editor's perspective

Keeping Young Eyes Less Nearsighted

BY JOSEPH T. BARR, OD, MS, EDITOR
AUGUST 1999

You can argue that being a -4.00D myope is not much different from being a -3.75D myope, but some, including me, may disagree. The world of myopia is under much research, and it's covering much more than how night lights probably do not make you more nearsighted. My teenage offspring are still low enough myopes that they get by with squinting (not much) and are not nearsighted enough to want the hassle of contact lens or spectacle wear. But if their myopia advances any more, I'm convinced that my first treatment plan will probably be RGP lenses or an aspheric multifocal. This will certainly also be a discussion with our other patients as well. And although there is very little data to back it up, I'm becoming a believer.

First of all, Contact Lens Spectrum's contributing bifocal editor, Dave Hansen, O.D., F.A.A.O., recommends these treatment options. For young advancing myopes, he prescribes multifocal RGPs. I'm sure that there are more of you out there who think similarly. The data supporting RGP spherical lenses minimizing the progression of myopia is inconclusive, but at least it's heading in the right direction. Future studies, especially by Jeffrey Walline, O.D., M.S., and Karla Zadnik, O.D., Ph.D., will help clarify this area.

Why multifocals? A very interesting study was just published in Optometry and Vision Science by Leung, J.T.M. and Brown, B., entitled, "Progression of Myopia in Hong Kong Chinese Schoolchildren is Slowed by Wearing Progressive Lenses." In this study, baseline myopia was about -3.75D for all subjects who were between the ages of 9 and 12. Thirty-two children wore single-vision spectacle lenses for 2 years and had a mean -1.23D myopic increase. Twenty-two children wore +1.50 progressive addition spectacles and had a mean -0.76D myopic increase. Fourteen children wore +2.00D progressive addition spectacles and had a mean -0.66D increase in myopia. The authors recommend starting myopic patients with these lenses at age seven, and acknowledged that there may be a difference in the treatment of myopia according to race, as other studies have shown.

Why couldn't this treatment be done with soft contact lenses? Recent reports by Dumbleton, et al., have shown less myopic creep with high-Dk silicone-hydrogel lenses than with extended wear soft lenses, and certainly we've seen myopic creep in daily wear soft lens wearers which may or not be lens related. One wonders if teen myopes should be placed in bifocal soft lenses if they are going to wear soft lenses. These reports make contact lens choices for teens not only more interesting, but also more important from a treatment standpoint.