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To develop and validate an ideal nomogram and an online calculator for predicting rapid myopia progression risk in children managed with orthokeratology (ortho-k). Data of children undergoing ortho-k treatment at Shanghai Children's Hospitals between January 2018 and April 2021 were retrospectively assessed. Potential predictors were screened using univariable analyses and a bidirectional stepwise procedure based on Akaike's information criterion. The final model was constructed using multivariable logistic regression and validated using an internal validation cohort. A nomogram and an online calculator were used to present the final model. In this retrospective study with 1051 eyes of 560 myopia patients, the training cohort included 735 eyes, and the validation cohort included 316 eyes. Among 11 potential predictors of rapid myopia progression considered, the following four variables identified as independent predictive factors were included in the nomogram: age (odds ratio [OR], 0.69; 95% confidence interval [CI], 0.61–0.79), baseline spherical equivalent (OR, 1.53; 95% CI, 1.31–1.79), pupil diameter (OR, 0.56; 95% CI, 0.32–0.97), and horizontal visible iris diameter (OR, 0.57; 95% CI, 0.33–0.97). The mean concordance statistics for the training and validation cohorts were 0.705 (95% CI 0.664–0.747) and 0.707 (95% CI 0.639–0.774), respectively. The online calculator is publicly available (). This study developed a simple-to-use nomogram and online calculator that predicted rapid myopia progression risk in children treated with ortho-k, who will likely benefit from early intervention and improved surveillance. [ABSTRACT FROM AUTHOR]