Myopia control contact lenses safe for a lifetime of wear
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The use of contact lenses for myopia control was safe starting in childhood and over the course of a lifetime and carried potential preventive ocular health benefits compared with the lifetime risk for visual impairment from myopia, according to findings from a recent study.
“While the benefits of contact lens wear for children and for pediatric myopia control are becoming better understood across eye care professions, a recent international survey indicates that only 2.3% of contact lenses fit to children are for myopia control,” Kate Gifford, PhD, of the school of optometry and vision science, Institute of Health and Biomedical Innovation, Queensland University of Technology, and colleagues wrote. “The purpose of this review was to collate peer–reviewed scientific data to provide a comparison of these risks, which could be used in the informed consent process for myopia control contact lens treatments.”
Using peer-reviewed scientific data, risks for microbial keratitis in daily disposable and orthokeratology contact lenses were calculated over both childhood (ages 8 to 18 years) and lifelong (ages 8 to 65 years) wear. Conclusions from large epidemiological studies examining incidence of microbial keratitis were included as well as data on the cumulative risk for vision impairment by age 75 years based on axial length and level of myopia.
Comparative results showed that the lifetime risk for vision impairment in patients with axial lengths above 26 mm and more than 6 D of myopia was greater than the lifetime risk for microbial keratitis with any type of contact lens wear. Conversely, lifelong contact lens wear, with the exception of daily disposables, carried more risk in patients with an axial length below 26 mm and myopia lower than 3 D.
Further analysis indicated that the likelihood of microbial keratitis development from daily disposable (one in 431 wearers) and reusable (one in 116 wearers) soft contact lens wear in children is uncommon. While the risk in orthokeratology contact lens wear was more common (one in 67 wearers), the confidence interval overlap indicated similar safety profiles.
“The comparative lifetime risks of contact lens wear commenced at age 8 for myopia control and continued throughout life until age 65 are relatively less than the lifetime risks of vision impairment from myopia-associated pathology,” Gifford and colleagues concluded. “Eye care practitioners should be confident to proactively recommend myopia control contact lens wear to younger children as both the safety profile and potential preventive ocular health benefits are evident.”
Perspective
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Justin Kwan, OD, FAAO
Gifford has essentially given a call to action for initiating myopia management before age 12 years. Doing so not only reduces lifetime risk for visual impairment from complications of high myopia but is safe. By posing five different lifetime journeys, she was able to comparatively show the likelihood of an adverse event as very common, common or uncommon.
Practically, eye care providers can use this information to inform the average parent of a myopic child of the relative risk for vision loss associated with contact lens use compared with risk for vision loss from myopia. It is important to state to a parent that reducing myopia by 1 D reduces the risk for myopic maculopathy by 40%. Drawing an analogy strengthens the message. One should also emphasize the positive aspects of myopia management particularly when contact lens methods have multiple benefits.
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