November 15, 2021
By Dwight Akerman, OD, MBA, FAAO, FBCLA
The risk of ocular pathology and visual impairment is high with increasing myopia, but a common myopia management method — contact lens wear — comes with its own risks. Gifford recently sought to answer whether this treatment is a safe recommendation in a younger cohort. She found that the comparative childhood and lifetime risks are skewed toward the positive impact of contact lens use, especially in daily disposable wear.
The study evaluated peer-reviewed data to determine the absolute risks of microbial keratitis (MK) in daily disposable soft, reusable soft, and orthokeratology contact lens wear over both a childhood (age 8 to 18) and a lifetime (age 8 to 65) of use. The results were then compared with previously published data on the cumulative risk of visual impairment by age 75 based on increasing myopia and axial length.
The author found that the lifetime risk of visual impairment in axial lengths greater than 26 mm and more than 6.00D of myopia is greater than the lifetime risk of MK in any contact lens modality, except for soft contact lens extended wear in adults. If axial length is less than 26 mm and myopia lower than 3.00D, the author noted that a lifetime of contact lens wear is riskier, except in the case of daily disposable wear. Gifford added that 10 years of childhood contact lens wear of any modality presents a lower likelihood of MK than any comparable risk of visual impairment.
“Clinicians should be confident to proactively recommend myopia control contact lens wear to younger children, as both the safety profile and potential preventative ocular health benefits are evident,” the author concluded.
Childhood and Lifetime Risk Comparison of Myopia Control with Contact Lenses
Purpose: The relative risks of ocular pathology with increasing myopia have been described; the absolute lifetime risk of vision impairment from myopia is yet to be compared to the childhood and lifetime risks of contact lens wear for myopia control.
Methods: Using peer-reviewed data, the absolute risks of microbial keratitis (MK) in daily disposable soft, reusable soft, and orthokeratology contact lens (CL) wear were calculated over both a childhood (age 8-18) and a lifetime (age 8-65) of CL wear. This was compared to the previously published cumulative risk of vision impairment by age 75 based on increasing myopia and axial length. Data were converted utilizing the Council of International Organizations of Medical Sciences (CIOMS) classification system for frequency of adverse events, with 95% confidence intervals included.
Results: The lifetime risk of vision impairment in axial lengths over 26 mm and more than 6D of myopia is greater than the lifetime risk of MK in any CL modality, except for adult SCL extended wear. If axial length is below 26 mm and myopia is lower than 3D, a lifetime of CL wear is riskier in comparison, except in the case of daily disposable wear. Ten years of childhood CL wear of any modality presents lower likelihood of MK than any comparable risk of vision impairment.
Conclusion: The comparative lifetime risks of contact lens wear commenced at age 8 for myopia control are less than the lifetime risks of vision impairment with myopia more than 6D or axial length more than 26 mm. When only childhood CL wear is considered, the risk comparison is clearly skewed toward the positive impact of CL wear, especially in daily disposable wear. Clinicians should be confident to proactively recommend myopia control CL wear to younger children, as both the safety profile and potential preventative ocular health benefits are evident.
Gifford, K. L. (2020). Childhood and lifetime risk comparison of myopia control with contact lenses. Contact Lens and Anterior Eye, 43(1), 26-32.