Purpose: To measure changes in visual performances and optical quality in myopic children during the first month of wearing orthokeratology lens, and to reveal the association between those two.Methods: Thirty-five myopic children participated in this study. Visual performances were evaluated with visual acuity and shape discrimination threshold (SDT) for radial frequency patterns. Placido disc-based corneal topography for central 4 mm and 6 mm zones was collected and decomposed by Fourier analysis into the spherical, asymmetric, and regular astigmatic components. Root-mean-square of third-order, fourth-order, and total higher-order aberrations (HOA) were extracted for the 4 mm and 6 mm zones. All examinations were conducted at baseline, 1-week, and 1-month after lens dispensing. The changing trends over time and association between SDT and optical quality were analysed with linear-mixed model.Results: All subjects' uncorrected visual acuity improved to 0.1 logMAR or better at 1-week and 1-month lens wear (P < .01). SDT did not change significantly from the baseline at 1-week and 1-month after lens wear (P > .05). For the two zones with diameters of 4 mm and 6 mm, the spherical component decreased significantly at 1-week (P < .01) and remained stable thereafter (P < .01); the asymmetric component increased significantly at 1-week (P < .01) and remained high at 1-month (P < .01); and the regular astigmatism did not show any significant change throughout (P > .05). At the two zones with diameters of 4 mm and 6 mm, the third-order, fourth-order, and total HOA increased significantly over time (P < .05). Change of SDT did not correlate with impairments in optical quality (P > .05 for all parameters).Conclusions: While corneal optical quality decreased steadily during the first month following lens wearing, the visual acuity and shape discrimination sensitivity assessed by SDT remained very satisfactory.