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.

Zusammenfassung

Hintergrund Circa 49,8% der Weltbevölkerung wird bis 2050 myop. Multifokale Kontaktlinsen (MFCLs) und Orthokeratologie (OK) reduzieren die hyperope Defokussierung in der Peripherie der Netzhaut, was sich gemäß Tierstudien positiv auf das myope Augenwachstum auswirken soll. MFCLs sollen das Fortschreiten der Myopie um 20 – 50% verlangsamen und OK um 30 – 60%. In Anbetracht der Richtlinien für das Myopiemanagement, die 2019 vom International Myopia Institute herausgegeben wurden, ist das Ziel dieser retrospektiven Datenanalyse eines tertiären Versorgungszentrums, frühere Erfahrungen mit OK und MFCLs für Myopiekontrolle zu sammeln und diskutieren.

Patienten und Methoden Die Kontaktlinsendatenbank (CL) der Augenklinik des Universitätsspitals Basel wurde mit dem Label „Myopieprogression“ zwischen Januar 2012 – 2020 durchsucht. Patienten wurden eingeschlossen, wenn die Einverständniserklärung vohanden war, wenn die Patienten zur Baseline unter 19 Jahre alt waren und keine okularen Komorbiditäten, die das Sehvermögen beeinträchtigen könnten, hatten. Primäre Endpunkte waren das Fortschreiten der sphärischen äquivalenten Refraktion für MFCL-Patienten und Fortschreiten der axialen Länge (AL) für die OK-Gruppe im Vergleich mit historischen Daten aus OK-Trials. Sekundäre Endpunkte waren Risikofaktoren für Myopie, Alter, Refraktion bei Baseline, Follow-up-Dauer und Nebenwirkungen während der Therapie.

Ergebnisse 21 Patienten wurden eingeschlossen. Bei Baseline waren sie 12,80 ± 3,32 Jahre alt (y). Die Mehrheit der Patienten war älter als 12 Jahre und bereits myop (− 3,89 ± 2,30 D), als die Myopiebehandlung mit Kontaktlinsen begonnen wurde. Insgesamt lag das Follow-up zwischen 0,08 und 6,33 Jahren (2,03 ± 1,66 Jahre). Bei den mit MFCL behandelten Patienten verbesserte sich die Myopieprogression. In der OK-Gruppe hörten 14% mit der Therapie im 1. Jahr auf. Zwei OK-Patienten hatten mehrere AL-Messungen während der Therapie, welche ein langsameres Wachstum von AL zeigte im Vergleich zu anderen OK-Trials. Insgesamt gab es 2 Fälle von nicht schwerer Keratitis. Umweltrisikofaktoren wurden nicht dokumentiert und nur bei 48% der klinischen Akten wurden die familiären Risikofaktoren bewertet.

Schlussfolgerung Die Patienten zeigten ein langsameres Fortschreiten der Myopie unter MFCLs oder OK, was ihre Rolle im Myopiemanagement unterstützt. Die AL-Messung ist ein wichtiger Parameter, der aufgenommen werden muss für die Beurteilung des Fortschreitens der Myopie im klinischen Alltag. Die Identifizierung von Kindern mit einem hohen Risiko für eine Myopia magna (Familienanamnese, Umweltrisikofaktoren) muss verbessert werden, sodass die Prämyopiephase erkannt und die Therapie früh begonnen wird. Änderungen im Lebensstil sollten aktiv gefördert werden, vor allem, wenn die Auswirkungen der zunehmenden Screening-Zeit nach COVID-19 noch nicht klar sind.

Key words

pediatric ophthalmology - physiological optics - contact lenses

Schlüsselwörter

Kinderophthalmologie - Kontaktlinsen - physiologische Optik

Publication History

Received: 23 September 2020

Accepted: 09 March 2021

Article published online:
30 April 2021

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