Article Date: 2/1/2014

Pediatric and Teen CL Care
Pediatric and Teen CL Care

Convenience or Myopia Control

By Jeffrey J. Walline, OD, PhD, FAAO

There currently isn’t a commercially available contact lens in the United States that provides the convenience of daily disposability while also slowing myopia progression. So in correcting myopicchildren, should we recommend convenience or myopia control?

I typically ask parents: “Why would you like your child to wear contact lenses?” If the answer is, “for general use,” we talk about daily disposables and myopia control lenses. If parents show more interest in keeping their children from becoming more nearsighted, we discuss corneal reshaping and soft bifocal contact lenses. It should be noted that this is an off-label use of these contact lenses.

Pros and Cons

The benefits of daily disposable contact lenses are convenience and improved ocular health, especially now with options that allow greater amounts of oxygen to reach the cornea. The primary disadvantage of those lenses is the high cost, especially for those that maximize oxygen transmissibility.

Soft bifocal contact lenses have been shown to slow myopia progression (Aller, 2006; Anstice & Phillips, 2011; Sankaridurg et al, 2011; Walline et al, 2013), but no randomized clinical trial has been published in the peer-reviewed literature. Soft bifocal lenses are initially the most cost effective, but there are limited options available (Table 1), and children are required to care for and replace their lenses and cases.

Corneal reshaping contact lenses also slow eye growth (Cho et al, 2005; Kakita et al, 2011; Walline et al, 2009; Charm and Cho, 2013; and others; full list available at www.clspectrum.com/references.asp), which has been confirmed in a randomized clinical trial (Cho and Cheung, 2012). Corneal reshaping contact lenses offer the convenience of correction-free clear vision throughout the day, lens care only in the home, and no lens wear while swimming. They do, however, include a higher risk of microbial keratitis due to overnight wear, greater initial cost, and fewer eyecare practitioners fit them due to the advanced fitting procedure.

Discuss the Available Options

At this time, we cannot provide children with both daily disposable convenience and myopia control. Parents should be informed of the contact lens options available to their children. When provided with the appropriate information, parents will frequently choose contact lenses for myopia control. CLS

TABLE 1 Mass produced center-distance soft bifocal contact lenses with moderate-to-high add powers that are commercially available in the United States.

COMPANY

BRAND

DISTANCE POWERS (D)

ADDS (D)

Vistakon

Acuvue Oasys for Presbyopia

+6.00 to –9.00

low (+0.75 to +1.25)

medium (+1.50 to +1.75)

high (+2.00 to +2.50)

CooperVision

Proclear Multifocal “D” (also available in extended range)

+6.00 to –8.00 (0.50D steps above –6.00)

+1.00, +1.50, +2.00, +2.50

CooperVision

Biofinity Multifocal “D”

+6.00 to –8.00 (0.50D steps above –6.00)

+1.00, +1.50, +2.00, +2.50

For references, please visit www.clspectrum.com/references.asp and click on document #219.


Dr. Walline is an associate professor at The Ohio State University College of Optometry. His research interests primarily involve pediatric contact lenses and myopia control. He has received research funding from Johnson & Johnson Vision Care. You can reach him at walline.1@osu.edu.



Contact Lens Spectrum, Volume: 29 , Issue: February 2014, page(s): 48