Can we reconsider contact lenses?
In this article:
Here is a case from RS that was posted in the Myopia Profile Facebook group. She was presented with a patient who had declined contact lens options and was looking how to modify a treatment regime to give better myopia control efficacy.
Is the treatment working?
While axial length is the ideal metric to judge myopia progression and control, especially in the situation of atropine which can influence refraction,1 we can look at the refractive data provided to evaluate the suitability of the current treatment.
Consider the patient's rate of myopia progression
This patient is age 13, with a refraction of around R (OD) -6.00 and L (OS) -7.00. Her rate of myopia progression when managed wtih 0.02% atropine and corrected with progressive addition lens (PAL) spectacles is reported as -0.50D per year, compared to -1.00D per year 'before'.
The clinical data provided does indicate a slowing of historical myopia progression. DS suggested it was due to the low-dose atropine whilst PC proposed that it could just be a natural reduction in progression attributed to the child's increasing age. Both could be true. The "illusion of inflated success" has been described by Brennan et al1 whereby an over-estimation of treatment effect can arise when using past 'measured' refractive progression as a basis to treat, or in this case, judge success.
Do we need to change treatment?
Data on annual progression in 7-12 year old children wearing single vision corrections, with myopia no worse than -6.00D, indicates a 12-year-old child of Asian ethnicity would progress by a mean of -0.50D in a year, which a non-Asian child would progress -0.35D in a year. There is a useful reference table for this in the Johnson & Johnson Vision Managing Myopia Guide (Table 5 on page 8).
Consider if the treatment suits the patient
This case also highlights the importance of asking a patient questions to gauge how the treatment modality works in their day-to-day life and environment. The example here is that this patient’s reading posture was incompatible with proper use of the PAL spectacles. While this may not have influenced myopia control outcomes - given the low efficacy of progressive addition lenses1 - it could affect visual comfort if there were side effects of atropine which were not appropriately supported by the PALs.
Can we reconsider contact lenses?
Compared to PAL spectacles, myopia controlling contact lenses and orthokeratology have higher efficacy in controlling myopia progression. Atropine 0.02% may have similar efficacy to these contact lens options,1 but for this highly myopic patient, there are are number of benefits in wearing contact lenses aside from myopia control. At age 13 it is still worth discussing and pursuing myopia control, especially given that the patient and their parents are already undertaking a myopia control treatment. The Johnson & Johnson Vision Managing Myopia Guide notes that myopic children aged 13+ have a possibility of continued myopia progression and that myopia control options should be presented.
Why should this patient consider contact lenses?
For a high myope, we can highlight the advantages of using CLs to the parent and patient. These include:
Why might parents and patients be concerned about contact lens wear?
Typical concerns can include safety and handling. Let's address each of these in turn.
Other clinical considerations
If the patient and parent are willing to reconsider contact lenses for the variety of myopia correction and control benefits they offer, then these could be used as a monotherapy and atropine 0.02% could be discontinued.
Take home messages:
- Myopia control treatment for young teens and higher myopes is worth pursuing to reduce their long term risk of eye disease, but can present a challenge in determining the success of a treatment strategy
- With many treatment strategies providing similar efficacy, it is important to consider options for myopia correction and control which are most suitable to the patient's characteristics and capacity
- Just because a patient or parent has declined an intervention, in this case contact lens options, does not preclude discussing the reasons you would recommend it, and its benefits. Being provided more information, backed up with scientific evidence, could change their mind.
- Contact lenses are a great option for children, and especially for high myopes. Explaining the benefits, high safety profile and good handling ability that children and teens typically exhibit in CL wear can help allay parent and patient concerns.
Further reading on contact lenses and managing outcomes
Meet the Authors:
About Connie Gan
Connie is a clinical optometrist from Kedah, Malaysia, who provides comprehensive vision care for children and runs the myopia management service in her clinical practice.
About Kimberley Ngu
Kimberley is a clinical optometrist from Perth, Australia, with experience in patient education programs, having practiced in both Australia and Singapore.
This content is brought to you thanks to unrestricted educational grant from
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