THE WIDELY POPULAR “10,000- steps-a-day” mantra has become a phenomenon in recent years. While it varies with one’s lifestyle and beliefs, this mantra has inspired me and resonated with my philosophy of prescribing contact lenses, particularly for children.

With the rapid innovation of contact lens technology, eyecare practitioners have immense opportunities to utilize contact lenses of all kinds with greater accessibility than ever. In the latest international contact lens prescribing survey conducted by Morgan and colleagues (2023), soft contact lenses (SCL) accounted for 86% of all fits worldwide. Prescriptions for daily disposable (DD) lens fits (39%) were found comparable with those for reusables (42%). Remarkably, the advancement of multifocal contact lens designs has fundamentally changed the paradigm of how we understand the utility of the device with the goal of slowing myopia progression for children (Tilia et al, 2023; Cooper et al, 2022; Chamberlain et al, 2022).

Interestingly, though, the aforementioned survey regarding prescribing habits reported that the market for multifocal lens fits still remains relatively slim and underutilized. In particular, their application for myopia management accounted for merely 5% of soft lens fits (Morgan et al, 2023). For that, the aforementioned mantra can be used, not as a doctrine, but as a positive reinforcement for young myopic patients and their parents to consider multifocal lenses as their primary “go-to” modality.

While not all parents are expected to understand the scientific nuances of myopia management, what they do know is the disappointment of seeing their kids’ vision continue to worsen. When we consciously advocate for the “therapeutic” impact of multifocal contact lenses for myopia progression compared to the “corrective” impact of single-vision lenses, we can help patients and parents overcome the stigmas of contact lenses and thereby achieve the best possible clinical outcomes for their children.

A comment frequently heard is “multifocal lenses don’t work well for astigmatic patients.” This echoes with the finding that practitioners’ low rate of prescribing soft toric contact lenses does not adequately address the growing prevalence of astigmatism (Efron et al, 2011; Morgan et al, 2023).

Once perceived as a deterrent, the application of multifocal toric lenses can indeed yield great clinical benefits, not merely for subjective satisfaction (Cho et al, 2012; Logan et al, 2020; Cox et al, 2015), but also to mitigate axial length elongation (Queirós et al, 2016; Demir et al, 2015; Berntsen et al, 2009). The premise is primarily based on the multifocality that creates greater relative peripheral myopic defocus (Berntsen et al, 2009), along with the high-order aberrations (HOAs) induced by toric lenses that have a prism-ballast design (Tomiyama et al, 2021). Further studies are warranted to ascertain how HOAs influence treatment efficacy for myopia management using various lens modalities.

In addition, selection of SCL parameters merits more in-depth considerations than simply matching with the refractive error and the “as-is” lens parameters alone. A recent study revealed marked variations, notably with an average of 276± 39 microns (standard deviation), in the sagittal depth (SAG) among SCLs that share the same diameters and base curves (van der Worp et al, 2021).

It illustrates that the principle of fitting or switching the type of SCL solely based on the existing parameters could inadvertently result in misinterpretations of SAG, thereby impacting the overall lens fit. It is anticipated that optical coherence tomography would likely rise as the next wave of innovation for daily disposable SCL fitting and further enhance treatment outcomes (Giovanzana et al, 2020).

With the abundant opportunities in the SCL arena, practitioners should embrace the exciting challenges and “make it count” for every child’s contact lens experience. CLS

REFERENCES

1. Morgan PB, Woods CA, Tranoudis IG, et al. International Contact Lens Prescribing in 2022. Contact Lens Spectrum. 2023 Jan;38:28-35.
2. Tilia D, Diec J, Ehrmann K, et al. Visual Performance and Binocular/Accommodative Function of S.T.O.P. Contact Lenses Compared With MiSight. Eye Contact Lens. 2023 Feb 1;49:63-70.
3. Cooper J, O’Connor B, Aller T, Dillehay SM, Weibel K, Benoit D. Reduction of Myopic Progression Using a Multifocal Soft Contact Lens: A Retrospective Cohort Study. Clin Ophthalmol. 2022 Jul 4;16:2145-2155.
4. Chamberlain P, Bradley A, Arumugam B, et al. Long-term Effect of Dual-focus Contact Lenses on Myopia Progression in Children: A 6-year Multicenter Clinical Trial. Optom Vis Sci. 2022 Mar 1;99:204-212.
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