Editor’s Perspective

PALliative?

November 1, 2020

By Dwight Akerman, OD, MBA, FAAO, FBCLA

Eye care professionals often prescribe interventions to slow childhood myopia progression that are not evidence-based. Last year, Jobson Optical Research polled more than 300 optometrists from around the United States to learn more about their attitudes and behaviors regarding myopia management. One survey question was, “Which treatments do you currently prescribe for children with progressive myopia?” Surprisingly, the most prescribed intervention was progressive addition spectacles or bifocals.

Of all the spectacle interventions assessed for their efficacy in slowing myopia, progressive addition lenses (PALs) have been the most widely studied. The rationale for their use has been to reduce the accommodative demand and/or reduce accommodative lag during near tasks.1

The results of randomized controlled trials (RCTs) on PALs have been underwhelming. The NEI-funded Correction of Myopia Evaluation Trial (COMET) followed 462 children over three years assigned to wear either a PAL with a +2.00D add or a single-vision lens. While the mean difference in refractive error was statistically significant after three years of treatment, the dioptric difference was only 0.20D and not considered clinically significant.2

COMET reported a larger treatment effect of PALs in children with higher accommodative lag and esophoria. This prompted a clinical trial of myopic children with high accommodative lag and near esophoria. Children were again randomized to receive either +2.00D PALs or single vision lenses. The mean three-year difference in refractive error was only 0.28D. Like the original COMET, this difference was statistically significant but not clinically meaningful. Some practitioners still point to the original COMET to justify prescribing PALs to esophoric myopes without recognizing that the second clinical trial does not support this approach.3

With many myopia management treatment options now available, optometrists have a professional responsibility to prescribe interventions based on well-controlled clinical trials.

Best professional regards,

 

 

 

Dwight H. Akerman, OD, MBA, FAAO, FBCLA
Chief Medical Editor
dwight.akerman@gmail.com

  1. Wildsoet, C. F., Chia, A., Cho, P., Guggenheim, J. A., Polling, J. R., Read, S., … & Wu, P. C. (2019). IMI–interventions for controlling myopia onset and progression report. Investigative ophthalmology & visual science, 60(3), M106-M131.
  2. Gwiazda, J., Hyman, L., Hussein, M., Everett, D., Norton, T. T., Kurtz, D., … & Scheiman, M. (2003). A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression of myopia in children. Investigative ophthalmology & visual science, 44(4), 1492-1500.
  3. Correction of Myopia Evaluation Trial 2 Study Group for the Pediatric Eye Disease Investigator Group. (2011). Progressive-addition lenses versus single-vision lenses for slowing progression of myopia in children with high accommodative lag and near esophoria. Investigative ophthalmology & visual science, 52(5), 2749.

 

 

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