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Clinicians anticipate distance-center multifocals for myopia control
Optometrists on our "At Issue" panel look forward to the availability of an approved daily disposable option.
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“At Issue” asked a panel: Are multifocal contact lenses effective in managing myopia progression, and, as a result, are daily disposable multifocal lenses destined to become the contact lens of choice for children?
Doctors need to educate parents
Jeffrey J. Walline, OD PhD: Several studies, including randomized clinical trials, have shown that multifocal contact lenses provide meaningful myopia control. On average, they slow the progression of myopia by approximately 40% (Walline et al.). Only center-distance design soft multifocal contact lenses have been investigated to date, so the available options are limited.
In the U.S., the only center-distance design options available are Proclear multifocal D (CooperVision), Biofinity multifocal D (CooperVision), Acuvue Oasys for Presbyopia (Johnson & Johnson Vision), NaturalVue Multifocal 1 Day (VTI Vision) and custom soft multifocal contact lenses. None of these contact lenses have FDA approval for myopia control, but they can all be used off label for that purpose. No direct comparisons of the brands have been made, so there is no information available about which brand may work best. Of these, only NaturalVue is a daily disposable contact lens.
Without FDA approval, contact lens companies cannot tout their lenses as being able to slow the progression of myopia. The only way that patients may learn about this benefit is from their doctor. Therefore, doctors need to educate parents about children’s ability to independently care for contact lenses, as well as the potential myopia control benefits of contact lens wear. If eye care practitioners routinely provide parents with a variety of options for treating their child’s myopia, including corneal reshaping contact lenses, soft multifocal contact lenses and low concentration atropine, soft multifocal contact lenses may certainly become the contact lens of choice. However, more center-distance design daily disposable options are probably necessary before they become the contact lens of choice for young children because we know that no single contact lens works for all patients.
- Reference:
- Walline JJ, et al. Eye Contact Lens. 2016;42(1):3-8;doi: 0.1097/ICL.0000000000000207.
- For more information:
- Jeffrey J. Walline, OD, PhD, is associate dean for research at The Ohio State University in Columbus. He can be reached at: walline.1@osu.edu.
Disclosure: Walline reports he receives contact lens solution from Bausch + Lomb for the Bifocal Lenses in Nearsighted Kids Study.
Orthokeratology is convenient, effective
Sarah Henderson, OD: Multifocal contact lenses have been shown to be very effective in managing myopia progression in children. This type of lens is shown to reduce a child’s peripheral hyperopic defocus, thereby eliminating the stimulus for axial elongation, which slows the myopia progression.
Research has shown that multifocal contact lenses not only reduce the progression of myopia by 50%, but also reduce axial elongation by 29% (Walline et al.). Multifocal contact lenses are a safe and effective way of slowing down myopia progression in children.
Personally, I do not think daily disposable multifocal lenses will become the contact lens of choice for children. Multifocal lenses are highly effective and safe at reducing myopia progression, however, the vision correction through the lenses may not be as optimal as in single vision lenses. While multifocal contact lenses are an excellent choice, orthokeratology provides a very convenient avenue for children by eliminating the use of daily wear contact lenses and is also highly effective at reducing myopic progression. Together, these two different lenses will hopefully be the mainstay of treatment for progressing myopes.
Overall, multifocal contact lenses are highly effective at slowing the progression of myopia and are an excellent choice. Whatever avenue the practitioner and patient choose to treat myopia progression (ie, multifocal lenses or orthokeratology), what is important is that myopic children be properly treated.
- Reference:
- Walline JJ, et al. Optom Vis Sci. 2013;90(11):1207-1214;doi:10.1097/OPX.0000000000000036.
- For more information:
- Sarah Henderson, OD, practices at Specialty Eyecare Group in Kirkland, Wash. She can be reached at: drhenderson@specialtyeye.com.
Disclosure: Henderson was named one of CooperVision’s Best Practices in 2017.
Soft multifocals will be used soon
Roy Kline, OD: Myopia is clearly on the increase in the U.S. Studies show almost a 70% increase in the last 20 years, with 45% to 50% of the population now myopic (Vitale et al.). Globally, the numbers are even more staggering. Understanding myopia causes, progression and management is paramount to the successful treatment of our patients.
Soft contact lenses with a center-distance design and peripheral profile designed to reduce the peripheral retinal defocus have shown promise in slowing myopic progression. It is believed that the lenses impose myopic defocus across areas of the peripheral retina, which is believed to inhibit eye growth. The numbers have been impressive, showing a 25% to 70% halt in the progression of myopia utilizing these specialty-designed multifocals (Hasebe et al., Berntsen et al., Walline et al.). These studies are still in their infancy; however, different designs, protocols and materials are being investigated.
With this in mind, I believe we will be actively fitting our patients in soft multifocal lenses designed for myopia control in the very near future. In our practice, we are already fitting 70% of our patients in daily disposable contacts. This number approaches 95% when we look at our pediatric (8 years and older), teenage and college population.
As studies show us what designs are most effective to help prevent myopia progression, the contact lens industry will wholeheartedly utilize their proven materials, especially in the daily disposable realm, and manufacture lenses that we can utilize in our practices. This will certainly be an important choice for treatment of our myopic patients.
- References:
- Berntsen DA, et al. Invest Ophthalmol Vis Sci. 2012;53(2):640-649;doi:10.1167/iovs.11-7769.
- Hasebe S, et al. Invest Ophthalmol Vis Sci. 2014;55(11):7177-7188;doi:10.1167/iovs.12-11462.
- Vitale S, et al. Arch Ophthalmol. 2009;127(12):1632-1639;doi:10.1001/archophthalmol.2009.303.
- Walline JJ, et al. Optom Vis Sci. 2013;90(11):1207-1214;doi:10.1097/OPX.0000000000000036.
- For more information:
- Roy Kline, OD, practices at Drs. Kline and Boyd Optometrists in Glens Falls, N.Y. He can be reached at drkline@gmail.com.
Disclosure: Kline reports he is a consultant for Bausch + Lomb.
Anticipating a disposable distance-center multifocal
Pamela A. Lowe, OD, FAAO: It’s an exciting time to be a contact lens fitter when recent studies have shown that multifocal contact lens wear is effective in slowing down the progression of myopia in children. It is awesome to not only afford young patients visual freedom from their spectacles, but also keep their myopic correction in check, especially those at risk for high myopia.
When it comes to kids and contact lenses, fitting lens designs that have a high safety profile is of utmost importance. Most practitioners would agree that safety and compliance with daily disposable lenses makes the most sense, especially with neophyte wearers. A 2011 study (Robertson et al.) showed that of the 85% of patients that reported compliance with contact lens care, only 2% actually exhibited compliance with cleaning and the prescribed replacement schedule.
When it comes to kids and myopia, the recent myopia control studies agree that fitting distance-center designed multifocal contact lenses is effective in slowing the progression of myopia. In our practice, we have seen this clinically with many of our young myopes and proactively educate parents of this viable treatment option. Recently, distance-center multifocal contact lenses were not available as a healthier daily disposable lens option, so my myopia control cases have been managed with the next most compliant replacement schedule, that being monthly.
Fortunately, a daily disposable distance-center design multifocal is now available as a viable option for an even healthier patient experience. Because one single lens design cannot achieve a successful fit 100% of the time, I encourage more of our contact lens industry partners to innovate in this lens category. As a practitioner proactively treating myopia, I would love to have as many healthy options for my young patients as possible.
- Reference:
- Robertson DM, et al. Optom Vis Sci. 2011;88(12):1402-1408;doi:10.1097/OPX.0b013e3182333cf9.
- For more information:
- Pamela A. Lowe, OD, FAAO, is a diplomate of the American Board of Optometry who practices at Professional Eye Care Center in Niles, Ill. She can be reached at plowe@visionsource.com.
Disclosure: Lowe reports she is a consultant or on the speakers bureau for Alcon, Diopsys, Heidelberg, Maculogix, Optos, Visionix and ZeaVision.