High add power contacts control myopia progression in children
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High add power contact lenses were more effective and stable in controlling myopia progression in children, according to a study published in Ophthalmic Research.
“Previous systematic reviews and meta-analyses have assessed the effectiveness of [soft multifocal contact lenses (SMCLs)] but did not explore differences in efficacy across add powers and perform a quantitative assessment of adverse effects and acceptability,” Zengfang Yu, of the Eye School at Chengdu University of Traditional Chinese Medicine in China, and colleagues wrote.
To expand on earlier findings and determine the safety and efficacy of added power SMCLs, Yu and colleagues conducted a meta-analysis of seven randomized controlled studies, which included 805 children with myopia, aged 6 to 18 years (57% white; 43% Asian). Researchers compared myopic progression, axial elongation and changes in visual performance in groups with SMCLs of varying added powers vs. control groups with monovision soft lenses or glasses. They also evaluated the groups for adverse effects and dropout rates.
The weighted mean difference in myopia progression at year 1 between SMCL and control groups was –0.22 D (95% CI, –0.56 to 0.12) for low add power SMCLs, 0.09 D (95% CI, 0-0.19) for medium add power and 0.2 D (95% CI, 0.13-0.27) for high add power.
At 2 years, the difference was 0.12 D (95% CI, 0.03-0.27) for medium add power SMCLs and 0.25 D (95% CI, 0.14-0.35) for high add power.
Compared with controls, high add power SMCLs had significant efficacy (P < .001), and medium add power SMCLs had no significant efficacy. Researchers did not detect differences for axial elongation, adverse effects and dropout rates between different added powers, nor did they detect differences in visual acuity.
“Our current meta-analysis confirmed that SMCLs are effective in slowing myopia progression in children,” Yu and colleagues concluded. “Differences were found between SMCLs of different add powers, with high add power contact lenses being more effective and stable in controlling myopia progression in children. On the other hand, the medium and low contact lenses showed no myopia control efficacy.”
Perspective
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Myopia control in children is one of the hottest topics in modern optometry, with much of the relevant research still being undertaken by clinicians around the world. With remote schooling and the increased use of screens during the COVID-19 pandemic, concerns over myopic progression in children has never been higher.
For clinicians uncertain which add power they should be using with their patients, this study review shows that high add power lenses provide the best efficacy in reducing progression with minimal reports of blurred vision or decreases in contrast sensitivity. Meanwhile, the medium and low add lenses show little to no efficacy in slowing myopic progression.
We don’t know the long-term efficacy and safety beyond a 2-year period of using a high add multifocal contact lens to slow myopic progression in kids. However, every bit of data on which treatments provide the best results for our patients with the fewest side effects helps us in finding our way to establishing a set standard-of-care for myopia control. This study should help clinicians feel more confident in their add power selection when choosing a multifocal contact lens for their myopic pediatric patient.
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