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Daniel Tilia, Jennifer Sha, Danny Kho, Anna Munro, Shona Delaney, Varghese Thomas, Klaus Ehrmann, Ravi Chandra Bakaraju; Accommodative responses in myopic children wearing extended depth of focus contact lenses. Invest. Ophthalmol. Vis. Sci. 2016;57(12):1480.
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Our group has previously reported accommodative responses in non-presbyopic adult myopes wearing multifocal contact lenses (MFCLs) compared to single vision (SV) lenses: accommodative facility is reduced; center-near lenses induce exophoria and produce more negative static accommodative response (M) than center-distance lenses; accommodative adaptation is unlikely to occur with long-term MFCL wear. This study compared the accommodative responses in myopic children wearing extended depth-of-focus (EDOF) CLs against a SV lens.
This was a prospective, cross-over, randomized, clinical trial where 16 children (age<18 years) bilaterally wore 2 EDOF designs (EDOFL/EDOFH) and 1 SV design. Participants were fitted with refraction-matched lenses and measurements began 10 minutes after insertion. Study variables included binocular high-contrast visual acuity (HCVA, logMAR) at 6m and 40cm; phorias (Howell-Phoria Card, positive=exo, negative=eso) at 3m and 33cm; accommodative facility (monocular: ±2 flip spheres, CPD) at 33cm. Static accommodative response was assessed with the BHVI-EyeMapper in a fogged state (+1D) and at two object vergences (-3D and -5D). Paraxial curvature matching of the wavefront aberration map over a 4mm pupil yielded the spherical equivalent (M). Variables were compared between lens types using a linear mixed model.
Static accommodative responses (as gauged by M) were significantly more negative with both EDOFL and EDOFH designs compared to the SV lens at both -3D and -5D target vergences (range: -0.42 to -1.05D, p ≤ 0.004), leaning towards an ideal accommodative response. The SV lens was significantly better than both EDOFL/EDOFH for HCVA at 6m (-0.09 ± 0.05 vs. -0.06 ± 0.05/-0.06 ± 0.05, p = 0.004) but differences were not clinically significant. There were no significant differences between SV and EDOFL/EDOFH for HCVA at 40cm (-0.06 ± 0.10 vs. -0.04 ± 0.09/-0.08 ± 0.09, p = 0.56), accommodative facility at 33cm (13.1 ± 2.9 vs. 13.1 ± 4.3/12.6 ± 4.7, p = 0.634); phorias at 3m (0.56 ± 1.82 vs 0.06 ± 2.05/0.19 ± 1.17, p = 0.281) and 33cm (2.13 ± 3.81 vs. 1.88 ± 4.40/1.38 ± 3.59, p = 0.734).
In contrast to our previous findings with commercial MFCLs in non-presbyopic adults, EDOF lenses worn by children showed more favourable static accommodation responses than the SV lens, without compromising accommodative facility or phorias
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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