STUDIES FIRST PUBLISHED in the 1980s showed small impacts with bifocal spectacle lenses on slowing myopia (Pärssinen and Hemminki, 1988; Goss, 1986). Results appeared to be stronger for children who had esophoria and higher accommodative lag at near (Goss, 1986). 

In the early 2000s, progressive addition lenses (PALs) were studied in randomized controlled trials that measured axial length outcomes, the research gold standard (Wolffsohn et al, 2019). Results were again minimal (Gwiazda et al, 2003; Yang et al, 2009). One study of PALs prescribed specifically to children who had high accommodative lag and/or esophoria found the most noteworthy results for this category—still modest in comparison to today’s newest interventions (Berntsen et al, 2012).

The implication of binocular vision factors in myopia control was then expanded from the spectacle to the contact lens realm. In 2008, a case report of twins who had esophoria fit with bifocal soft contact lenses showed effectiveness. The add power was specifically selected for each child to neutralize the near point esophoria (Aller and Wildsoet, 2008).

This spectacles-to-contact lenses translation arguably was the gateway for the development of various soft contact lens (SCL) designs to slow myopia progression, coinciding with the first successful studies in orthokeratology (Cho et al, 2005; Walline et al, 2009). While accurate accommodation does appear to be a factor in myopia control outcomes with contact lenses (Cheng and Brennan, 2019; Ding et al, 2022), scientific interest shifted to a more consistently modifiable optical property—simultaneous defocus (Smith, 2011; Smith et al, 2020).

Simultaneous defocus in myopia control involves having one plane, zone, or component of the entire optical image focusing on the retina, and another falling in front of the retina to create myopic defocus. This could be off-axis (i.e., peripheral defocus) or on-axis. A volume of animal research has indicated that this optical pattern signals slowed eye growth (Smith, 2011; Smith et al, 2020). Orthokeratology was shown to create this optical profile (Kang and Swarbrick, 2011) and, to a lesser extent, multifocal SCLs (Ticak and Walline, 2013).

Contact lenses create a consistent optical profile, maintaining the same focus/defocus properties in all directions of gaze. A variety of SCL designs for myopia control have been developed, tested, and commercialized in the last several years. 

These include dual-focus concentric with 2D of myopic defocus (Chamberlain et al, 2019), extended-depth-of-focus (EDOF) utilizing higher-order aberrations (Sankaridurg et al, 2019), EDOF with “a single high add” (Cooper et al, 2018), and a non-coaxial ring focus design with a reported 7D to 10D of defocus (Cheng and Brennan, 2022). Center-distance multifocal SCLs with a +2.50 add, originally designed for presbyopia, have also been demonstrated to be effective (Walline et al, 2020). The volume of evidence varies between these designs, and while comparative efficacy is not yet fully understood, it is reasonable to state that all are effective to some degree. 

It is important to note that a labeled add power on a multifocal or multizone SCL does not necessarily behave as an “addition” in the sense of the original spectacle lens studies or as intended for presbyopic SCL fitting. In fact, young eyes appear to be more influenced by the optical design, in terms of their accommodative response, than by the labeled add power (Gifford et al, 2021).

So, just as the original contact lens studies took inspiration from bifocal and PAL trials, the newest spectacle lenses are designed to work like contact lenses. Since 2020, several such spectacle lens designs have been revealed, employing simultaneous defocus of varying powers and configurations (Lam et al, 2020; Bao et al, 2022; Liu et al, 2023) or diffusion optics (Rappon et al, 2023). All aim to provide the same gaze-independent optical profile as SCLs or orthokeratology, and they appear to be meeting a similar bar for myopia control efficacy (Lam et al, 2020; Bao et al, 2022; Liu et al, 2023; Rappon et al, 2023).

As technology builds on what has come before, what could the next back-to-the-future innovation be in myopia control? 

REFERENCES

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14. Kang P, Swarbrick H. Peripheral refraction in myopic children wearing orthokeratology and gas-permeable lenses. Optom Vis Sci. 2011 Apr;88:476-482. 

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16. Chamberlain P, Peixoto-de-Matos SC, Logan NS et al. A 3-Year Randomized Clinical Trial of MiSight Lenses for Myopia Control. Optom Vis Sci 2019 Aug;96:556-567. 

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20. Walline JJ, Walker MK, Mutti DO, et al; BLINK Study Group. 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.

21. Gifford KL, Schmid KL, Collins JM, et al. Multifocal contact lens design, not addition power, affects accommodation responses in young adult myopes. Ophthalmic Physiol Opt. 2021 Nov;41:1346-1354. 

22. Lam CSY, Tang WC, Tse DY, et al. Defocus Incorporated Multiple Segments (DIMS) spectacle lenses slow myopia progression: a 2-year randomised clinical trial. Br J Ophthalmol. 2020 Mar;104:363-368.

23. Bao J, Huang Y, Li X, et al. Spectacle Lenses With Aspherical Lenslets for Myopia Control vs Single-Vision Spectacle Lenses: A Randomized Clinical Trial. JAMA Ophthalmol. 2022 May 1;140:472-478. 

24. Liu X, Wang P, Xie Z, et al. One-year myopia control efficacy of cylindrical annular refractive element spectacle lenses. Acta Ophthalmol. 2023 Sep;101:651-657.

25. Rappon J, Chung C, Young G, et al. Control of myopia using diffusion optics spectacle lenses: 12-month results of a randomised controlled, efficacy and safety study (CYPRESS). Br J Ophthalmol. 2023 Nov;107:1709-1715.

Kate Gifford, PhD, BAppSc(Optom)Hons, is a clinician-scientist and peer educator from Brisbane, Australia. She is a co-founder of Myopia Profile. She has received an educational grant or contract with Alcon, CooperVision, EssilorLuxottica, Hoya Vision Care, Johnson & Johnson Vision, Menicon, Oculus, SightGlass Vision Inc., Topcon Healthcare, Visioneering Technologies Inc., and Vyluma. She has received travel expenses, stipend, or reimbursement from CooperVision, EssilorLuxottica, and Johnson & Johnson Vision.