This article was originally published in a sponsored newsletter.

At times, managing a patient’s myopia requires out-of-the-box thinking because the traditional options of orthokeratology, soft multifocal contact lenses, and atropine may not be a viable option for the patient in the chair. In this case, a 10-year-old Asian female experienced a large myopic shift in less than a year. Despite having educated her parents for many years about the importance of myopia management, they previously declined all interventions due to financial concerns.

Current Manifest Refraction and Axial Length

–7.25 –2.50 x 177, 25.41mm OD
–8.50 –1.25 x 180, 25.55mm OS

Original Manifest Refraction and Axial Length (eight months prior)

–6.50 –2.00 x 175, 25.31mm OD
–7.50 –1.25 x 180, 25.49mm OS

The patient had a history of single-vision soft toric contact lens wear for sports only. She reported dissatisfaction with the lenses due to intermittent blurry vision from lens rotation and instability. After another thorough discussion about the dire necessity for intervention, the family decided to pursue a contact lens option rather than atropine for myopia control. Her refractive error and previous experience with soft toric lenses made her a poor candidate for both orthokeratology and soft toric multifocals.

However, a multifocal hybrid with an extended depth of focus (EDOF) design offers an excellent option for patients who have significant astigmatism and need myopia control. Although there is no published data on the effectiveness of this particular lens, the EDOF design has been shown to slow myopia progression when incorporated into a soft lens.^1,2In addition, due to the center-distance design, the EDOF provides peripheral myopic defocus that should slow axial elongation.^3-6

We designed this patient’s lens with an empirical lens calculator. Keeping in mind that the Bifocal Lenses In Nearsighted Kids (BLINK) clinical trial found the +2.50 add was the most effective in slowing myopia progression for kids wearing soft multifocal lenses,⁷ we chose the High add for this patient. After minor fit and power changes, the patient was able to wear the following lenses successfully (Figure 1).

Final Lens Parameters

7.46mm Base Curve (BC), 42mm skirt, Power –7.50D power, High Add OD
7.46mm BC, 42mm skirt, 8.50D power, High Add OS
Visual Acuity: 20/20 OD, OS, and OU

We have followed this patient for more than three years while she has consistently worn these lenses. Her refraction has been stable overall with only –0.50 OD and –0.75 OS increases during that time. Her axial elongation has also slowed significantly.

Although this lens design is considered off-label for myopia control, the options were to either continue to do nothing at all or try a lens that had all the qualifications for success. We took what some may consider a risk, but it has certainly paid off for this patient.

1. Sankaridurg P, Bakaraju RC, Naduvilath T, et al. Myopia control with novel central and peripheral plus contact lenses and extended depth of focus contact lenses: 2 year results from a randomised clinical trial. Ophthalmic Physiol Opt. 2019 Jul;39:294-307.

2. Weng R, Lan W, Bakaraju R, et al. Efficacy of contact lenses for myopia control: Insights from a randomised, contralateral study design. Ophthalmic Physiol Opt. 2022 Nov;42:1253-1263.

3. Michaud L, Simard P, Marcotte-Collard R. Defining a Strategy for Myopia Control. Contact Lens Spectrum. 2016 Mar;31:36-42. Available at >https://www.clspectrum.com/issues/2016/march-2016/defining-a-strategy-for-myopia-control. Accessed Aug. 4, 2023.

4. Li SM, Kang MT, Wu SS, et al. Studies using concentric ring bifocal and peripheral add multifocal contact lenses to slow myopia progression in school-aged children: a meta-analysis. Ophthalmic Physiol Opt. 2017 Jan;37:51-59.

5. Dinardo A, Rosen CM. A Bright View of Soft Multifocal Contact Lens Optics. Contact Lens Spectrum. 2017 Nov;32:28-32.

6. Gregory HR, Nti AN, Wolffsohn JS, Berntsen DA, Ritchey ER. Visual Performance of Center-distance Multifocal Contact Lenses Fit Using a Myopia Control Paradigm. Optom Vis Sci. 2021 Mar 1;98:272-279.

7. 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;324:517-580.