Although 2020 has fallen short of expectations for many, this year has produced some exciting new research in myopia management; note: some treatments are still off-label.

The Role of Multifocal Add Power

Soft multifocal lenses are one of the most commonly prescribed interventions for progressive myopia, boasting a broad body of evidence supporting their effectiveness in practice (Li et al, 2017). However, until recently, limited evidence existed regarding the relationship between magnitude of contact lens add power and effectiveness at slowing myopia progression. Fortunately, the latest findings from the BLINK (Bifocal Lenses in Nearsighted Kids) trial provide robust evidence that practitioners can incorporate into practice (Walline et al, 2020).

The study compared three-year myopia progression among +2.50D add, +1.50D add, and spherical contact lenses in a population of nearly 300 myopic children between ages 7 to 11 years who had low-to-moderate myopia (–0.75D to –5.00D). Of particular note, statistical analysis showed the higher-add lenses to be significantly more effective at slowing myopia progression compared to both single-vision and lower-add lenses, while the lower-add lenses were not statistically more effective compared to the single-vision lenses (Walline et al, 2020). While the results seem clear—higher-add powers result in greater myopia control—the authors are quick to point out that additional research is warranted to fully understand the clinical implications of these findings. It is also important to remember that factors such as visual acuity, subjective visual assessment, and lens fit are also critical to successfully fitting soft multifocals for myopia control.

Optimal Atropine Dosing

Generally speaking, most research on topical atropine for slowing myopia progression has implemented daily dosing with an abrupt washout period (Cooper et al, 2018). A well-known disadvantage of the protocol established by the Atropine for the Treatment of Myopia (ATOM) researchers is rebound myopia progression after discontinuation of therapy (Chia et al, 2016). This phenomenon has led some practitioners to wonder whether less frequent dosing (or perhaps some form of medication tapering) might deliver positive results while reducing or avoiding rebound myopia progression.

A randomized controlled study from Zhu et al (2020) evaluated the four-year safety and efficacy of 1.0% atropine dosed once monthly for two years, followed by every other month for one year, followed by a one-year washout. The results showed significant slowing of myopia progression and of axial elongation. However, this study was also able to show that this novel dosing regimen prevented the rebound phenomenon seen with abrupt discontinuation of atropine therapy. Note: this study used 1.0% atropine, which causes strong cycloplegia and mydriasis in all children, rather than lower doses, such as 0.025% or 0.05%, that tend to result in milder objective and subjective side effects. Future research using a similar protocol with lower dose concentrations may provide a clinically optimal dosing regimen.

Spectacle Myopia Control

Recent evidence suggests that spectacle lenses can be an effective myopia management option for progressive myopes. Preliminary results from the CYPRESS (Control of Myopia Using Novel Spectacle Lens Designs) study suggest significant slowing of myopia progression and of axial elongation from baseline over a 12-month period (Rappon et al, 2020). This study used “novel spectacle lenses that modulate peripheral contrast with no impact to on-axis vision.” This data complements previous data supporting the use of defocus incorporated multiple segments (DIMS) spectacle lenses in progressive myopes (Lam et al, 2020). Although these options are not yet available in the United States, spectacle lens therapies may represent the “next frontier” in myopia management due to the ease of prescribing this modality and the potential for incorporation into practices not currently prescribing proactively for progressive myopia. CLS

For references, please visit www.clspectrum.com/references and click on document #301.