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Three Part Question

Can [Contact Lenses] [control/reduce the progression] of [myopia in children]?

Clinical Scenario

A parent of a 9 year old male suffering from myopia came to the clinic wondering if using contact lenses would slow the progression of myopia in her child as she read in the Internet.

Search Strategy

PubMed:2010-2015
UNSW Library: 2010-2015

-Keywords: Contact Lens, Control, Progression, Myopia, and Children.

Modifications:
1-use the term (reduce) instead of (control) in PubMed.
2-change the publication date to the last five years.
Which results: 5 papers in Pubmed.
3-choose results dates for the last five years(2010-2015).
4-adjust the resource type as only (articles).
5- limiting the research to only (peer-reviewed) journals.
Which results: 15 articles in UNSW Library.
So,
-A total of 20 articles found but not all directly related to my clinical question.

Search Outcome

5 relevancies

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Nicola S. Anstice, BOptom, PhD, John R. Phillips, MCOptom, PhD 26 January 2011 New Zealand	40 Children. Inclusion criteria: -(11–14) years old -SER between -1.25 and - 4.50 D -Myopia progression ≥ 0.50D in the previous 12 months -Best corrected spectacle visual acuity of Snellen 6/6 or better -Prepared to wear contact lenses for at least 8 hours/day. Exclusion criteria: -Astigmatism of ≥1.25 D -Anisometropia ≥ 1.00 D -Strabismus at distance or near -Ocular or systemic pathology likely to affect refractive development or successful contact lens wear or a birth weight of 1250 g.	Prospective, randomized, paired-eye control, investigator-masked trial with cross-over. (Level II)	Myopia progression and eye elongation were reduced significantly in eyes wearing Dual-Focus soft contact lenses.	In 70% of the children, myopia progression was reduced by 30% or more in the eye wearing the Dual-Focus (DF) lens relative to that wearing the Single Vision Distance (SVD) lens.	-Methodological flaws(e.g. the study was not carried out under the binocular condition in which the lenses would normally be worn). -Study short duration.
			Period 1 (Baseline to 10 Months):	-Change in refraction (D): P<0.0001, Percent Reduction:37%. -Eye elongation (mm): P<0.0001, Percent Reduction:49%.
			Period 2 (Cross-over to 20 Months):	-Change in refraction (D): P=0.003, Percent Reduction:54%. - Eye elongation (mm): P<0.0001, Percent Reduction: 80%.
Carly Siu Yin Lam, Wing Chun Tang, Dennis Yan-Yin Tse, Ying Yung Tang, Chi Ho To 29 October 2013 China	221 children. Inclusion & Exclusion criteria: -(8–13) years old -SER (−1.00 to −5.00D) -Astigmatism (1.00 D or less) -Anisometropia (1.25 D or less) -Spectacle corrected monocular VA 0.0 logMAR or better -Contact lens corrected monocular VA: 0.1 logMAR or better -Free of ocular and systemic abnormalities might affect visual functions or refractive development -No prior use of PALs, bifocal contact lenses -No contraindication for contact lens wear -Willingness to wear contact lenses regularly	Prospective, randomized, controlled, and double-blinded study. (Level II)	The daily wearing of DISC lens significantly slowed myopia progression and axial elongation in Hong Kong schoolchildren.	Myopia progressed 25% more slowly for children in the DISC group compared with those in the control group (0.30 D/year; 95% CI −0.71 to −0.47 vs 0.4 D/year; 95% CI −0.93 to −0.65, p=0.031).	-Methodological flaws (e.g.when retinal curvature profile was not measured) -High dropout rate caused by different reasons. -sample were from specific geographical location (Chinese children).
				Myopia in children who wore the DISC lenses for ≥ 5 hours/day progressed 46% (mean difference=−0.382 D, p=0.001; 95% CI −0.59 to −0.17) less than those in the SV group.
Laura E. Downie, B.Optom., Ph.D., F.A.C.O., P.G.Cert.Oc.Ther., Dip.Mus.(Prac), A.Mus.A. and Russell 4 July 2013 Australia	56 Children. Inclusion criteria: -Younger than 16 years -Myopia more than 0.50D in each eye -Astigmatism less than 2.00D in each eye -Anisometropia less than 1.50D -Best VA (at least 6/7.5). Exclusion criteria: -Ocular or systemic conditions that may affect refractive error developmen	Retrospective, controlled study. (Level III-3)	Orthokeratology (OK) lenses can reduce the rate of progression of childhood myopia over the long term.	OK eyes showed a significantly (P‹0.05) more stable myopic refractive prescription than control eyes over all of the 2-year treatment intervals.	-Lack of masking. -Methodological flaws(e.g. different measurement techniques and practice protocols, since patients were derived from different optometric practices).
Padmaja Sankaridurg, Brien Holden, Earl Smith III,Thomas Naduvilath, Xiang Chen 20 October 2011 China	60 children. Inclusion & Exclusion criteria: -age: 7-14 years -myopia: - 0.75 to -3.50D -astigmatism: -1.00 D or less -same geographic and demographic locale -examined by the same researchers using the same facilities, equipment, and methods -best corrected VA (at least 6/9.5) in both eyes -No Ocular/systemic pathologies -subjects were willing to wear the lens type assigned to them.	Derived from randomized, controlled, prospective clinical studies. (Level III-3)	Contact lenses that is designed to reduce relative peripheral hyperopia can slow the rate of progression of myopia in children.	At 12 months, 59.4% of the spectacle lens–wearing eyes had progressed by at least −0.75 D in comparison to only 28.6% of the eyes in the contact lens group. (odds ratio, 3.8; 95% CI, 1.5–9.5; P = 0.005).	-Lack of proper randomization. -Methodological flaws (e.g. some clinical criteria were not investigated before applying intervention).
Takashi Fujikado, Sayuri Ninomiya, Takuma Kobayashi, Asaki Suzaki, Mitsuhiko Nakada, Kohji Nishida 23 September 2014 Japan	24 Children. Inclusion criteria: -age 6–16 years -children and parents agreed to wear randomly assigned CLs -spherical refractive error (-0.75 D to -3.50 D) -astigmatism < 1.0 D -vision correctable to at least 20/20 in both eyes -normal ocular findings. Exclusion criteria: -anisometropia ≥ 1.0 D -presence of strabismus -ocular diseases and history of orthokeratologic lens, bifocal, or progressiveaddition spectacle wear in the past 12 months.	Pilot, randomized, controlled and blinded study. (Level II)	Low-addition soft CLs with decentered optical design can reduce the degree of axial elongation in myopic children.	Change of axial length between 12 months and 1 month in the new-CL group (0.09±0.08 mm) was significantly smaller (47%) than that in the control-CL group (0.17±0.08 mm, P<0.05).	-Small sample size. -Methodology flaw(e.g. short follow-up period).

Comment(s)

Other studies related to Contact lenses controlling myopia progression in children were not included, since they had a lower level of evidence than the five studies that was provided in this summary.

Clinical Bottom Line

Specialty contact lenses can control (reduce) the progression of myopia in children.

References

1. Nicola S. Anstice, BOptom, PhD, John R. Phillips, MCOptom, PhD Effect of Dual-Focus Soft Contact Lens Wear on Axial Myopia Progression in Children The American Academy of Ophthalmology 2011;118:1152–1161
2. Carly Siu Yin Lam, Wing Chun Tang, Dennis Yan-Yin Tse, Ying Yung Tang, Chi Ho To Defocus Incorporated Soft Contact (DISC) lens slows myopia progression in Hong Kong Chinese schoolchildren: a 2-year randomised clinical trial Britich journal of Ophthalmlogy 2014;98:40–45. d
3. Laura E. Downie, B.Optom., Ph.D., F.A.C.O., P.G.Cert.Oc.Ther., Dip.Mus.(Prac), A.Mus.A. and Russell Lowe, B.Sc.Optom., F.A.A.O. Corneal Reshaping Influences Myopic Prescription Stability (CRIMPS): An Analysis of the Effect of Orthokeratology on Childhood Myopic Refractive Stability Eye and Contact Lens 2013;39: 303–310
4. Padmaja Sankaridurg, Brien Holden, Earl Smith III,Thomas Naduvilath, Xiang Chen Decrease in Rate of Myopia Progression with a Contact Lens Designed to Reduce Relative Peripheral Hyperopia: One-Year Results Investigative Ophthalmology and Visual Sience 2011;52: 9362–9367
5. Takashi Fujikado, Sayuri Ninomiya, Takuma Kobayashi, Asaki Suzaki, Mitsuhiko Nakada, Kohji Nishida Effect of low-addition soft contact lenses with decentered optical design on myopia progression in children: a pilot study Clinical Ophthalmology 2014:8 1947–1956