pediatric and teen cl care

Contact Lenses and Myopia Progression

BY JEFFREY J. WALLINE, OD, PHD, & MARJORIE J. RAH, OD, PHD

There are reports of epidemic proportions of myopia occurring throughout the world, and myopia has become a very important topic especially for myopic parents. We all know that myopic patients are smart, and they often do their homework on the Internet before having their children examined. When they ask, "Do gas permeable contact lenses slow the progression of myopia?" they already have an answer in mind, depending on what Web site they got their information from. Because of this, we need to have evidence-based information available to educate parents and to present the best option for their children.

Soft Lenses and Alignment-Fitted GP Lenses

One question is: do soft contact lenses increase myopia progression? A simple answer is "no." Short-term studies of adult myopic patients have shown small increases in myopia, especially for wearers of low-Dk contact lenses. Long-term investigations of myopia progression in adolescents have failed to replicate these findings. Two three-year, randomized clinical trials assigning children to wear low-Dk contact lenses or glasses have both shown no clinically meaningful increase in myopia progression.

Alignment-fitted GP contact lenses also have no effect on the axial growth of the eyes. Although several early investigations indicated a myopia control effect for GP contact lenses, two recently reported randomized clinical trials lasting at least two years indicated that the axial growth of the eye is the same for GP contact lens wearers as it is for control subjects. So, GP lenses shouldn't be fit solely to slow the progression of myopia.

A More Promising Option

What about orthokeratology contact lenses? Tom Reim, OD, published the first report of the myopia control benefit of orthokeratology contact lenses in the article "Orthokeratology and Adolescent Myopia Control," in the March 2003 issue of Contact Lens Spectrum. Since then, a case report and a controlled clinical trial, both from Asia, have also reported similar benefits. Now a second controlled trial from the United States has been reported at meetings and shows benefits very similar to the study conducted in Asia. The two studies showed that eye growth was cut in half by orthokeratology contact lens wear. More importantly, the treatment effect continued to accrue after the first year, which has never been found in previous myopia control investigations of a variety of modalities.

Although a randomized clinical trial of myopia control effect by orthokeratology contact lenses has not been conducted, we can tell parents, "Initial evidence indicates that orthokeratology contact lenses slow the growth of the eye, so fitting your child with these lenses will benefit your child in many ways and may also slow the growth of the eye."

Do your homework before the next parent asks you about myopia progression in children and arm yourself with the knowledge that will lead to optimal treatment for your patients. CLS

To obtain references for this article, please visit http://www.clspectrum.com/references.asp and click on document #154.

Dr. Walline is an assistant professor at The Ohio State University College of Optometry, where he conducts studies of pediatric contact lens wear. Dr. Rah is an assistant professor at the New England College of Optometry where she works primarily in the Cornea and Contact Lens Service in patient care, teaching and research.