Several treatment modalities successfully slow myopia progression

LAS VEGAS – Soft bifocal contact lenses, corneal reshaping lenses and atropine have all been shown to affect the progression of myopia in children, Jeffrey J. Walline, OD, PhD, told attendees here at Vision Expo West’s Global Contact Lens Forum.

“Randomized clinical trials have shown that ortho-K slows the progression of myopia 43%,” Walline said. “Several studies have shown that soft bifocals have also slowed myopia progression by 43%, but no randomized clinical trials have been conducted over a long period of time for these lenses.

“We all know atropine slows the progression, but we don’t prescribe it because of side effects,” he added. “One study conducted with 0.01% atropine showed it slowed the progression of myopia by about 60% – an even slightly greater amount than with soft bifocals or ortho-K. They also compared it to 0.1% and 0.50% atropine, and you see much less reduction in accommodation and much less reduction in pupil size. When they used 0.1% and 0.50% atropine, 60% of the kids needed to wear glasses to see at near. When they used 0.01% atropine, only 8% of kids asked for glasses to see at near.”

Walline referred to a small study where atropine was shown to prevent the onset of myopia in young patients who were treated before they reached 0.50 D of myopia

He noted that while 0.01% atropine is not commercially available, it is easy to order from compounding pharmacies and is inexpensive.

“The question remains, do we give them contact lenses, either ortho-K or soft bifocal, and atropine?” he asked. “We don’t know the answer. It seems to me – they are two different mechanisms, so I don’t know why they wouldn’t be additive.”

Walline noted that contact lenses and atropine are both approved by the U.S. Food and Drug Administration for use in children; however, they are not approved for myopia control.

“That’s something you need to let your patients know,” he said. “You’re using them off label, but there’s evidence they work off label, so you’re justified in doing so. I have patients read and sign a document.”

Panelist Jeffrey Sonsino, OD, FAAO, said he discusses myopia control with parents for any child in which he sees progression.

Forum co-director Louise Sclafani, OD, said she discusses it when children need to wear their glasses full-time.

Sonsino noted that Walline recently received a multimillion dollar grant to study soft bifocal contact lenses for reducing myopia progression. – Nancy Hemphill, ELS

Disclosure: Sclafani is a consultant or speaker for Alcon, Allergan, Bausch + Lomb, the Brien Holden Vision Institute and CooperVision. Sonsino is a consultant for Alcon, SynergEyes, Optovue and Visionary Optics; a principal in LVR Technologies; and receives research support from Visioneering. Walline has received research materials from CooperVision and is currently receiving research materials from Bausch + Lomb.