Multifocal Contact Lenses With High Add Power Help Slow Myopia Progression

By Megan Brooks

August 12, 2020

NEW YORK (Reuters Health) - Soft multifocal contact lenses with a high add power help slow progression of myopia in children, more so than multifocal lenses with medium add power or single-vision lenses, according to results of the BLINK trial.

"Over the past five years, many eye care practitioners have been fitting children with multifocal contact lenses to slow the progression of nearsightedness. However, the best add power for slowing myopia progression was unknown. We now know that the stronger add power provides better myopia control," Dr. Jeffrey Walline of The Ohio State University College of Optometry told Reuters Health by email.

The objective of the BLINK study was to see whether soft contact lenses with a central correction for myopia plus a high add (+2.50 D) or medium add (+1.50 D) power to the peripheral concentric zone can slow myopia progression in children more than single-vision (no add) contact lenses that correct for myopia.

Participants included 294 children (mean age, 10 years) with -0.75 D to -5.00 D of spherical component myopia and less than 1.00 D astigmatism. Ninety-eight children were randomly assigned to each type of lenses.

The adjusted three-year myopia progression, the primary outcome, was significantly slower with high-add-power multifocal lenses (-0.60 D) than with medium-add-power multifocal (-0.89 D) or single-vision lenses (-1.05 D).

The adjusted mean eye growth, a secondary outcome, was 0.42 mm for high add power, 0.58 mm for medium add power, and 0.66 mm for single-vision lenses, all significant differences.

"The high add power did not clinically alter the ability to see or result in a greater number of adverse events. Although these contact lenses were approved for wear by the U.S. Food and Drug Administration (FDA) without age restriction, they did not have a specific FDA indication for myopia control and were prescribed off label," the researchers note in their JAMA article.

"The key takeaways are that soft multifocal contact lenses can slow myopia progression, especially if the high add power is used," Dr. Walline told Reuters Health.

"Future questions remaining to be answered by the study include determining the signals created by the contact lenses that optimize myopia control and whether these signals slow eye growth in general or change how the eye grows. We will be able to answer both of those questions with the data we collected," Dr. Walline said.

In a JAMA editorial, Dr. Neil Bressler of the department of ophthalmology at Johns Hopkins University School of Medicine, in Baltimore, Maryland, says the BLINK study makes a contribution to an "important and growing public health problem."

The BLINK study results "support and build on similar conclusions from previously reported clinical trials that were smaller in size or only followed up participants for 2 years. Nevertheless, the answers to questions regarding longer-term effects on reducing the risk of axial elongation and pathologic myopia seem warranted before soft contact lens correction to reduce myopia progression becomes standard care," Dr. Bressler concludes.

Funding for the BLINK study was provided by grants from the National Institutes of Health. Bausch + Lomb provided contact lens solutions for the study. Dr. Walline reported receiving nonfinancial support from Bausch + Lomb and grants from the National Eye Institute (NEI) during the conduct of the study and personal fees from SightGlass outside the submitted work.

SOURCE: JAMA, online August 11, 2020.