Myopia Management
Slowing Down Myopia Progression
Abridged from the original article written by David Kading, O.D* and Amber Mayberry
More than 41% of people in the United States are suffering from myopia.1 Although there are currently no interventions that cease myopic progression ,we can decrease its progression, which could possibly save them from the devastating vision loss due to myopic retinopathy, retinal detachment and glaucoma that is associated with myopia.2-4
Best
Multifocal Soft Contact Lenses
In one study, myopia progression and eye elongation were reduced significantly with the use of bifocal contact lenses.10 Researchers found that for 70% of the children, myopia progression was reduced by 30% or more in the eye wearing the bifocal lens compared to the single vision lens.10
Better
Traditional Bifocal Glasses
A study has shown that there was a 20% reduction in myopia progression with bifocal lenses versus single vision lenses.9 Older studies have suggested that bifocals could provide reduction in myopia progression of 44% or more.7
Good
Progressive Addition Lenses
For young children and adolescents, the appearance of the lenses cannot be overstated. Patients enjoy the smooth transition of vision from their distance to near vision without the distinct junction line.
The Correction of Myopia Evaluation Trial (COMET) looked at the effect of PALs compared to single vision lenses on myopic progression.8. Although their findings were statistically significant, the authors concluded that the use of PALs as a clinically significant treatment option is not warranted on a routine basis. Considering the significant cost of PALs compared to single vision lenses and how minimal the reduction is, PALs are not recommended for myopia control.
Worse
Undercorrected Single Vision Lenses
Parents often get concerned when their children’s spectacle prescriptions increase, fearing that their child will end up highly myopic. So, many times, they ask us to prescribe lenses that are not as strong in order to “keep their child’s prescription from getting worse.” The bottom line is there’s no evidence to back it up—in fact, it’s just the opposite. A 2006 study looked at myopic children between ages six and 15 years old over a period of 18 months.5 Twenty-three of the participants were fully corrected, while 25 were undercorrected by +0.50. Although statistically insignificant, there was a slight progression of myopia (0.17D) in the children who were undercorrected.5 A 2002 study showed similar results of increased myopia progression (0.23D) over a two-year period.6 Although the increase was not significant, both studies suggest that under correcting myopes has a negative effect on the progression of myopia.5-6 Ergo, undercorrected single vision lenses should not be used for slowing the progression of myopia.The data shows undercorrected children progress faster in their myopia—therefore, we make sure these children have a new update prescription as soon as their eyes change in an effort to stabilize their vision as best as possible.5-6
*David Kading, O.D., owns Specialty Eyecare Group in Seattle, a group practice with multiple locations. He specializes in anterior segment disease and custom contact lens fitting. Amber Mayberry, a 4th year student at the University of Saint Louis Missouri College of Optometry, is an optometric intern at Specialty Eyecare Group.
1. Vitale S, Sperduto RD, Ferris FL 3rd. Increased prevalence of myopia in the United States between 1971-1972 and 1999-2004. Arch Ophthalmol. 2009 Dec;127(12):1632-9.
2. Celorio JM, Pruett RC. Prevalence of lattice degeneration and its relation to axial length in severe myopia. Am J Ophthalmol. 1991 Jan 15;111(1):20-3.
3. Sørensen KE, Baggesen K. Retinal detachment following intracapsular cataract extraction. Acta Ophthalmol (Copenh). 1990 Oct; 68(5):549-53.
4. Saw SM, Katz J, Schein OD, et al. Epidemiology of myopia. Epidemiol Rev. 1996;18(2):175-87.
5. Adler D, Millodot M. The possible effect of undercorrection on myopic progression in children. Clin Exp Optom. 2006 Sep;89(5):315-21.
6. Chung K, Mohindin N, O’Leary DJ. Undercorrection of myopia enhances rather than inhibits myopia progression. Vision Res 2002 Oct;42(22):2555-9.
7. Goss DA, Uyesugi EF. Effectiveness of bifocal control of childhood myopia progression as a function of near point phoria and binocular cross-cylinder. J Optom Vis Dev. 1995 June;26(2):12-7.
8. Walline JJ, Jones LA, Sinnott L, et al. Randomized trial of the effect of contact lens wear on self-perception in children. Optom Vis Sci. 2009 Mar;86(3):222-32.
9. Walline JJ, Jones LA, Sinnott L, et al. A randomized trial of the effect of soft contact lenses on myopia progression in children. Invest Ophthalmol Vis Sci. 2008 Nov;49(11):4702-6.
10. Anstice NS, Phillips JR. Effect of dual-focus soft contact lens wear on axial myopia progression in children. Ophthalmology. 2011 Jun;118(6):1152-61.