Slowing Down Myopia Progression with Contact Lenses – Everyday Cases from the Clinic

Abstract

Background An estimated 49.8% of the world population will be myopic by 2050. Multifocal contact lenses (MFCLs) and orthokeratology (OK) reduce peripheral retinal hyperopic defocus, which animal studies have shown to positively impact eye growth. MFCLs are expected to slow myopic progression by 20 – 50% and OK by 30 – 60%, making them valuable therapeutic tools. In view of the guidelines for myopia management published by the International Myopia Institute in 2019, the aim of this retrospective data analysis of a tertiary care center was to review past experience with OK and MFCLs for myopia control and gain information to update current practice. Patients and Methods The contact lens (CL) database of the Eye Clinic of the University Hospital of Basel was searched with the label “myopia progression” between January 2012 – 2020. Patients were included if they gave informed consent, were younger than 19 years old at baseline, and had no ocular comorbidities that could potentially compromise vision. Primary outcomes were progression of spherical equivalent refraction for MFCL patients and progression of axial length (AL) for the OK group, comparing with historical data from OK trials. Secondary outcomes were the presence of risk factors for myopia, age, refractive error at baseline, follow-up duration, and adverse effects during therapy. Results Twenty-one patients could be included, with a mean age of 12.80 ± 3.32 years (y) at baseline. The majority of patients were older than 12 years and already myopic (− 3.89 ± 2.30 diopters) when control treatment was started. Overall, follow-up ranged from 0.08 to 6.33 years (2.03 ± 1.66 y). In the patients treated with MFCLs, myopia control improved significantly when patients changed from spectacles to MFCLs. In the OK group, 14% dropped out during the first year and 2 patients had multiple AL measurements during therapy, which showed a slower growth of AL when compared to other OK trials and controls with spectacles. There were two cases of non-severe keratitis. Environmental risk factors had not been documented and only 48% of clinical records had a documented family risk assessment. Conclusion Patients showed a slower myopia progression under MFCLs or OK, which supports their role as a treatment option in myopia management. In this regard, AL measurement is an important additional parameter to be included in the assessment of myopia progression in clinical practice. Identification of children at risk of developing high/pathologic myopia (family history, environmental risk factors) needs to improve so that the first stages of myopic shift can be recognized and targeted. Changes in lifestyle should be actively encouraged, especially when the impact of decreases in outdoor time secondary to COVID-19 is yet to become clear.

Epidemiology of myopia and the effect of orthokeratology on controlling the disease

“…In the 21-person group, two cases of mild keratitis occurred. It supports the view that OK was a good treatment option in myopia progression [21]. The authors emphasize, that early identification and treatment of myopia is essential to prevent serious side effects.…”

“…The increase in myopia prevalence and the complications the disease leads to has driven interest into restraining progression of myopia from an early age. Findings from several studies showed that orthokeratology lenses are a safe approach not only for short-sightedness correction, but more importantly -retardation of myopia progression [11][12][13][14][15][16][17][18][19][20][21]. Orthokeratology (OK) dates back to 1960s [12,20] and nowadays is approved in all countries in the world for the temporary reduction of myopia [20], despite the fact that orthokeratological lenses make no more than 1% of total number of contact lenses used worldwide [3].…”

“…Unfortunately, the effect of myopia reduction is temporary, so contact lenses must be worn regularly to continue the gains, nonetheless a patient can function without any correction during the waking day [20]. The newest study about orthokeratology and myopia progression, which results were published in April 2021, was held in Switzerland between 2012 and 2020 [21]. It involved patients up to 19 years old with myopia but no other comorbidities.…”

Correlation analysis of angles κ and α with the refraction and anterior segment parameters in children

“…More than 12.8 million (0.96%) children aged 5–15 years are affected by ametropia all over the world and the prevalence of myopia in China remains high [ 1 ]. The children are at a higher risk of myopia progression during the COVID-19 pandemic [ 2 – 4 ], and the applications of low-concentration atropine [ 5 ] and corneal contact lenses [ 6 ] (multifocal contact lenses [MFCL] and orthokeratology [OK]) have shown to be effective in controlling myopia progression. During the stage of emmetropization and ocular growth in childhood, different biological parameters may correlate to refractive parameters, and affect the outcome of clinical prescription.…”