Amy K. Hutchinson, MD, discussed myopia control using contact lenses during “Preventing Myopia Progression in the Pediatric Patient” (Sym03V) on Saturday. Along with atropine eyedrops, both multifocal contact lenses and overnight orthokeratology (ortho-k) are among the main approaches for control of myopia progression.
Multifocal contact lenses. These special contact lenses slow myopia progression by reducing peripheral hyperopic defocus and promoting peripheral myopic defocus. Currently, the MiSight multifocal lens (CooperVision) is the only FDA-approved contact lens for myopia control. A daily-wear disposable lens, MiSight has a center-distance design with concentric peripheral rings that add +2.00 D. According to a recent randomized clinical trial, three years of MiSight use can slow myopia progression and axial elongation by 59% and 52%, respectively, compared with single-vision contact lenses. Other brands of spherical and toric multifocal lenses are available for off-label use, but they vary in cost, powers, adds, and efficacy, noted Dr. Hutchinson.
Orthokeratology. Also known as corneal reshaping therapy, overnight ortho-k lenses are made of a rigid gas-permeable material. They temporarily flatten the cornea to provide a focused image on the fovea and clear uncorrected daytime vision. Studies report 30% to 80% reduction in axial length elongation with this method. Although these lenses appear to be most effective for low/moderate myopia, recent studies suggest that ortho-k may also be beneficial for cases of higher myopia and anisometropia.
In the United States, ortho-k has been FDA approved for overnight wear to correct myopia and mild astigmatism but has not been cleared for control of myopia progression.
Microbial keratitis risk. “No talk about contact lenses in children would be complete without some discussion about safety,” said Dr. Hutchinson. Overall, the risk of microbial keratitis is relatively low. The estimated upper limit of incidence is 1 in 500 years of wear for daily soft contact lenses and 1 in 200 years of wear for overnight ortho-k.
Additional studies are needed to clarify the optimal time to start treatment, optimal therapy duration, and rate of rebound myopia after contact lens use stops. —Kanaga Rajan, PhD
Watch the symposium in full. If you are registered for AAO 2020 Virtual, you have access to the archived presentations on the virtual meeting platform until Feb. 15, 2021. Log in to the virtual meeting platform: Next, from the Lobby screen, select “Sessions” from the top navigation; click “Agenda” from the drop-down menu; click the “Saturday” tab and then scroll down to “Sym03V: Preventing Myopia Progression in the Pediatric Patient.”
Financial disclosures. Dr. Hutchinson: None.
Read more news from AAO 2020 Virtual.