In this technology-driven age, the use of smart devices has caused near-work activities to consume the majority of our lives causing myopia to increase at alarming rates. With new technologies, tools, and medications, eyecare professionals are more equipped than ever to combat myopia progression.
Multifocal Contact Lens
Dual-action zone lenses (MiSight by Coopervision)
MiSight has been one of the top modalities used for myopia control in Europe and was recently released in the USA in March 2020. Not only is it a daily lens which means less risk of infection in children, but it has a unique dual focus design (see below), resulting in an even stronger treatment zone. A 3-year clinical study showed that it is superior in both refractive and axial length changes compared to its competitors, illustrating a reduced refractive rate of nearly 60% and axial elongation by 52%.1 The cost is approximately $110 for a 3-month supply for both eyes, making it one of the more affordable treatment options.
EDOF lenses (Mylo by mark’ennovy and NaturalVue by VTI Vision)
While the Mylo lens is not currently available in the USA, the NaturalVue lens is available at a cost of about $1000 for a year's supply. Both lenses use a unique extended depth of focus (EDOF) technology, which allows for a wider range of clearer vision without reducing the accommodative response. The latest study of the Mylo lens showed slightly larger absolute progression in both treatment and control groups. This study focused on patients of Chinese origin, whereas the MiSight and Biofinity MF study included children across multiple countries.2
The NaturalVue study showed comparable results to the Mylo lens; however, it was a retrospective study instead of a randomized clinical trial.3 Furthermore, the NaturalVue lens has been noted to be a little more uncomfortable than other multifocal contact lens and takes a few days to adapt to the optics. New data has been recently been added which shows continual minimization of the progression of myopia, with the amount of refractive change on average less than 0.125D and approx. 0.10 mm of axial length growth per year.
Distance-center focused design (Biofinity MF CL by Coopervision)
One of the original myopia studies looked at the effect of Biofinity multifocal lenses in comparison to regular single vision lenses in slowing refractive and axial length changes over three years. The famous BLINK study demonstrated this distance-center focused design to be effective in slowing myopia by nearly 50%, making it one of the first myopia control treatments available to patients.4 Some of the advantages include the price and availability of the lens: it costs approx. $85/box which includes a six-month supply per eye, making it one the cheapest modalities compared to its competitors. However, it is a monthly rather than a daily lens, and the design is a bit outdated compared to dual-action and extended depth of focus lenses. The new Biofinity multifocal toric lens released last year may allow astigmatic patients to be treated with soft multifocal lenses. New studies will have to be performed to determine the effectiveness of this lens in treating myopia and astigmatism in patients.
Atropine is another one of the major modalities used to treat myopia. Not only is it safe in lower concentrations, but it can be used in astigmatic patients as well. The cost runs anywhere from $95 to $150 per bottle, depending on insurance. It was originally thought that 0.01% atropine was the safest and clinically similar to 0.025% and 0.05% concentrations treatment for myopia control (Atom 2 study),5 but it was later discovered through the LAMP study that 0.05% showed the greatest effect on axial length and refractive changes compared to 0.01% and 0.025%, with minimal to no side effects.6
In 2020, an analysis of the LAMP Study showed that younger age is associated with poor treatment outcomes to low-concentration atropine (0.01%). Therefore, younger children (4-12) need a higher concentration of atropine 0.05% in order to achieve a similar reduction in myopic progression as those greater 12 years of age.7
Orthokeratology was originally used to gently shape the cornea at nighttime, eliminating the need for correction during the day. However, researchers later found out the second benefit of orthokeratology: myopia control! It is one of the more costly modalities, costing around $500 per lens (not including fitting fees); however, one lens lasts approximately one year.
Orthokeratology slightly reshapes the cornea at nighttime, causing peripheral myopic defocus which allows the patient to see clearly during the day and also signals the eye to slow growth. Loertscher et al. took this idea one step further by comparing multifocal orthokeratology to regular single vision orthokeratology.8 The multifocal lens molds a center-distance, multifocal surface onto the anterior cornea, with a concentric treatment zone power of +2.50 D. Results demonstrated a significant reduction in axial length compared to single vision ortho-k; however, visual acuity was reduced up to a few lines in patients due to aberrations. Unfortunately, this lens is not available in the US currently, and it may be a while before the product is brought overseas.
Table provided by MyopiaProfile.com—a nice comparison and summary of all the spectacle lens myopia control studies.
The original spectacle study was performed by Gwiazda et al. 2003 in the famous COMET study.9 They compared the axial length and refractive change between single vision and executive bifocal lenses. However, the study did not find a clinically significant difference and glasses were not considered a viable myopia control treatment. In the past few years, new innovative designs have emerged that have shown to be effective in slowing myopia progression. These include the MyoVision Lens by Zeiss, the MyopiLux by Essilor, and the DIMS by Hoya.
The MyoVision Lens is distance-centered with peripheral plus zones (either +1.00 and +2.00D were tested). The major study found efficacy of around 20% in Chinese children aged 6-12 with a family history of myopia: 0.29D lower refraction but no difference in axial length progression over 12 months.10 The cost of these lenses is approximately $400-$700 per year.
The MyopiLux Lens is an executive bifocal with an ADD of +1.50 and three diopters base in prism. The study compared a single vision lens group to an executive bifocal group with an ADD of +1.50 to an executive bifocal group with an ADD of +1.50 and 3D BI prism in each eye (6D total).11 Results showed that both bifocal groups demonstrated a significant difference in refraction change reduction compared to control, but no significant difference between the two bifocal groups. What is unique about this study is that it also looked at the relationship between binocular vision issues (accommodative lag) and bifocals with or without prism. They found that children grouped with high lag (> 1.00D) had significantly more control from binocular lens groups, while children with low lag (<1.00D) showed that only the prismatic bifocals were effective in treatment. One of the biggest takeaways from this research was that high lag children also had significantly higher levels of myopia because untreated binocular vision disorders can accelerate myopia progression. Therefore, it is imperative that you treat them more aggressively. The cost of these lenses runs from $275 to 600 per pair.
Last but not least, the Defocus Incorporated Multiple Segments, also known as DIMS, is receiving a lot of publicity due to the intricated design. The lens consists of a 9 mm centre optical zone, then an annular multiple focal zone with multiple segments (33mm in diameter) having a relative positive power (+3.50D). This lens dotting is placed all around the outside of the lens. A 2-year randomized study found 52% less myopia progression and 62% reduction in axial elongation compared to single vision spectacle group.12 One disadvantage to note is 7 out of 20 children complained of mid-peripheral blur with DIMS lenses and lost 3 letters of near acuity (central distance was not affected). Although this seems like a very unique and innovative design, the real-world applications of this lens design for everyday wear is still unclear. The cost of these lenses is unknown at this stage.
What's next in myopia control?
In the span of just 12 months during the COVID-19 pandemic, practitioners have seen a surge in the number of young patients with accelerating myopia.13 As the world is becoming more myopic by the day, researchers and clinicians are more determined than ever to find a way to slow this world-wide pandemic. From innovative designs of multifocal contact lenses and spectacles to the latest insight in atropine treatment, we have the opportunity to use our new knowledge, tools, and devices to slow the growing prevalence of myopia worldwide.
- Chamberlain P, Peixoto-de-Matos SC, Logan NS, Ngo C, Jones D, Young G. A 3-year Randomized Clinical Trial of MiSight Lenses for Myopia Control, Optom Vis Sci. 2019;96:556-567.
- Sankaridurg P, Bakaraju RC, Naduvilath T, Chen X, Weng R, Tilia D, Xu P, Li W, Conrad F, Smith EL 3rd, Ehrmann K. Myopia control with novel central and peripheral plus contact lenses and extended depth of focus contact lenses: 2 year results from a randomized clinical trial. Ophthalmic Physiol Opt. 2019 Jul;39(4):294-307. doi: 10.1111/opo.12621. Epub 2019 Jun 10. PMID: 31180155; PMCID: PMC6851825.
- Cooper J, O’Connor B, Watanabe R, Fuerst R, Berger S, Eisenberg N, Dillehay SM. Case Series Analysis of Myopic Progression Control With a Unique Extended Depth of Focus Multifocal Contact Lens. Eye Contact Lens. 2018 Sep;44(5):e16-e24. doi: 10.1097/ICL.0000000000000440. PMID: 29053555.
- 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(6):571-580. doi:10.1001/jama.2020.10834
- Chia A., Lu Q.S., Tan D. Five-year clinical trial on Atropine for the Treatment of Myopia 2: myopia control with atropine 0.01% eyedrops. Ophthalmology. 2016; 123: 391-399
- Two-Year Clinical Trial of the Low-Concentration Atropine for Myopia Progression (LAMP) Study. Yam, Jason C. et al. Ophthalmology, Volume 127, Issue 7, 910 - 919
- Fen Fen Li, Yuzhou Zhang, Xiujuan Zhang, Benjamin Hon Kei Yip, Shu Min Tang, Ka Wai Kam, Alvin L. Young, Li Jia Chen, Clement C. Tham, Chi Pui Pang, Jason C. Yam. Age effect on treatment responses to 0.05%, 0.025%, and 0.01% atropine: Low-concentration Atropine for Myopia Progression (LAMP) Study. Ophthalmology, 2021.
- Loertscher, M.; Backhouse, S.; Phillips, J.R. Multifocal Orthokeratology versus Conventional Orthokeratology for Myopia Control: A Paired-Eye Study. J. Clin. Med. 2021, 10, 447. https://doi.org/10.3390/jcm10030447
- Gwiazda J, Hyman L, Hussein M, Everett D, Norton TT, Kurtz D, Leske MC, Manny R, Marsh-Tootle W, Scheiman M. A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression of myopia in children. Invest Ophthalmol Vis Sci. 2003 Apr;44(4):1492-500. doi: 10.1167/iovs.02-0816. PMID: 12657584.
- Kanda H, Oshika T, Hiraoka T, Hasebe S, Ohno-Matsui K, Ishiko S, Hieda O, Torii H, Varnas SR, Fujikado T. Effect of spectacle lenses designed to reduce relative peripheral hyperopia on myopia progression in Japanese children: a 2-year multicenter randomized controlled trial Jpn J Ophthalmol. 2018 Sep;62(5):537-543. doi: 10.1007/s10384-018-0616-3. Epub 2018 Aug 6. PMID: 30083910
- Cheng D, Woo GC, Drobe B, et al. Effect of bifocal and prismatic bifocal spectacles on myopia progression in children: three-year results of a randomized clinical trial. JAMA Ophthalmol 2014;132:258–64.
- 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.
- Wang J, Li Y, Musch DC, et al. Progression of Myopia in School-Aged Children After COVID-19 Home Confinement. JAMA Ophthalmol. Published online January 14, 2021. doi:10.1001/jamaophthalmol.2020.6239