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Brien A. Holden, Padmaja R. Sankaridurg, Percy Lazon De La Jara, Thomas Naduvilath, Arthur Ho, Deborah F. Sweeney, Maria Markoulli, Earl L. Smith, III, Jian Ge, Vision CRC Myopia Clinical Study Group; Decreasing Peripheral Hyperopia With Distance-centre Relatively-plus Powered Periphery Contact Lenses Reduced The Rate Of Progress Of Myopia: A 5 Year Vision Crc Study. Invest. Ophthalmol. Vis. Sci. 2012;53(14):6300. doi: https://doi.org/.
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To determine whether reducing peripheral hyperopic defocus using distance-centre relatively-plus peripheral power contact lenses slows the rate of progress of myopia.
In Phase 1, 40 children aged 8 to 14 years with myopia -0.50 to -4.00 D and cylinder ≤0.75D were randomised to wear soft contact lenses that were either a Test Lens (TL) with relatively narrow central optical zone (2.3mm) with back vertex power to correct the child’s distance vision and a relatively plus (+1.50D) peripheral optical zone, or, a single vision Control Lens (CL) in the same material and monitored for 43±4 months. In Phase 2, the remaining subjects wore TLs in both eyes for a further 2 years. Refractive error (RE) (cycloplegic autorefraction) and axial length (AL) (partial coherence interferometry) were measured 6 monthly. Differences in progression of RE and AL were compared using quadratic fits of a linear mixed model after adjusting for age, gender and ethnicity based on an intent-to-treat principle. Progression within Phase 2 was analyzed using % change relative to Phase 2 baselines.
40 children entered; 27, 20 and 16 completed 36±1 and 43±3 months (Phase 1) and 67 ± 3 months (after Phase 2) respectively. The changes in Phase 1 in RE with TCL v CCL were -0.37 ± 0.43D v -0.59 ± 0.32 D; -0.61 ± 0.30D v -0.99 ± 0.46; -0.80 ± 0.37D v -1.31± 0.60D and -0.99 ± 0.58D v -1.63 ± 0.66D at 12, 24, 36 and 43 months respectively. The changes in AL with TCL v CCL were 0.12 ± 0.12 mm v 0.21 ± 0.10mm; 0.22 ± 0.15mm v 0.39 ± 0.17mm; 0.29 ± 0.19mm v 0.53 ± 0.26mm and 0.41 ± 0.24mm v 0.67 ± 0.29mm at 12, 24, 36 and 43 months respectively. The slopes of change in RE and AL over 43 months were significantly less for TCL than CCL (p<0.0001). TCL also reduced LCVA by 0.12 Log MAR units (p=0.021). The slopes for the percent rate of progression for both Phase 1 groups refitted with TCL in Phase 2 were not different (p=0.211 for RE and p=0.796 for AL).
The peripheral plus design lenses slowed rate of progress of myopia by 39% and axial elongation by 41% over 43 months. When both TL and CL groups from Phase 1 were fitted with TLs in Phase 2 they showed similar % rates of progression. The small sized optic related decrement in central vision with TCL can be avoided by increasing the central optic zone size (Holden et al 2010 ARVO abstract E 2220).
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