<p>The predictive value of trace elements in blood combined with systemic inflammatory factors for evaluating the effectiveness of orthokeratology in the treatment of myopia was investigated. A prospective study design was conducted, involving 169 myopic patients who underwent orthokeratology treatment between October 2022 and September 2023. All patients were followed for 1 year, and changes in axial length were reassessed. Based on axial elongation, patients were divided into a well-controlled group and a progression group. Logistic regression analysis and receiver operating characteristic (ROC) curve analysis were employed to identify factors influencing treatment effectiveness and assess the predictive value of trace elements and systemic inflammatory markers. Following orthokeratology treatment, unaided visual acuity was significantly improved, while refraction and corneal curvature were markedly reduced (<i>P</i> &lt; 0.05); however, no significant difference in axial length was observed compared with baseline (<i>P</i> &gt; 0.05). When grouped according to axial elongation, serum copper levels were significantly higher in the progression group, whereas iron and zinc levels were lower than those in the well-controlled group (<i>P</i> &lt; 0.05). In addition, systemic immune-inflammation index (SII) and systemic inflammation response index (SIRI) were significantly elevated in the progression group (<i>P</i> &lt; 0.05). Based on univariate analysis, a logistic regression model was constructed, identifying copper, iron, zinc, SII, and SIRI as influencing factors. ROC analysis demonstrated that the combined prediction using these five indicators yielded an AUC of 0.874, which was significantly higher than that of individual predictors (<i>P</i> &lt; 0.05). A significant correlation was found between axial length and copper, iron, zinc, SII, and SIRI after treatment (<i>P</i> &lt; 0.05). Orthokeratology has been found to effectively improve unaided visual acuity, refraction, axial length, and corneal curvature in myopic patients. Nonetheless, suboptimal outcomes have been observed in certain cases, with myopia continuing to progress. This may be closely associated with the levels of trace elements and systemic inflammatory factors, especially copper, iron, zinc, SII, and SIRI, which serve as important clinical indicators for predicting treatment efficacy. Their application may facilitate more precise and individualized treatment strategies in clinical practice.</p>