In Focus Blog

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SynergEyes In Focus Blog

At SynergEyes, we pride ourselves in delivering contact lens products that improve vision and ultimately enhance the quality of everyday life.

This blog is geared towards practitioners to highlight case studies from your peers and covers topics such as fitting & troubleshooting, as well helpful articles on practice management and the handling and care of SynergEyes lenses like Duette and UltraHealth.

Research Overview: Options for Myopia Control

By Louise Sclafani, OD

Combating the progression of myopia has long been a source of frustration. Although we have a fairly clear understanding of how myopia develops, consistent and dependable strategies for treatment are still being developed. What’s more, in the United States, only ortho-K is an FDA-approved method to specifically treat myopia.

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On the positive side, a significant amount of new global research is helping to guide practitioners as they chart a course for patients at risk.

Today, doctors have several effective tools for combating myopia and slowing its progression. These include environmental adjustments, glasses, contact lenses, corneal reshaping, and atropine therapy.

  • Environmental Adjustments. It has become increasing clear that time spent engaged in outdoor daylight activity helps retard myopia progression.  In today’s technologically driven world of the internet and hand held devices, children are spending dramatically more time with indoor near point activities.  As such, it is important to stress the importance of outdoor activity for many reasons including the control of myopia.
  • Glasses. Multifocal spectacles can result, in some cases, in about a 33% reduction in myopia progression.[1] However, this may be deemed insufficient by some doctors in light of other more effective options. For example, clinical trials and case studies show specially designed contact lenses slow myopia progression from 25% to 72% compared with spectacles. [2]
  • Contact Lenses. Multifocal contact lenses for children with myopia can slow the progression of nearsightedness, providing a more effective and efficient treatment option, says the American Optometric Association.[3] In fact, studies show that multifocal designs, in particular, can slow progression by about 48%.[4] Center distance designs are commonly prescribed for kids with myopia because, unlike single vision distance prescriptions,[5][6] they can halt or slow progression of myopia.
  • Corneal Reshaping. Corneal reshaping is FDA approved up to -6.00D of myopia, however it may offer less myopia control in patients with lower levels of myopia.[7][8] Research shows that orthokeratology can reduce myopia progression by roughly 40 to 45%.[9][10] However, success with ortho-K is largely dependent on lens design and the practitioner’s experience, since fitting these lenses is often considered a specialty in its own right. Also, this is one of the more technically challenging methods of controlling myopia, as generally the process of physically changing the shape of the cornea is accomplished through overnight wear. As such, to prevent complications, it’s important to monitor for complications and ensure an ongoing proper fit.
  • Atropine. Atropine is often cited as the most effective way of controlling myopia.[11] Proponents also say it’s one of the easiest ways to manage the disease since one drop per day is fairly manageable for most patients. Low-dose atropine (0.02%) can be considered in patients as a stand-alone or combination therapy. In fact, dosages as low as 0.01% can have a clinically meaningful ability to slow myopia without significant mydriasis or cycloplegia.[12] Atropine also has greater efficacy rates; [13][14] however, studies indicate that myopia may rebound once treatment is stopped. [15][16]

It is apparent that, not unlike treating other visual conditions, there is no single best answer that applies to all patients. Prescription, personality and parents are all key parts of the decision-making process.

Of the various interventions, contact lenses fare well in terms of the risk-benefit ratio compared with other interventions for myopia control[17] and those with center distance daytime wear designs can slow the progression of myopia as well as, or in some cases more effectively, than corneal reshaping.[18]

For parents concerned about the safety of contact lens wear in children, research is also quite convincing. A 2017 report shows the incidence of complications in kids is no higher than in adults—and in the youngest age range of 8 to 11 years, complication rates may be even lower in kids than they are in adults.[19]

There are other benefits to contact lens wear as well. Studies show that children who wear contact lenses enjoy added psychological benefits. [20] Indeed, research shows young wearers report feeling a significant improvement in their physical appearance, acceptance among friends, athletic ability and increased confidence in academic performance.[21]

No matter what strategy you arrive at with a parent, also remind them that prevention is one of the most effective strategies to reduce myopia. Several clinical trials suggest that lifestyle intervention, including more time spent outdoors and a reduction of time spent with hand-held devices, has a positive effect.[22][23]

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References

[1] Walline JJ. Myopia Control: A Review. Eye Contact Lens 2016;42:3–8.

[2] Sankaridurg P. Fitting Multifocal Contact Lenses for Myopia Control. Review of Cornea and Contact Lenses, February 2017.

[3] American Optometric Association. Multifocal contact lens effective at treating myopia in kids. APRIL 25, 2016. Available at: https://www.aoa.org/news/clinical-eye-care/multifocal-contact-lens-effective-at-treating-myopia-in-kids

[4] Smith MJ, Walline JJ. Controlling myopia progression in children and adolescents. Adolesc Health Med Ther 2015;6:133–40.

[5] Sun Y-Y, Li S-M, Li S-Y, Kang M-T, Liu L-R, Meng B, Zhang F-J, Millodot M, Wang N. Effect of uncorrection versus full correction on myopia progression in 12-year-old children. Graefes Arch Clin Exp Ophthalmol 2017;255:189–95.

[6] Gwiazda J, Hyman L, Hussein M, Everett D, Norton TT, Kurtz D, Leske MC, Manny R, Marsh-Tootle W, Scheiman M. A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression of myopia in children. Invest Ophthalmol Vis Sci 2003;44:1492–500.

[7] Smith EL, 3rd. Optical treatment strategies to slow myopia progression: effects of the visual extent of the optical treatment zone. Exp Eye Res, 2013. 114:77-88.

[8] Anderson RL, Aller T, Walline JJ. Controlling Myopia, Changing Lives. Review of Cornea and Contact Lenses. September 2014.

[9] Leo SW. Current approaches to myopia control. Curr Opin Ophthalmol 2017;Publish Ahead of Print.

[10] Anderson RL, Aller T, Walline JJ. Controlling Myopia, Changing Lives. Review of Cornea and Contact Lenses. September 2014.

[11] Smith MJ, Walline JJ. Controlling myopia progression in children and adolescents. Adolesc Health Med Ther 2015;6:133–40.

[12] Chia A, et al. Atropine for the treatment of childhood myopia: safety and efficacy of 0.5%, 0.1%, and 0.01% doses (Atropine for the Treatment of Myopia 2). Ophthalmology, 2012. 119(2):347-54. 

[13] Sankaridurg P. Fitting Multifocal Contact Lenses for Myopia Control. Review of Cornea and Contact Lenses, February 2017.

[14] Chia A, Lu Q, Tan D. Atropine for the treatment of childhood myopia: safety and efficacy of 0.5%, 0.1%, and 0.01% doses (Atropine for the Treatment of Myopia 2). Ophthalmology. 2012;119(2):347-54.

[15] Sankaridurg P. Fitting Multifocal Contact Lenses for Myopia Control. Review of Cornea and Contact Lenses, February 2017.

[16] Chia A, Lu Q, Tan D. Atropine for the treatment of childhood myopia: safety and efficacy of 0.5%, 0.1%, and 0.01% doses (Atropine for the Treatment of Myopia 2). Ophthalmology. 2012;119(2):347-54.

[17] Sankaridurg P. Fitting Multifocal Contact Lenses for Myopia Control. Review of Cornea and Contact Lenses, February 2017.

[18] American Optometric Association. Multifocal contact lens effective at treating myopia in kids. APRIL 25, 2016. Available at: https://www.aoa.org/news/clinical-eye-care/multifocal-contact-lens-effective-at-treating-myopia-in-kids

[19] Bullimore MA. The Safety of Soft Contact Lenses in Children. Optometry and Vision Science, Vol. 94, No. 6, June 2017.

[20] Walline JJ, Jones LA, Sinnott L, et al; ACHIEVE Study Group. Randomized trial of the effect of contact lens wear on self-perception in children. Optom Vis Sci 2009;86:222-232.

[21] Walline JJ, Jones LA, Sinnott L, et al; ACHIEVE Study Group. Randomized trial of the effect of contact lens wear on self-perception in children. Optom Vis Sci 2009;86:222-232.

[22] Wu PC, Tsai CL, Wu HL, et al. Outdoor activity during class recess reduces myopia onset and progression in school children. Ophthalmology. 2013;120(5):1080-5.

[23] He M, Huang W, Zheng Y, et al. Refractive error and visual impairment in school children in rural southern China. Ophthalmology. 2007;114(2):374-82.