-93.75) 0.060 Open in a new tab Practical skills assessment performance The practical skills assessment scores are presented in Table 3 . The experimental group achieved significantly higher overall practical skills scores compared to the control group (90.33 ± 6.29 vs. 81.91 ± 7.94, P = 0.010). When examining individual assessment components, the experimental group demonstrated significantly superior performance in both static fluorescence evaluation ( P = 0.027) and dynamic fluorescence evaluation ( P = 0.004).No statistically significant differences were observed between groups for the remaining assessment components, including patient information documentation, OK lens selection principles, OK lens adjustment decisions, or overall procedure quality (all P > 0.05). Table 3. Comparison of Practical Skill Assessment Scores between the Two Groups Assessment Component Control Group ( n = 11) [Median (IQR)] Experimental Group ( n = 12) [Median (IQR)] P -value Patient information documentation 10(10–10) 10(8.5–10) 0.402 OK lens selection principles 10(10–10) 10(8.5–10) 0.579 Static fluorescence evaluation 30(21–32) 32(29.5–36) 0.027 Dynamic fluorescence evaluation 10(7–12) 14(12–14) 0.004 OK lens adjustment decisions 14(11–15) 13.5(12–15) 0.850 Overall procedure quality 14(12–15) 13(13–15) 0.924 Total score 81.91 ± 7.94 90.33 ± 6.29 0.010 Open in a new tab Questionnaire results All 23 participants completed the post-training questionnaire (100% response rate). (Table 4 ). The experimental group demonstrated significantly higher satisfaction across multiple evaluation indicators. The difference was observed in “self-awareness of performance” ( P = 0.048), where the experimental group reported better recognition of their strengths and weaknesses. The experimental group also achieved significantly higher scores in “detail of practical demonstration” ( P = 0.008), “timeliness of instructor guidance” ( P = 0.019), and “helpfulness of the course” (P = 0.014). Regarding “clarity of theoretical instruction,” although the experimental group scored slightly higher, the difference did not reach statistical significance ( P = 0.068). Table 4. Comparison of Student Questionnaire Results Between the Two Groups Evaluation item Control group ( n = 11) Median (IQR) Experimental group ( n = 12) Median (IQR) P -value Helpfulness of the course 4 (2–4) 4(4–5) 0.014 Clarity of theoretical instruction 4 (4–5) 5 (4.25-5) 0.068 Detail of practical demonstration 4 (4–5) 5 (5–5) 0.008 Timeliness of instructor guidance 4 (4–5) 5 (5–5) 0.019 Self-awareness of performance 3 (3–4) 4(4–5) 0.048 Open in a new tab Summary of key findings In this pilot study, video-based feedback teaching showed potential benefits for practical skill performance and course satisfaction. Preliminary indications of enhanced metacognitive awareness were observed, though the small sample size and limited scope of metacognitive assessment necessitate cautious interpretation and further investigation. Compared with conventional instruction, students in the experimental group achieved higher overall practical skills scores ( P = 0.010) and demonstrated superior performance in both static ( P = 0.027) and dynamic ( P = 0.004) fluorescein evaluations. The experimental group also reported higher levels of self-awareness regarding their performance strengths and weaknesses ( P = 0.048) and greater perceived course helpfulness ( P = 0.014). These preliminary findings suggest that video-based feedback may represent a valuable pedagogical enhancement for OK lens education, particularly for complex clinical skills requiring precise visual discrimination and manual dexterity. Further investigation with larger samples is warranted. Discussion With the rising global prevalence of myopia [ 16 ] and increasing clinical application of OK lenses for myopia control [ 17 ], developing effective educational strategies to train students in precise OK lens fitting has become an urgent priority in optometry education. High-quality OK lens fitting skills training is essential not only for cultivating competent optometry professionals but also for safeguarding the ocular health of myopic patients. Previous studies have demonstrated that video-based feedback teaching methods are well-structured and enhance student confidence in skill acquisition, showing good feasibility as an effective supplement to traditional teaching approaches [ 18 , 19 ]. This pilot study extends the literature on video-based feedback by examining its application in OK lens fitting education, a complex skill requiring visual discrimination and manual dexterity. Our preliminary findings suggest potential benefits for practical performance and metacognitive awareness, though the exploratory nature and modest sample size ( n = 23) necessitate cautious interpretation. These initial results nonetheless provide a foundation for understanding how video-based feedback might enhance clinical skills education in optometry and potentially other health professions. Video feedback enhances practical skill acquisition The experimental group achieved significantly higher overall practical skills scores compared to the control group, with the most substantial improvements observed in static and dynamic fluorescence evaluation—the most technically demanding components of OK lens fitting assessment. This finding is consistent with previous research demonstrating video-based feedback’s effectiveness in enhancing procedural skills in medical education [ 10 , 20 ]. Static fluorescence evaluation requires systematic assessment of the OK lens-cornea fluorescence relationship across all corneal meridians, while dynamic fluorescence evaluation demands continuous observation and interpretation of real-time changes as the OK lens settles. Both tasks require sophisticated visual pattern recognition and interpretation skills that are particularly challenging to convey through verbal instruction alone. Video-based feedback addresses this pedagogical challenge by providing concrete visual evidence of correct and incorrect techniques, enabling students to develop accurate mental models of optimal performance [ 21 ]. The method’s effectiveness appears to stem from its ability to make abstract performance standards tangible [ 8 ]. Video playback transforms instructor feedback from verbal descriptions into specific, visually anchored guidance [ 10 , 22 ]. Students in our study reported that video-based feedback was clearer and more helpful than verbal feedback alone, supporting findings that personalized video-based feedback enhances skill development [ 8 ]. Additionally, video recordings provide reusable learning materials for self-directed review. Notably, no significant differences were observed for other assessment components, including patient information documentation, OK lens selection principles, OK lens adjustment decisions, and overall procedure quality (all P > 0.05). This pattern suggests that video-based feedback provides particular advantages for visually complex assessment tasks requiring real-time pattern recognition, while more algorithm-driven or protocol-based skills may be equally well learned through traditional instruction. These findings align with educational theories suggesting that different instructional modalities offer varying benefits depending on the cognitive demands of the target skill [ 23 , 24 ]. Mechanisms of video-based feedback effectiveness The improved performance in fluorescein pattern assessment may be attributed to three synergistic mechanisms grounded in established learning theories. Video-based feedback temporally separates skill execution from analytical evaluation, addressing working memory limitations during concurrent task performance [ 25 ]. By allowing students to focus exclusively on pattern recognition without simultaneously manipulating OK lenses, video playback may reduce extraneous cognitive load and facilitate schema construction [ 25 ], aligning with multimedia learning principles shown to enhance procedural skill efficiency [ 26 ]. The integration of visual demonstration with verbal instruction creates redundant memory traces across verbal and visual cognitive systems [ 26 ]. Video feedback simultaneously presents fluorescein patterns and diagnostic explanations, facilitating deeper encoding through cross-modal associations. This multimedia approach has demonstrated enhanced retention and transfer compared to verbal feedback alone, particularly for visuospatial pattern recognition tasks [ 26 ]. Recorded performances enable focused, goal-directed repetition with immediate error correction [ 27 , 28 ]. Video review may transform observation into active metacognition, whereby students identify errors, formulate strategies, and verify progress [ 29 , 30 ]. This iterative cycle, anchored in visual evidence rather than subjective recall, has been associated with improved self-assessment skills [ 30 ]. In our study, students in the experimental group reported higher self-awareness of their performance strengths and weaknesses, suggesting that video review may facilitate more accurate self-assessment [ 31 ]. The permanence of recordings enables repeated viewing to identify subtle errors, a feature shown to improve technical skill acquisition [ 29 ]. Meta-analytic evidence supports simulation-based education incorporating deliberate practice with video feedback [ 28 ]. These mechanisms may synergistically address the cognitive and metacognitive demands of complex clinical skill acquisition. While our findings suggest enhanced outcomes in the video-based feedback group, the modest sample size necessitates cautious interpretation and warrants further investigation. Theoretical knowledge outcomes: interpretation and implications Although the experimental group achieved a higher median theoretical examination score (93 vs. 86), this difference did not reach statistical significance ( P = 0.060). However, a significant difference in pass rates was observed: the experimental group (100.0%, 12/12) demonstrated a significantly higher pass rate compared to the control group (45.5%, 5/11), with this difference being statistically significant (Fisher’s exact test, P = 0.004). This finding indicates that while video-based feedback may not substantially increase scores among high-performing students, it appears to be particularly effective in ensuring that all students achieve threshold competency. Given the small sample size, these findings warrant cautious interpretation. The observed pattern suggests several possible explanations. First, the primary mechanism of video-based feedback appears to align more closely with observational learning and psychomotor skill development than with declarative knowledge acquisition [ 29 ]. Since both groups received identical theoretical instruction, the modest difference in theoretical scores is theoretically consistent with this mechanism. Video-based feedback provides spatially and temporally anchored visual demonstrations that directly support procedural skill acquisition but may offer primarily indirect benefits for theoretical understanding. Second, our theoretical examination emphasized factual recall and declarative knowledge through multiple-choice and true/false questions, which may not fully capture higher-order cognitive skills such as clinical reasoning or knowledge application [ 32 ]. Video-based feedback’s benefits may be more pronounced for integrating theoretical concepts with clinical practice—a dimension not directly assessed by traditional written examinations. If video review facilitates deeper conceptual understanding by connecting abstract principles to concrete visual examples, this could manifest as improved pass rates (reflecting threshold competency) without necessarily producing substantial differences in raw scores among higher-performing students. This interpretation aligns with cognitive load theory, which suggests that multimedia learning aids are particularly beneficial when learners must integrate multiple information sources [ 33 ]. The statistically significant difference in pass rates ( P = 0.004) provides empirical support for video-based feedback’s role in ensuring that all learners achieve the minimum competency threshold required for safe clinical practice. These preliminary findings suggest that video-based feedback’s primary educational value may lie in enhancing procedural competency and supporting threshold-level theoretical understanding rather than advancing mastery of theoretical knowledge as measured by traditional written examinations. However, definitive conclusions regarding video-based feedback’s impact on theoretical learning require replication in larger samples with validated assessment instruments. Practical recommendations for implementation Based on our findings and supporting literature, several recommendations can guide educators seeking to integrate video feedback into OK lens or similar clinical skills training. Combining case-based learning with video review can enhance students’ understanding of clinical application and decision-making [ 34 ]. Providing personalised, video-based feedback that targets individual performance issues is more effective than generic instruction and maximises the educational value of the approach [ 8 ]. Using structured observation checklists or rubrics promotes systematic performance analysis and ensures consistency in instructor feedback across learners [ 9 ].Facilitating peer learning through small-group video discussions encourages reflection, collaboration and exposure to multiple perspectives [ 6 ]. Adequate opportunities for deliberate practice and repeated recording help consolidate complex skills such as dynamic fluorescein assessment [ 8 ]. Multiple video reviews appear beneficial, though excessive repetition may yield limited additional value; further research should explore optimal review timing and frequency. Successful implementation also depends on creating a supportive, non-judgmental learning environment in which students feel comfortable reviewing and discussing their performance. Limitations and future directions Several limitations warrant consideration when interpreting our findings. The modest sample size ( n = 23) represents the most significant constraint, limiting statistical power and the robustness of our conclusions. As a pilot study, these results should be interpreted cautiously and require replication in larger cohorts before definitive conclusions can be drawn regarding the effectiveness of video-based feedback for OK lens fitting education. Additionally, we did not employ multiple comparison corrections in our statistical analyses, introducing potential risk of Type I error. Our study focused exclusively on immediate post-training outcomes, precluding assessment of long-term skill retention—a critical consideration for evaluating any educational intervention’s sustained impact on clinical competency. Future research should address these limitations through larger, adequately powered randomized controlled studies with validated assessment instruments and longitudinal follow-up to assess skill retention and transfer to clinical practice. Investigations examining optimal implementation parameters—including review frequency, timing, and format—would help refine this pedagogical approach. Exploring video-based feedback’s applicability to other optometry competencies and across different learner levels would provide broader evidence to guide health professions education. Conclusions This pilot study provides preliminary evidence that video-based feedback may represent a valuable enhancement for OK lens fitting education. While both approaches achieved comparable theoretical knowledge outcomes, video-based feedback showed potential advantages in practical skills, particularly for fluorescein pattern evaluation. Additionally, video-based feedback appeared to enhance students’ metacognitive awareness and appreciation of instructor guidance when grounded in visual evidence. Given the modest sample size and focus on immediate outcomes, these findings require confirmation through larger studies with longitudinal follow-up. Video-based feedback should be considered as a potential complement to traditional methods, addressing specific pedagogical challenges in developing self-assessment capabilities and providing concrete evidence for instructor guidance. By integrating video-based feedback with hands-on practice and expert supervision, optometry educators may create more effective learning experiences that support clinical competency development. Acknowledgements We thank all optometry interns who participated in this study for their enthusiasm and commitment to learning. We also thank science and education section for assistance with video recording and data management. All intellectual content, data analysis, interpretation and critical discussion were solely developed by the authors. The final manuscript was reviewed and approved by all authors before submission. Abbreviations OK lens Orthokeratology Authors’ contributions Xu Feng’e: study implementation, data collection and statistical analysis, writing original draft. Liu Xiaotian: study design, statistical analysis, writing - review and editing. Wu Xiaolan: study implementation, data collection.Wang Bilian: manuscript review. Funding This study was supported by Research Project on Undergraduate Education and Teaching Reform of Wenzhou Medical University (JG2014182). Data availability The data that support the findings of this study are available from the corresponding author upon reasonable request. Video recordings are not available due to privacy and ethical considerations. Anonymized quantitative data may be shared following appropriate data sharing agreements. Declarations Ethics approval and consent to participate This study was conducted in accordance with the Declaration of Helsinki. All student participants provided written informed consent after being informed about the study objectives, procedures, and their right to withdraw without penalty. Students were explicitly assured that participation would not affect their academic evaluation or grades.To ensure confidentiality, students were assigned random identification codes, and all data were anonymized prior to analysis. Only aggregated data were reported. The video files are encrypted and stored in the hospital’s password-protected server and are only used for teaching purposes. This study was approved by the Medical Ethics Review Committee of Ningbo Eye Hospital (approval number: 2025-021). Consent for publication Not applicable. Competing interests The authors declare no competing interests. Clinical trial number Not applicable. Footnotes Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. References 1. Lam CS, Goldschmidt E, Edwards MH. Prevalence of myopia in local and international schools in Hong Kong. Optom Vis Sci. 2004;81(5):317–22. [ DOI ] [ PubMed ] [ Google Scholar ] 2. He M, Zheng Y, Xiang F. Prevalence of myopia in urban and rural children in mainland China. Optom Vis Sci. 2009;86(1):40–4. [ DOI ] [ PubMed ] [ Google Scholar ] 3. Yang X, Li Z, Zeng J. A review of the potential factors influencing myopia progression in children using orthokeratology. Asia Pac J Ophthalmol (Phila). 2016;5(6):429–33. [ DOI ] [ PubMed ] [ Google Scholar ] 4. 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