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MULTIFOCALS ARE NOT JUST FOR PRESBYOPES ANYMORE

In this article, we will discuss the use of multifocal contact lenses for non-presbyopic patients. There are two additional situations in which multifocal, or bifocal, contact lenses can be incorporated into the treatment plan. Both involve patients who are young. The first is for those individuals who have binocular vision issues, such as accommodative excess and convergence excess. The second is for the control of myopia.

Managing Binocular Vision Issues

In youngsters who have accommodative disorders, bifocal glasses have been used for centuries (Griffin, 1980). Using bifocal or multifocal contact lenses is an approach that is often overlooked because of the patients’ youth. The result is the same with either treatment option. The accommodative excess is relaxed, leading to a more normal convergence response (Griffin, 1980).

Children are capable of handling application and removal on their own at an early age. Many prefer the cosmetic appeal of contact lenses rather than wearing glasses. Also, other forms of vision therapy can be undertaken with contact lenses as easily as with spectacles.

Managing Myopia

Myopia management has been a hot topic recently. Worldwide, the number of myopic people is increasing, and so is the number who have high degrees of myopia. It appears to be a larger problem in Asian countries. Higher levels of myopia are associated with an increased risk of retinal tears and detachment as well as myopic macular degeneration, glaucoma, and cataracts (Smith, 2011).

Measures that attempt to prevent the progression of myopia include atropine drops, orthokeratology lenses, bifocal/multifocal contact lenses, and combinations of these approaches. The use of atropine has been studied, and good results achieved, with various concentrations (Walline, 2016). Very low concentrations (0.01%) seem to work as well as the traditional 1% concentration, with fewer side effects.

Orthokeratology also has a place in the myopia management arena (Si, 2015). It is particularly popular in China and Japan, where a large number of myopic patients live.

A number of ongoing studies are looking at the use of soft multifocal lenses, alone or in combination with some form of atropine, to stem the progression of myopia. Better results seem to occur when a center-distance lens design is utilized.

There are numerous proprietary designs for such contact lenses in various stages of development around the world. Once U.S. Food and Drug Administration clearance and/or CE approval is received, these designs will be marketed with an indication for myopia progression control. Until then, currently available contact lens designs may be used as an off-label application.

Children are usually quite willing to wear contact lenses, particularly if they are physically active. As the level of myopia increases, it becomes more difficult to simply remove the glasses for sports, etc.

If a youth is showing rapid increases in myopia, a center-distance multifocal can solve the vision issue for active times and may slow the progression of the myopia as well. Children are generally not bothered by the presence of the multifocal optics at any viewing distance.

Using a daily disposable option can be wise in young people. This eliminates the angst of losing or tearing a lens (usually at the worst possible time), and it greatly reduces the chance of a contact lens-related inflammatory event. Parents may also be relieved to have their youngster in a lens that is easy to use and requires minimal (i.e., no) care.

Look Beyond Presbyopia

So, the next time you reach for a multifocal lens for your presbyopic patients, keep in mind that they are no longer just for presbyopes. CLS

For references, please visit www.clspectrum.com/references and click on document #265.