Over the past year, I have had the opportunity to help develop the UAB Eye Care Myopia Control Clinic, which has a mission to educate patients about myopia and the options that may potentially slow its progression. While no method has been cleared by the U.S. Food and Drug Administration (FDA) to specifically control myopia progression, multifocal and orthokeratology contact lenses as well as 0.01% atropine have all gained acceptance as viable options (Walline et al, 2011; Walline, 2016).

The Options

When selecting myopia control options, a number of considerations need to be made, which above all should include patients’ refractive error and maturity level.

Atropine Generally, practitioners could consider atropine to be a catch-all that can be prescribed to almost all of their patients, including those who are not mature enough to wear contact lenses and those who have high amounts of myopia with or without clinically significant astigmatism (Walline, 2016). Unfortunately, atropine is unable to simultaneously correct patients’ visual symptoms, which is why contact lens-based options might be a better choice.

Contact Lenses The center-distance add design for multifocal contact lenses is thought to best slow myopia progression, though some evidence suggests that center-near designs may work as well (Aller, 2017). Commercially available center-distance multifocal and orthokeratology contact lenses typically come in limited refractive error ranges (Aller, 2017; Bennett, 2008). Specifically, standard commercially available center-distance soft multifocal contact lenses come only in spherical designs and do not correct extreme amounts of myopia, while orthokeratology contact lenses are approved to correct moderate amounts of myopia and astigmatism. But what can be done for patients who want to wear contact lenses but fall outside of these standard parameters?

Other Options

When the clinic’s practice opened, initially I simply educated patients who had refractive errors outside of these approved/acceptable contact lens parameter ranges that they were not good candidates for myopia control contact lenses; this left them with only the options of using atropine and spectacles or an alternative type of contact lens. However, after gaining more experience, I became disheartened that I was failing to meet those patients’ visual needs. Therefore, I started to consider other modalities that may provide these patients with similar myopia progression-slowing optical effects (Smith et al, 2009).

While commercially available center-distance multifocal custom soft, bitoric GP, and scleral contact lenses have never been officially tested in a rigorous randomized controlled trial for controlling myopia progression, they have the potential to be an option for patients who cannot wear standard myopia-controlling contact lenses (Smith et al, 2009; Barnett et al, 2015). Although these three options are unorthodox, prescribing them will allow patients who are highly motivated to wear contact lenses the option to potentially slow their eye growth while simultaneously having other added benefits of contact lens wear such as improving their ability to play sports and improving their self-esteem (Walline et al, 2007). With that said, discussing these options with patients should include the fact that they have not been formally studied for the purpose of controlling myopia and that they are considered off-label.

Overall, it is important to meet all patients’ expectations, to make efforts to help prevent disease from developing or progressing, and to fully inform those patients about all of the potential options. Prescribing these alternative contact lens modalities also bears a relatively low risk. In the end, practitioners may be able to achieve all three of these goals for their astigmatic patients. CLS

For references, please visit www.clspectrum.com/references and click on document #273.