Abstract
Purpose :
Myopia is a significant public health concern because of its rapidly increasing prevalence and the ocular complications associated with myopia progression. Multifocal soft contact lenses (MFCLs) are used for myopia management, but with variable effectiveness, potentially caused by reduced accommodative responses during MFCLs wear (see Kang 2016 and Gong 2017). In this study we investigated the accommodative response in children during early MFCL wear for myopia management and measured the change in refractive error (RE) and axial length (AL) over one year.
Methods :
Ten myopic children (mean age 10.8 ± 2.3 yrs; 5Ms/5Fs) with no history of myopia control and normal binocular functions were fit with Biofinity MFCLs with a +2.00 D ADD. MFCLs were worn for at least 10 hrs/d and 5 d/wk. At the beginning of treatment, accommodative responses to 2, 2.5, and 4 D stimuli, were measured monocularly with a Grand Seiko open field autorefractor while the subjects wore the MFCLs. The gains of the accommodative stimulus-response functions were estimated by the slopes of linear regressions fit to each subject’s data. Wet autorefraction and AL were measured at baseline, 6 months, and 12 months using a Grand Seiko autorefractor and Lenstar Biometer, respectively.
Results :
The mean (± SEM) wet RE was OD –2.94 ± 0.27 D, OS –2.88 ± 0.37 D at baseline and was –3.35 ± 0.38 D and –3.28 ± 0.47 D one year later, respectively. Greater axial elongation caused more myopia progression in both eyes after wearing MFCLs for one year (R2, OD 0.65 and OS 0.78; p < 0.01 for both). Accommodative gain measured during MFCL wear varied at baseline (OD 0.80 ± 0.14, OS 0.90 ± 0.12) and was a significant predictor of myopia progression and axial elongation: Lower accommodative gain during MFCL wear at baseline was correlated with more myopia and greater axial elongation at 1 yr (see fig for details).
Conclusions :
These data support the hypothesis that children with higher accommodative gains during MFCL wear experience more ADD power leading to more effective myopia management. To improve the effectiveness of MFCLs for myopia management, we speculate that accommodative biofeedback training during MFCL wear may be helpful (see Wagner 2020).
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.