January 2, 2025
By Dwight Akerman, OD, MBA, FAAO, Dipl AAO, FBCLA, FIACLE
Photo Credit: Getty Images
The American Academy of Ophthalmology prepares Ophthalmic Technology Assessments to evaluate new and existing procedures, drugs, and diagnostic and screening tests. The goal of an Ophthalmic Technology Assessment is to systematically review the available research for clinical efficacy, effectiveness, and safety. The purpose of this assessment by the Ophthalmic Technology Assessment Committee Pediatric Ophthalmology/Strabismus Panel is to review the published literature on the efficacy of multifocal contact lenses for the treatment of myopia progression in children 18 years of age and younger.
Cavuoto et al. (2024) authored a report evaluating the efficacy of multifocal soft contact lenses in slowing the progression of myopia in children aged 18 years and younger. The study involved a comprehensive review of existing literature, focusing on 12 selected articles that met the inclusion criteria. The primary outcomes assessed were changes in spherical equivalent (SE) refraction and axial length (AL) elongation over a minimum of one year of follow-up.
The findings indicate that children wearing multifocal soft contact lenses experienced significantly less myopic progression compared to those using single-vision spectacles or contact lenses. Specifically, the changes in SE ranged from 0.22 to 0.81D for the multifocal lens group, compared to 0.50 to 1.45D in the control group. Similarly, axial elongation was less pronounced in the multifocal lens group, with changes ranging from 0.05 to 0.39 mm, compared to 0.17 to 0.67 mm in the control group. These differences were statistically significant in 11 of the 12 studies for SE and in all 12 studies for AL.
The report concludes that multifocal soft contact lenses are effective in reducing the progression of myopia and axial elongation in children over a period of at least one year. However, it also highlights the need for further research to determine the optimal duration of treatment, the long-term effects, and the progression after the discontinuation of the lenses. No serious adverse events were reported in any of the studies reviewed.
Overall, the report supports the use of multifocal soft contact lenses as a viable option for managing myopia progression in children. It also emphasizes the importance of continued research to address remaining questions and to optimize treatment protocols.
Abstract
Multifocal Soft Contact Lenses for the Treatment of Myopia Progression in Children
Kara M. Cavuoto, MD, Rupal H. Trivedi, MD, MSCR, S. Grace Prakalapakorn, MD, MPH, Julius T. Oatts, MD, Sudha Nallasamy, MD, David G. Morrison, MD, Stacy L. Pineles, MD, Melinda Y. Chang, MD
Purpose: To review the published literature assessing the efficacy of multifocal soft contact lenses for the treatment of myopia progression in children 18 years of age and younger.
Methods: A literature search of the PubMed database was conducted last in March 2024 and was limited to articles published in English without date restrictions. The search yielded 76 articles, which were reviewed by the primary author in abstract form, and 28 articles were selected for full-text review. Twelve articles were deemed to have met the inclusion criteria and were assigned a level of evidence rating by the panel methodologist. Eleven studies were rated level I and 1 study was rated level II.
Results: All studies showed less myopic progression, with changes in spherical equivalent (SE) ranging from 0.22 to 0.81 diopters (D) for multifocal soft contact lenses compared with 0.50 to 1.45 D in control groups who used single-vision spectacles or single-vision contact lenses over the course of at least 1 year. Additionally, axial elongation was less in the multifocal soft contact lens group compared with control groups, with a change in axial length (AL) of 0.05 to 0.39 mm in treatment groups compared with 0.17 to 0.67 mm in control groups with at least 1 year of follow-up. The difference in change between the groups was clinically modest and statistically significant in 11 studies for SE and all 12 studies for AL. No serious adverse events were reported in any of the studies.
Conclusions: Level 1 evidence supports slower myopia progression and AL elongation in children who used multifocal soft contact lenses compared with spectacles or single-vision contact lenses over at least 1 year of follow-up. However, few data are available on optimal treatment duration, progression over longer periods, or progression after discontinuation of the multifocal contact lenses.
Cavuoto, K. M., Trivedi, R. H., Prakalapakorn, S. G., Oatts, J. T., Nallasamy, S., Morrison, D. G., … & Chang, M. Y. (2024). Multifocal Soft Contact Lenses for the Treatment of Myopia Progression in Children: A Report by the American Academy of Ophthalmology. Ophthalmology.
DOI: https://doi.org/10.1016/j.ophtha.2024.09.031
