High-add power multifocal contacts reduce myopia progression
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The use of multifocal contact lenses with a high-add power outer lens may be beneficial in slowing the progression of myopia in children, according to findings published in the Journal of the American Medical Association.
“It is especially good news to know that children as young as 7 [years] achieved optimal visual acuity and got used to wearing multifocal lenses much the way they would a single vision contact lens. It’s not a problem to fit younger kids in contact lenses. It’s a safe practice,” Jeffrey J. Walline, OD, PhD, the BLINK study chair and the associate dean for research at The Ohio State University College of Optometry, said in a press release
Walline and colleagues examined whether high-add power contact lenses provided better slowing of myopia and eye growth compared with medium-add power contact lenses.
They performed a double-masked randomized clinical trial of children between 7 and 11 years old with –0.75 to –5 D of spherical myopia, according to the study. They completed follow-ups 3 years later.
Investigators stratified participants (n = 294; mean age, 10.3 years; 60.2% girls) into groups wearing single-vision contact lenses or multifocal lenses with outer lenses of either medium-add power (+1.5 D) or high-add power (+2.5 D). The children wore the lenses as much as they could comfortably during the day, according to the study
The researchers discerned that after 3 years, the children wearing the high-add power multifocal contact lenses showed the slowest progression of myopia. The high-add group had a mean myopia progression of –0.60 D compared with –0.89 D in the medium-add group and –1.05 D for the single vision group.
The difference in progression was 0.46 D (95% CI, 0.29-0.63) when comparing the high-add and single-vision groups and 0.3 D (95% CI, 0.13-0.47) when comparing the high-add and medium-add groups, the researchers wrote. The progression difference between the medium-add and single-vision groups was 0.16 D (95% CI, –0.01 to 0.33).
Children who wore multifocal lenses also experienced eye growth suppression, the researchers wrote. Three-year adjusted eye growth was 0.42 mm in the high-add group, 0.58 mm in the medium-add group and 0.66 mm in the single-vision group.
The difference in eye growth was –0.23 mm (95% CI, –0.3 to –0.17) when comparing the high-add and single-visions groups and –0.16 mm (95% CI, –0.23 to 0.09) when comparing the high-add and medium-add groups, Walline and colleagues wrote. Eye growth difference between the medium-add and single-vision groups was –0.07 mm (95% CI, –0.14 to –0.01).
“There is a clear benefit from multifocal lenses at 3 years, but further study is needed to determine the ideal duration for wearing the lenses. Researchers will need determine how permanent the prevention of myopia progression will be once children stop wearing the multifocal lenses,” Lisa A. Jones-Jordan, PhD, principal investigator of the Data Coordinating Center at The Ohio State University, said in the release.
Perspective
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Myopia is a growing epidemic. With myopia prevalence increasing every decade and the current COVID-19 pandemic likely affecting myopia onset and progression, myopia management has become very important in our optometric practice.
One evidence-based treatment for myopia progression is multifocal contact lenses. The BLINK study looked at whether or not the degree of the add affected myopia progression. The key takeaway from this study is that there is a dose-dependent response with the add power on refraction and axial length.
Over the course of 3 years, myopia progression was the least in the high add compared with the medium add and single vision contact lens. Axial length elongation was also the least in the high add, with the medium add and single vision lens having similar axial length progression. Not only is it important to slow progression of a child’s prescription, but also their axial length to prevent sight-threatening retinal findings of pathologic myopia. This paper shows us that clinically, we should be prescribing a high add in multifocal contact lenses to all of our pediatric patients undergoing myopia management to get the most effective treatment.
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