If management strategies are not effectively employed, it is estimated that one-half of the global population will be myopic by 2050 (Holden et al, 2016). Myopia is being diagnosed in many countries at increasingly younger ages and, when children develop myopia at a younger age, it progresses more quickly and to higher levels (Holden et al, 2015). Myopia is a disease process that carries significant risk of vision-threatening complications if it is allowed to progress to high myopia (Flitcroft, 2012). Early intervention aimed at controlling the growth in axial length and refractive error can prevent high myopia from developing. What follows is a review of current soft contact lens options that are available for myopia control.

Current Offerings

All soft multifocal (MF) lenses validated for myopia control are center distance in design. Originally prescribed for presbyopia, both aspheric and concentric-ring-design MF lenses are commercially available with center-distance optics that can be prescribed for myopia management. Standard aspheric center-distance designs are typified by a continuous add power gradient radiating from the center to the peripheral extent of the optic zone. Concentric-ring designs differ in having alternating rings of near and distance power that extend beyond the central distance to the periphery. Interestingly, the concentric-ring MF potentially creates optics that equally balance between distance and near correction with varying pupil size.

Currently, there is only one commercially available soft lens that is approved by the U.S. Food and Drug Administration for use in slowing the progression of myopia in children. This concentric zone daily disposable soft contact lens was studied over a three-year period and showed a change in spherical equivalent refractive error of −0.51D ± 0.64D versus −1.24D ± 0.61D (a 59% reduction) in the study group and control group, respectively (Chamberlain et al, 2019). The mean change in axial length was 0.30mm ± 0.27mm versus 0.62mm ± 0.30mm (a 52% reduction). All other lens designs that create simultaneous center-distance MF optics may be prescribed for retarding myopia progression; however, this is considered an off-label use in the United States.

Clinically, it makes sense to infer that higher add powers may provide better myopia control, because they can focus light further in front of the retina compared to lower add powers (Walline et al, 2020). To examine this hypothesis, the Bifocal Lenses In Nearsighted Kids (BLINK) study randomly assigned children to wear either commercially available single-vision contact lenses or medium (+1.50D) or high (+2.50D) add power soft MF contact lenses for three years. This study demonstrated that treatment with high-add-power MF contact lenses reduced the rate of myopia progression more effectively compared to either the medium add power MF or the single-vision contact lenses. Therefore, when prescribing soft MF lenses for myopia control, consider fitting children in higher add powers to best decrease myopia progression.

Summary

There has never been a better time than now to initiate myopia management in one’s practice. The growing global burden of myopia is addressable with tools that we already have. Safe and effective contact lens options are readily available for use in emerging myopes. Even young children tolerate contact lenses well, so begin myopia management as early as possible to maximize the treatment effect. CLS

References

1. Holden BA, Fricke TR, Wilson DA, et al. Global Prevalence of Myopia and High Myopia and Temporal Trends from 2000 through 2050. Ophthalmology. 2016 May;123:1036-1042.
2. Holden BA, Jong M, Davis S, Wilson D, Fricke T, Resnikoff S. Nearly 1 billion myopes at risk of myopia-related sight-threatening conditions by 2050 - time to act now. Clin Exp Optom. 2015 Nov;98:491-493.
3. Flitcroft DI. The complex interactions of retinal, optical and environmental factors in myopia aetiology. Prog Retin Eye Res. 2012 Nov;31:622-660.
4. Chamberlain P, Peixoto-de-Matos SC, Logan NS, Ngo C, Jones D, Young G. A 3-year Randomized Clinical Trial of MiSight Lenses for Myopia Control. Optom Vis Sci. 2019 Aug;96:556-567.
5. Walline JJ, Walker MK, Mutti DO, et al. Effect of High Add Power, Medium Add Power, or Single-Vision Contact Lenses on Myopia Progression in Children:The BLINK Randomized Clinical Trial. JAMA. 2020 Aug 11;324:571-580.