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Study shows soft contact lens wear does not increase myopia in children
Report adds to literature showing soft contact lenses are safe and effective for children.
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The use of soft contact lenses does not appear to accelerate myopic progression in children. As part of a large study, researchers found that long-term myopic progression was statistically greater in contact lens wearers than in spectacle wearers, but the difference was not clinically significant.
These results, combined with earlier data on the safety of soft contact lenses in children, make a strong case that children can safely wear soft contact lenses.
 Jeffrey J. Walline |
In a telephone interview with Ocular Surgery News, study author Jeffrey J. Walline, OD, PhD, OSN Contact Lenses Section Editor Penny A. Asbell, MD, FACS, MBA, and OSN Pediatrics/Strabismus Section Editor Robert S. Gold, MD, discussed how the findings may change some opinions about children being fitted with soft contact lenses.
Dr. Walline presented results that were part of the ACHIEVE (Adolescent and child health initiative to encourage vision empowerment) study at the Association for Research in Vision and Ophthalmology meeting. The study was sponsored by Johnson & Johnson Vision Care.
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“In this large study, what we found was that soft contact lenses do not clinically increase myopia progression. In other words, after wearing them for 3 years, the contact lens wearers weren’t more nearsighted than the spectacle wearers,” Dr. Walline told OSN.
The ACHIEVE study was designed primarily to compare the effects of contact lens wear vs. spectacle wear on children’s self-perception. The investigation of myopic progression resulted from concerns that soft contact lens wear increases myopia progression in children and adults, Dr. Walline noted.
“It is interesting because I think, in general, the data are good,” Dr. Asbell said. “It was over a 3-year period, which is also pretty good. So if there is an effect of the lenses, it’s a relatively small one and probably not clinically significant.”
Myopic progression is inevitable, regardless of the type of corrective lens used, Dr. Gold said.
“The study basically confirms that there is little difference in myopic progression whether you wear contact lenses or glasses,” he said.
Growth and myopic progression
 Robert S. Gold |
Increasing height in childhood correlates with growing axial length and myopic progression, Dr. Gold said.
“What I tell my families when the child is diagnosed with myopia is, ‘As your child grows taller, the eye will grow longer and they will become more nearsighted. It’s something you can’t prevent,’” he said.
Contact lenses may limit the amount of oxygen that reaches the eye, causing physiological changes that may alter corneal shape and result in myopia, Dr. Walline said.
“What people have thought in the past and have found is that it seems to be low oxygen, not as much oxygen getting to the eye,” he said.
Myopic progression resulting from contact lens wear lasts only about 9 to 12 months, Dr. Walline said, before spectacle wear reaches the same level of myopia.
“If you look back in the literature, any study that’s a year or less finds that effect,” he said. “So I think there probably is an initial adaptation to wearing contact lenses that may cause an increase in myopia. But if you look at it over the long term, the eyes just wearing contact lenses end up in the same place [that you would be in] if you were wearing spectacles.”
Dr. Asbell noted a general sense among clinicians that myopic progression occurs with contact use but is not fully understood.
“There is certainly a clinical feeling that it occurs, not in a significant amount, but a little bit, and it’s not clear why,” she said. “This study put some numbers on the trend, and it appears there is no clinically significant issue.”
Refraction, axial length and keratometry
The ACHIEVE study, a randomized, single-masked clinical trial performed at five clinics in the United States, included 484 children: 237 were assigned to wear spectacles and 247 were assigned to wear contact lenses for 3 years. The age of the subjects ranged from 8 years to 11 years at enrollment.
 Penny A. Asbell |
Inclusion criteria included 1 D to 6 D spherical component myopia based on cycloplegic autorefraction, 1 D or less of astigmatism and 20/20 or better bilateral best corrected visual acuity.
Children were fitted with single-vision glasses or Acuvue 2 or 1-Day Acuvue soft contact lenses (Vistakon).
Study results showed that myopia progressed –1.08 ± 0.71 D in spectacle wearers and –1.27 ± 0.72 D in contact lens wearers. Growth in axial length was 0.59 ± 0.37 mm in spectacle wearers and 0.63 ± 0.34 mm in contact lens wearers. Change in corneal steepening was 0.05 ± 0.69 D in the spectacle wearers and 0.10 ± 0.70 D in the contact lens wearers.
“The thing that’s never been measured before is actually axial length, and we did not find a statistically significant difference,” Dr. Walline told OSN. “That tells us there’s no lasting, permanent effect of contact lens wear on the eyes that makes them more nearsighted.”
Dr. Asbell commented on the study’s formal protocol for using cycloplegic refraction, axial length and keratometry readings, and randomization of patients.
“I think they did a much better job than we do individually in assessing the role of contact lenses in myopia,” she said. “That’s why clinical trials are helpful because so often from an individual’s clinical experience, there may be bias one way or the other. Randomized clinical trials provide much higher quality evidence than individual experience.”
Motivation and compliance
“For children, I recommend the daily disposable contact lenses because it improves their compliance,” Dr. Walline said. “They don’t have to clean them. They can just take them out and throw them away, so they’re more likely to take them out.”
There is no ideal age for children to start wearing contact lenses, Dr. Walline said.
“Look at the child and see if the child is responsible and motivated to wear contact lenses, and then make your judgment,” he said.
Dr. Walline cited a 2004 study in Optometry and Vision Science, in which he and colleagues found that children ages 8 to 11 years were capable of independently maintaining and wearing daily disposable contact lenses.
Dr. Asbell said that the decision to wear contact lenses should depend on the child’s motivation, not parents’ desires or expectations. Children and parents must understand the risks and responsibilities that come with contact lens use and care, she said.
Most children with sufficient motivation become successful contact lens wearers, Dr. Gold said.
“Most of these children are motivated to put their lenses in because they want to get rid of their glasses,” he said. “I haven’t had a compliance issue in my practice. Once these children make that decision, between 80% and 90% of them will be successful.”
Preliminary data from the ACHIEVE study on the impact of contact lens wear vs. spectacle wear on children’s self-perception are expected to be released later this year, Dr. Walline said.
For more information:
- Penny A. Asbell, MD, FACS, MBA, can be reached at Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1183, New York, NY 10029; 212-241-7977; fax: 212-289-5945; e-mail: penny.asbell@mssm.edu.
- Robert S. Gold, MD, can be reached at 225 W. State Road 434, Suite 111, Longwood, FL 32750; 407-767-6411; fax: 407-767-8160; e-mail: rsgeye@aol.com.
- Jeffrey J. Walline, OD, PhD, can be reached at 338 W. 10th Ave., Columbus, OH 43210-1240; 614-247-6840; fax: 614-247-6452; e-mail: walline.1@osu.edu.
References:
- Walline JJ, Jones LA, et al. The Adolescent and Child Health Initiative to Encourage Vision Empowerment (ACHIEVE) study design and baseline data. Optom Vis Sci. 2006;83(1):37-45.
- Walline JJ, Long S, Zadnik K. Daily disposable contact lens wear in myopic children. Optom Vis Sci. 2004;81(4):255-259.
- Matt Hasson is an OSN Staff Writer who covers all aspects of ophthalmology. He focuses on regulatory, legislative and practice management topics.