Multifocal Optics for Myopia Control

Abstract

The rising prevalence of myopia among children and adolescents necessitates effective interventions to mitigate long-term risks, such as retinal detachment and macular degeneration. Traditional approaches like undercorrection with single-vision lenses have proven ineffective. Recent research underscores the significance of peripheral vision in managing myopia progression. While hyperopic defocus in the peripheral retina may encourage axial elongation, multifocal lenses designed to induce peripheral myopic defocus can potentially curb this elongation. Randomized controlled trials (RCTs) have demonstrated that spectacle lenses with peripheral modifications, such as highly aspherical lenslets (HAL) or defocus incorporated multiple segments (DIMS), reduce myopia progression and axial elongation over 2 years. Similarly, multifocal contact lenses, especially those with high-add power (+ 2.50 D), have shown comparable reductions over 3 years. Safety is a critical consideration in myopia control. Multifocal spectacle lenses with peripheral plus designs are generally well tolerated, with only transient side effects, like dizziness and blurred vision. Soft multifocal contact lenses also exhibit a favorable safety profile, with low rates of serious adverse events. Thorough monitoring and reporting in these studies are essential to provide assurance about the safety of these interventions for children. Future research should aim to include more diverse populations in order to ensure the generalizability of findings across various demographic groups. Additionally, real-world data would offer valuable insights into the performance of these treatments in everyday scenarios. Observational studies, less influenced by industry sponsorship, could further validate these findings. Lastly, the clinical significance of the observed effects should be critically assessed to confirm that the reported benefits lead to meaningful reductions in myopia progression.

Zusammenfassung

Die zunehmende Prävalenz der Myopie bei Kindern und Jugendlichen erfordert effektive Maßnahmen, um langfristige Risiken wie Netzhautablösung und Makuladegeneration zu verringern. Herkömmliche Ansätze wie die Unterkorrektur (myoper Defokus) mit Einstärkengläsern haben sich als ineffektiv erwiesen. Aktuelle Forschungsergebnisse betonen die Bedeutung des peripheren Sehens, um das Fortschreiten der Myopie zu stoppen: Es wird angenommen, dass ein hyperoper Defokus auf der peripheren Netzhaut das axiale Längenwachstum des Auges fördert. Die Unterkorrektur der Myopie mit multifokalen Optiken, die den peripheren hyperopen Defokus reduzieren, wird daher als potenzielle Methode betrachtet, um das Fortschreiten der Myopie zu verlangsamen. Randomisierte kontrollierte Studien (RCTs) haben bereits gezeigt, dass multifokale Brillengläser, die einen peripheren myopischen Defokus erzeugen, die Myopieprogression und das axiale Längenwachstum über einen Zeitraum von 2 Jahren hemmen können. Zudem haben RCTs mit einer Beobachtungsdauer von 3 Jahren gezeigt, dass das Tragen von multifokalen Kontaktlinsen einen ähnlichen Rückgang der Myopie bewirkt. Der größte Nutzen wurde bei multifokalen Kontaktlinsen mit einer hohen Addition (+ 2,50 dpt) beobachtet. Multifokale Brillengläser sind im Allgemeinen gut verträglich und verursachen nur vorübergehende Nebenwirkungen wie Schwindel und verschwommenes Sehen. Auch weiche multifokale Kontaktlinsen weisen ein gutes Sicherheitsprofil mit nur sehr geringen Raten an schwerwiegenden unerwünschten Ereignissen auf. Zukünftige Studien zu multifokalen Optiken sollten jedoch eine breite Population einbeziehen, um die Übertragbarkeit der Ergebnisse auf verschiedene demografische Gruppen zu gewährleisten. Zudem könnten Real-World-Daten wertvolle Einblicke in die Wirksamkeit der Behandlungen im Alltag liefern. Solche Beobachtungsstudien wären auch weniger durch industrielles Sponsoring beeinflusst. Schließlich sollte die klinische Relevanz der Effekte sorgfältig bewertet werden, um sicherzustellen, dass der beschriebene Nutzen auch tatsächlich von klinischer Bedeutung ist.

Keywords

pediatric ophthalmology - myopia - multifocal optics

Schlüsselwörter

Kinderophthalmologie - Myopie - multifokale Optiken

Publication History

Received: 01 July 2024

Accepted: 11 August 2024

Article published online:
09 October 2024

• References

• 1 Dolgin E. The myopia boom. Nature 2015; 519: 276-278
• 2 Schuster AK, Krause L, Kuchenbäcker C. et al. Prevalence and Time Trends in Myopia Among Children and Adolescents. Dtsch Arztebl Int 2020; 117: 855-860
• 3 Haarman AEG, Enthoven CA, Tideman JWL. et al. The Complications of Myopia: A Review and Meta-Analysis. Invest Ophthalmol Vis Sci 2020; 61: 49
• 4 Smith EL, Hung LF, Arumugam B. Visual regulation of refractive development: insights from animal studies. Eye (Lond) 2014; 28: 180-188
• 5 Schaeffel F, Glasser A, Howland HC. Accommodation, refractive error and eye growth in chickens. Vision Res 1988; 28: 639-657
• 6 Howlett MH, McFadden SA. Spectacle lens compensation in the pigmented guinea pig. Vision Res 2009; 49: 219-227
• 7 Adler D, Millodot M. The possible effect of undercorrection on myopic progression in children. Clin Exp Optom 2006; 89: 315-321
• 8 Chung K, Mohidin N, OʼLeary DJ. Undercorrection of myopia enhances rather than inhibits myopia progression. Vision Res 2002; 42: 2555-2559
• 9 Walline JJ, Lindsley KB, Vedula SS. et al. Interventions to slow progression of myopia in children. Cochrane Database Syst Rev 2020; (01) CD004916
• 10 Berntsen DA, Barr CD, Mutti DO. et al. Peripheral defocus and myopia progression in myopic children randomly assigned to wear single vision and progressive addition lenses. Invest Ophthalmol Vis Sci 2013; 54: 5761-5770
• 11 Troilo D, Smith EL, Nickla DL. et al. IMI – Report on Experimental Models of Emmetropization and Myopia. Invest Ophthalmol Vis Sci 2019; 60: M31-M88
• 12 Liu Y, Wildsoet C. The effect of two-zone concentric bifocal spectacle lenses on refractive error development and eye growth in young chicks. Invest Ophthalmol Vis Sci 2011; 52: 1078-1086
• 13 Han X, Xu D, Ge W. et al. A Comparison of the Effects of Orthokeratology Lens, Medcall Lens, and Ordinary Frame Glasses on the Accommodative Response in Myopic Children. Eye Contact Lens 2018; 44: 268-271
• 14 Radhakrishnan H, Lam CSY, Charman WN. Multiple segment spectacle lenses for myopia control. Part 1: Optics. Ophthalmic Physiol Opt 2023; 43: 1125-1136
• 15 Lupon M, Nolla C, Cardona G. New Designs of Spectacle Lenses for the Control of Myopia Progression: A Scoping Review. J Clin Med 2024; 13: 1157
• 16 Bao J, Yang A, Huang Y. et al. One-year myopia control efficacy of spectacle lenses with aspherical lenslets. Br J Ophthalmol 2022; 106: 1171-1176
• 17 Bao J, Huang Y, Li X. et al. Spectacle Lenses With Aspherical Lenslets for Myopia Control vs. Single-Vision Spectacle Lenses: A Randomized Clinical Trial. JAMA Ophthalmol 2022; 140: 472-478
• 18 Silva-Leite S, Amorim-de-Sousa A, Queirós A. et al. Peripheral Refraction and Visual Function of Novel Perifocal Ophthalmic Lens for the Control of Myopia Progression. J Clin Med 2023; 12: 1435
• 19 Lam CSY, Tang WC, Tse DY. et al. Defocus Incorporated Multiple Segments (DIMS) spectacle lenses slow myopia progression: a 2-year randomised clinical trial. Br J Ophthalmol 2020; 104: 363-368
• 20 Lu Y, Lin Z, Wen L. et al. The Adaptation and Acceptance of Defocus Incorporated Multiple Segment Lens for Chinese Children. Am J Ophthalmol 2020; 211: 207-216
• 21 Liu X, Wang P, Xie Z. et al. One-year myopia control efficacy of cylindrical annular refractive element spectacle lenses. Acta Ophthalmol 2023; 101: 651-657
• 22 Sankaridurg P, Weng R, Tran H. et al. Spectacle Lenses With Highly Aspherical Lenslets for Slowing Myopia: A Randomized, Double-Blind, Cross-Over Clinical Trial: Parts of these data were presented as a poster at the Annual Research in Vision and Ophthalmology meeting, 2022. Am J Ophthalmol 2023; 247: 18-24
• 23 Lawrenson JG, Shah R, Huntjens B. et al. Interventions for myopia control in children: a living systematic review and network meta‐analysis. Cochrane Database Syst Rev 2023; (02) CD014758
• 24 Anstice NS, Phillips JR. Effect of dual-focus soft contact lens wear on axial myopia progression in children. Ophthalmology 2011; 118: 1152-1161
• 25 Aller T, Liu M, Wildsoet C. Myopia Control with Bifocal Contact Lenses: A Randomized Clinical Trial. Optom Vis Sci 2016; 93: 344-352
• 26 Walline JJ, Walker MK, Mutti DO. et al. Effect of High Add Power, Medium Add Power, or Single-Vision Contact Lenses on Myopia Progression in Children: The BLINK Randomized Clinical Trial. JAMA 2020; 324: 571-580
• 27 Chamberlain P, Peixoto-de-Matos SC, Logan NS. et al. A 3-year Randomized Clinical Trial of MiSight Lenses for Myopia Control. Optom Vis Sci 2019; 96: 556-567
• 28 Ruiz-Pomeda A, Pérez-Sánchez B, Valls I. et al. MiSight Assessment Study Spain (MASS). A 2-year randomized clinical trial. Graefes Arch Clin Exp Ophthalmol 2018; 256: 1011-1021
• 29 Lam CS, Tang WC, Tse DY. et al. Defocus Incorporated Soft Contact (DISC) lens slows myopia progression in Hong Kong Chinese schoolchildren: a 2-year randomised clinical trial. Br J Ophthalmol 2014; 98: 40-45
• 30 Fujikado T, Ninomiya S, Kobayashi T. et al. Effect of low-addition soft contact lenses with decentered optical design on myopia progression in children: a pilot study. Clin Ophthalmol 2014; 8: 1947-1956
• 31 Sankaridurg P, Bakaraju RC, Naduvilath T. et al. Myopia control with novel central and peripheral plus contact lenses and extended depth of focus contact lenses: 2 year results from a randomised clinical trial. Ophthalmic Physiol Opt 2019; 39: 294-307
• 32 Garcia-Del Valle AM, Blázquez V, Gros-Otero J. et al. Efficacy and safety of a soft contact lens to control myopia progression. Clin Exp Optom 2021; 104: 14-21
• 33 Cheng X, Brennan NA, Toubouti Y. et al. Safety of soft contact lenses in children: retrospective review of six randomized controlled trials of myopia control. Acta Ophthalmol 2020; 98: e346-e351
• 34 Yu Z, Zhong A, Zhao X. et al. Efficacy and Safety of Different Add Power Soft Contact Lenses on Myopia Progression in Children: A Systematic Review and Meta-Analysis. Ophthalmic Res 2022; 65: 398-416
• 35 Liu J, Lu Y, Huang D. et al. The Efficacy of Defocus Incorporated Multiple Segments Lenses in Slowing Myopia Progression: Results from Diverse Clinical Circumstances. Ophthalmology 2023; 130: 542-550
• 36 Deutsche Ophthalmologische Gesellschaft (DOG), Berufsverband der Augenärzte(BVA) Deutschland, Bielschowsky Gesellschaft für Schielforschung und Neuroophthalmologie. Stellungnahme: Empfehlungen bei progredienter Myopie im Kindes- und Jugendalter (Stand 06/2022). Accessed July 11, 2024 at: https://augeninfo.de/cms/fileadmin/stellungnahmen/progrediente_Myopie_Ki_Ju.pdf