Pediatric and Teen CL Care

Seeking Solutions to Curb Myopia Progression

By Mary Lou French, OD, MED, FAAO

If you attend meetings such as the American Academy of Optometry's, you may have noticed an increase in the amount of research on controlling myopia progression. There has always been research in this area, but improvements in technology have allowed a deeper understanding of peripheral focus.

Since graduating optometry school, I have attempted to control myopia with vision therapy, spectacle bifocal lenses, flat top bifocals initially, then PAL lenses, rigid lenses (including attempts at orthokeratology before corneal reshaping therapy), and under-correcting myopia. None worked with any success.

Current research is evaluating the effect of peripheral focus of retinal stimulation (Kwok et al, 2012). The only focus that prior studies were able to evaluate was the effect on the central retina. But with new technology, vision researchers are capable of designing studies to measure the impact of peripheral focus. Some research has been on chicken and other animal eyes. The results of these studies do indicate that myopia can be controlled (Guthrie, 2011; Huang et al, 2011; Rodgin, 2011).

All in the Family

All of that said, I'm going to share information about a patient who came to me wearing a daily wear multifocal lens fit by another practitioner with the intent of controlling his myopia.

Sam was 12 years old at the initial visit. His prescription was –3.00D OD, –4.25D OS. Eye health was normal as was his binocular vision. His year-old prescription was –2.75D OD, –3.75D OS, not a significant change for his age. History included myopia on both parents' sides but nothing overtly significant. His mom wore contact lenses in a moderate range of about –3.00D. She was concerned, however, about her son's increasing myopia.

That was 2006, and although there were rumblings in the research, I had not seen convincing evidence that a soft multifocal would work in controlling his myopia. However, I decided to continue Sam in his current multifocal lens design and do my own single case study. He wore the lenses successfully, the fit was good, and mom understood the concept and the limitations.

Fast forward to 2011. Sam's current prescription is –4.25D OD –6.25D OS. He has returned for annual lens exams with prescription changes every year, some years a greater degree compared to others. Interestingly, in the interim, I saw his sister. Unrelated to the possibility of decreasing her myopia, I fit her with a standard single-use lens due to fit and sensitivity issues. She was age 12 at the time of initiating lens wear with –3.50D OD –3.75D OS. She has progressed in three years to –4.00D OD, –4.50 OS.

In that same age range, Sam progressed approximately –0.25D more. Would Sam have had a higher amount of myopia without wearing the multifocal lens? Did gender make a difference in progression?

Looking Ahead

Because my patient base has a significant amount of young myopes, I am eagerly awaiting the results of the studies referred to above. Perhaps I am looking for an absolute solution to a perceived health issue, but how wonderful it would be to offer these patients an option that is within reach and affordable and has an improved level of success. CLS

For references, please visit www.clspectrum.com/references.asp and click on document #196.