Assessing the rebound phenomenon in different myopia control treatments: A systematic review.

Background: In children, myopia has become a widespread and serious global public health problem. Soft multifocal contact lenses (SMCLs) have been widely studied to control myopia progression in children. However, their efficacy in myopia control in children and its adverse effects and which added power SMCLs are more effective and safer remains to be explored. Objectives: Evaluate the efficacy and safety of various add power SMCLs to slow myopia progression in children. Method: Eligible randomized controlled trials were retrieved from PubMed, MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials databases. The present meta-analysis analyzed the mean differences (MD) in myopic progression, axial length, and odds ratios for adverse effects and dropout rates between SMCLs with different added powers and control groups. Changes in visual performance were also systematically evaluated. Results: Seven independent studies involving 805 children were included in the present meta-analysis. At 1-year, the weighted MD (WMD) in myopia progression between SMCL and control groups was −0.22 diopters (D) (95% confidence interval [CI]: −0.56 to 0.12 D) for low add power SMCLs, 0.09 D (95% CI: 0–0.19 D) for medium add power SMCLs, and 0.2 D (95% CI: 0.13, 0.27 D) for high add power SMCLs. At 2-years, the WMD for medium add power was 0.12 D (95% CI: −0.03 to 0.27 D), and for high add power was 0.25 D (95% CI: 0.14–0.35 D). No differences were detected for adverse effects (p = 0.2) and acceptability (p = 0.74) between different added powers. Additionally, differences in visual performance changes, produced by different added powers, were not detected. Conclusions: The present meta-analysis showed that high add power SMCLs are more effective and stable to control myopia progression. Besides, the adverse effects and acceptability were not related to the added power.

The ageing population will become one of the biggest issues affecting Singapore in the near future. Ophthalmic practitioners will need to be ready to deal with an increased prevalence of glaucoma, cataract, age related maculopathy and even presbyopia. As presbyopes lose their ability to accommodate at near vision, visual aids such as progressive lenses, bifocal lenses, reading glasses, monovision contact lenses and multifocal contact lenses are prescribed to help them with reading difficulties and improve their daily lives. Interestingly, an international survey in 2011 revealed zero percent soft multifocal contact lenses was prescribed in Singapore for presbyopia correction. Although there are improvements in multifocal lens design and material, no new research being conducted to investigate the presbyopic lens fitting status in Singapore. Nonetheless, recent studies have shown an increased in multifocal contact lenses prescribing trends, perhaps reflecting not just the availability of newer multifocal contact lenses, but also improvement in practitioners’ confidence and knowledge in multifocal contact lenses. However, in spite of the available guides on choosing multifocal contact lenses, there is no comprehensive way to help the practitioner in selecting the best option for an individual. As such, an examination of the simplest way of predicting the most suitable multifocal lens for a patient will only enhance and add to the current evidence available. A survey was conducted to understand the Singaporean practitioners’ attitude towards soft multifocal lenses and its prescribing trend. In this survey, an increase in the rate of soft multifocal contact lens fitting was observed, the perception of the unavailability of an ‘ideal’ multifocal contact lens, and increased chair time in fitting soft multifocal contact lenses were identified as significant barriers. However, enablers such as the increased in practitioners’ motivation, confidence and proactiveness in fitting soft multifocal contact lenses were gathered. Additionally, this study aimed to compare the relative performance of three daily-replacement soft contact lenses for presbyopic correction in an optometric practice population in Singapore. The three daily-disposable multifocal contact lenses included in this study were 1-day Acuvue® Moist Brand Multifocal Contact Lenses for Presbyopia (Johnson & Johnson Vision Care, Jacksonville, FL), Clariti 1-day Mulitfocal (Cooper Vision, NY) and Dailies AquaComfort Plus Multifocal (Alcon, Fort worth, TX). In this crossover study design, 35 presbyopic participants with myopia were fitted in a random order with three different types of multifocal contact lens. After 1 month, visual performance was quantified by high contrast distance, intermediate and near visual acuity, defocus curve under photopic and mesopic conditions, reading speed, Near Activity Visual Questionnaire rating and Photographic questionnaire for Photic Phenomena. The results showed comparable levels of binocular distance, intermediate and near visual acuity achieved with the three different types of multifocal contact lens at 1-month follow up. However, a better distance acuity at distance under mesopic condition for AquaComfortPlus. In terms of subjective participant lens preference, nine participants (26%) preferred Moist multifocal, 16 participants (46%) preferred Clariti multifocal and 10 participants (28%) preferred AquaComfortPlus multifocal. However, lens preference was not related to demographic factors relating to age, gender, refractive error and the magnitude of reading addition or physiological characteristic such as pupil size. In terms of the performance of participants with their preferred lens when observing the defocus curve under mesopic condition, it emerged that there was an interaction between lens types and acuity at different levels of defocus. From this, it seems that lens preference may perhaps be driven by a change in visual experience that only manifested in low illumination conditions, suggesting it may be important to conduct objective measure such as visual acuity under mesopic condition when fitting modern-day multifocal contact lenses. It remains a hope for the future that new clinical tests or more diverse lens designs would be valuable to help the practitioner to improve the chances of first time success when fitting a multifocal contact lens for presbyopic correction.

Lens power profiles can provide valuable insights on the imposed optical defocus and visual experience of contact lens wearers, especially in the context of myopia control. This study measured the refractive power profiles of multifocal soft contact lenses (MFCLs) currently used or that have the potential for use in myopia control using high spatial resolution aberrometry. The instrument's repeatability for determining MFCLs power profiles was also assessed. The power profiles of 10 MFCLs of various designs (centre-distance, centre-near and extended depth of focus) were measured using the Lambda-X NIMOEVO, a phase shifting Schlieren-based device. Power profiles were graphically expressed as measured power at each chord position and the maximum add power was calculated. The repeatability of the NIMOEVO was expressed as the within-subject standard deviation at each chord position for a subset of five MFCLs. The measured distance powers differed from nominal powers for more than half of the MFCLs with a definable distance zone. There were variations in the chord position of the distance and near correction zones, rate of power transitions and calculated maximum add between the MFCLs which did not depend on lens design. For half of the MFCLs, the power profile shape was inconsistent between different nominal back vertex powers of the same design. The repeatability of the NIMOEVO was dependent on the lens design, with designs featuring faster rates of power change exhibiting worse repeatability. Significant differences in MFCL power profiles were found which were not adequately represented in labelling. This is likely due to the small number of parameters used to define lens power characteristics. Eye health care practitioners should be aware of potential differences in power profiles between different MFCLs, which will impact the retinal defocus introduced during lens wear and the wearer's visual experience.

BackgroundMyopia is the most prevalent form of refractive error that has a major negative impact on visual function and causes blurring of vision. We aimed to determine if Repeated Low-Level Red Light (RLRL) treatment is beneficial in treating childhood myopia in terms of axial length (AL), spherical equivalent refraction (SER), and sub foveal choroidal thickness (SFCT).MethodsThis systematic review was performed on RLRL for treatment of myopia in children compared to single vision spectacles (SVS). We employed the search strategy with key terms myopia and low-level light therapy then we searched PubMed, Scopus, Cochrane, and Web of Science databases. The mean differences (MD) were used to evaluate the treatment effects. Heterogeneity was quantified using I2 statistics and explored by sensitivity analysis.ResultsFive randomized controlled trials (RCTs) were included in our meta-analysis with a total of 833 patients, 407 in treatment group and 426 in control group. At a 3 month follow up period, pooled studies show a statistical difference in AL between RLRL and SVS group (MD = -0.16; 95% CI [-0.19, -0.12], SER (MD = 0.33; 95% CI [0.27, 0.38]), and SFCT (MD = 43.65; 95% CI [23.72, 45.58]). At a 6 month follow up period, pooled studies show a statistical difference in AL between RLRL and SVS group (MD = -0.21; 95% CI [-0.28, -0.15]), SER (MD = 0.46; 95% CI [0.26, 0.65]), and SFCT (MD = 25.07; 95% CI [18.18, 31.95]). At a 12 month follow up period, pooled studies show a statistical difference in AL between RLRL and SVS group (MD = -0.31; 95% CI [-0.42, -0.19]) and SER (MD = 0.63; 95% CI [0.52, 0.73]).ConclusionThis is the first systematic review and meta-analysis investigating only RCTs evidence supporting the efficacy of 650 nm RLRL for myopia control in the short term of 3, 6, and 12 months follow up. The present review revealed the clinical significance of RLRL as a new alternative treatment for myopia control with good user acceptability and no documented functional or structural damage. However, the effect of long-term RLRL treatment and the rebound effect after cessation require further investigations.

PurposeTo compare peripheral defocus, higher-order aberrations (HOAs), and contrast visual acuity (CVA) in myopic children wearing orthokeratology (OK) lenses and multifocal soft contact lenses (MSCLs) designed with highly addition.MethodsThis is a prospective, nonrandomized, controlled study. Subjects at 8 to 13 years of age with spherical equivalent refraction from − 1.00 to − 5.00 dioptres (D) were included in the OK group (n = 30) and MSCL group (n = 23). Relative peripheral corneal defocus (RPCD) and relative peripheral refraction (RPR) were measured before and after wearing lenses. HOAs including spherical aberration (SA), coma, trefoil, and total HOAs, and high (100%) and low (10%) CVA were compared between the groups. Axial length (AL) was measured before and after wearing the lenses for 1 year.ResultsAfter wearing the lenses, subjects in the MSCL group had RPCD and RPR values similar to the OK group at the paracentral (within 2 mm of the cornea or 20° of the retina, all p > 0.05) but larger than the OK group at the periphery (all p < 0.05). All HOAs increased after wearing the lenses except the trefoil in the MSCL group (all p < 0.05). HOAs increased more in the OK group (all p < 0.05). The 100% and 10% CVAs were worse in the MSCL group (p = 0.02 and p = 0.004). After 1 year, AL elongation was 0.37 mm (SD = 0.16) in the MSCL group and 0.28 mm (0.16) in the OK group (p = 0.06).ConclusionMSCL produced larger myopic defocus at the periphery, increased less HOAs and had worse CVA than OK lens. The high addition of this MSCL did not result in better myopia control efficacyTrial registrationChinese Clinical Trial Registry: ChiCTR1800018564. Registered 25 September 2018; retrospectively registered, http://www.chictr.org.cn/showproj.aspx?proj=31376

PurposeTo gain insight into patients’ visual experiences and satisfaction when using different forms of myopia control lenses. MethodsPubMed, Cochrane Library, Embase, Scopus and Web of Science databases were searched for articles assessing subjective visual quality with myopia control lenses compared with single-vision lenses (SVLs) up to July 10, 2023. Eight-hundred-and-three articles were retrieved, reviewed and any questionnaire items on subjective impressions of lens wear were meta-analysed. Subgroup analyses were based on the magnitude of defocus (add power) of multifocal soft contact lenses (MFSCLs) and age groups. A random-effects model was employed for meta-analysis, and I2 statistic used to assess the statistical heterogeneity. ResultsNineteen articles fit the criteria, but only six articles involving MFSCLs had relevant data. MFSCLs were associated with lower subjective ratings of vision at different distances compared to SVLs (p < 0.001), but the differences were less than one unit. MFSCLs also yielded lower ratings when moving or walking and/or climbing stairs at −0.38 (−0.69 to −0.07, p = 0.02; I2 = 85 %, p < 0.001) and for subjective comfort (difference of −0.23, −0.41 to −0.05, p = 0.01; I2 = 63 %, p < 0.001). Subjective ratings for playing sports were not different between groups. Experience with MFSCLs was rated lower by young adults compared to children for all variables. In both children and young adults, ratings were lower with higher add compared to lower add MFSCLs. ConclusionAlthough subjective ratings for vision and comfort were lower with MFSCLs compared to SVLs, the difference was mostly less than one unit. Importantly, young adults rated their visual experience lower compared to children.

Clinical relevance Myopia control is a prominent area of global research, with multifocal contact lenses identified as an effective intervention for adolescents. Background This study aims to evaluate the visual performance and vision-related quality of life (QoL) of myopic adolescents when corrected with pupil-optimised multifocal soft contact lenses (MFSCLs) versus single-vision contact lenses (SVCLs), with each participant serving as their own control. Methods Thirty-five myopic adolescents, habitually wearing SVCLs and fitted with pupil-optimised MFSCL with mid-addition power, were recruited. The assessment included distance visual acuity (DVA), near visual acuity (NVA), maximum reading speed (MRS), reading acuity (RA), contrast sensitivity (CS), and stereoacuity (SA) in photopic conditions for both types of lenses. Vision-related QoL was quantified twice for both lens types using the National Eye Institute Visual Function Questionnaire (NEI VFQ-42), covering 13 vision-specific domains. Results Comparisons of visual outcomes between MFSCLs and SVCLs for the same subjects revealed statistically significant differences in DVA (p = 0.010), NVA (p = 0.014), MRS (p = 0.044), and RA (p < 0.001), with SVCLs outperforming in DVA only. No significant difference in CS and SA was observed between the two lens types. According to the NEI VFQ-42, scores for clarity of vision, far vision, glare, and satisfaction with correction were higher with SVCLs, while the score for near vision was higher with MFSCLs. When fitted with MFSCLs, no significant correlations were found between pupil size and age of the patient with any visual examination parameters. However, there was a significant negative correlation between the DVA, NVA and the spherical equivalent of the lens. Conclusion MFSCLs with mid-add power significantly improve NVA, MRS, and RA, albeit with a reduction in DVA compared to SVCLs. While SVCLs were associated with better clarity of vision, far vision, and satisfaction with correction, MFSCLs offered superior performance in near vision tasks, according to the NEI VFQ-42 scores.

Objectives: This study aimed to investigate the influence of soft multifocal contact lenses with high additions designed for myopia control on binocular vision in young adults. Methods: A prospective randomized, double-blind study including 24 subjects aged between 18 and 36 years. Subjects were divided into two groups. The first group wore multifocal soft contact lenses (MFSCLs) with a 3.0 mm central zone diameter, while the second group wore contact lenses with 4.5 mm central zones. Each subject was fitted with two MFSCLs: one with +2.00 D and the other with +4.00 D peripheral addition power and, additionally, with plano single vision contact lenses (SVCLs). Phoria at a distance and near, distance and near vergence ranges, vergence facility at near, stereopsis at near, and fixation disparity at near were measured in each study lens type.Results: No significant influence of addition on distance phoria was found in either group (p = 0.446 and p = 0.317, for 3 mm and 4.5 mm central zone diameter, respectively). Additionally, no significant difference was observed for any MFSCLs and SVCLs in near phoria (p = 0.320), near vergence facility (p = 0.197), or near fixation disparity (p = 0.203). A decline in fusional vergence ranges at a distance in the base-out direction was noted in subjects wearing +4.00 D addition compared to +2.00 D addition (p = 0.002) and plano lenses (p = 0.014). Both additions reduced fusional vergence ranges at near the base out (p = 0.020) and shifted vergence ranges more in the exophoria base in directions (p = 0.014). Conclusions: The study showed that MFSCLs with high additional power in the periphery have only a marginal impact on the binocular functions.

Myopia is an important public health problem due to its prevalence and significant public health cost. Elevating levels of myopia increase the risk of vision impairment, and therefore, high myopia has become one of the main causes of untreatable vision loss throughout the world due to its irreversible complications. At present, many options for slowing progression of myopia have already been proposed and evaluated such as progressive addition of executive bifocal spectacle lenses, peripheral defocusing lenses, overnight orthokeratology, pharmacological agents such as atropine eye drops, and multifocal soft contact lenses (MFSCLs). Use of MFSCLs has especially increased in recent years due to the growing demand to slow myopia progression during patient's adolescent growth period to avoid pathological myopia in adulthood. Compared with the other traditional methods of controlling myopia, MFSCLs allow myopic patients to better maintain their clear visual quality and slow myopia progression. In this manuscript, we aim to review the basics of myopia, recent advances in contact lenses to control myopia with emphasis on MFSCLs, define the elements for proper MFSCL fittings (such as pupil size, aberrations, accommodation and centering), discuss the potential rebound effect after discontinuation of contact lenses, and future directions for improvements of contact lenses for the control of myopia.

PurposeTo compare and evaluate the clinical performance and fit success of lehfilcon A and lotrafilcon B multifocal soft contact lenses (MfSCLs).Patients and MethodsThis was a prospective, randomized, double-masked, crossover, dispensing clinical study. Eligible wearers were fitted and wore study MfSCLs bilaterally (≥8 hours/day, ≥5 days/week) over 30 days. Endpoints: binocular visual acuity (VA) at distance (4 m), intermediate (80 cm), and near (40 cm) at day 30; fit rate success; eye care professional (ECP) rating, study dispensed lens power at visit 1; lens fit, and surface characteristics at dispense and day 30; safety assessments.ResultsOverall, 101 subjects were enrolled. At day 30, lehfilcon A MfSCLs were noninferior to lotrafilcon B MfSCLs for distance, intermediate, and near VA (non-inferiority margin: 0.05; 95% UCL of LSM difference 0.00, 0.02, 0.04; mean VA, lehfilcon A: −0.10 ± 0.08, −0.10 ± 0.08, and 0.01 ± 0.12; lotrafilcon B: −0.09 ± 0.07, −0.11 ± 0.08, and −0.02 ± 0.11). At visit 1, ≥99.5% of both MfSCLs achieved successful fit with 1–2 lenses/eye. Mean ECP ratings for ease of fit: lehfilcon A 9.8 ± 0.6; lotrafilcon B: 9.7 ± 0.6. About 96.0% of subjects had same sphere (D) power and 100.0% had same ADD power in both eyes for both lenses. All MfSCLs had optimal/acceptable fit. Majority of MfSCLs (>96%) had grade 0/1 front surface wettability and front/back surface deposits. No serious AEs were reported, and all biomicroscopy findings were graded 2 (mild) or lower.ConclusionLehfilcon A multifocal contact lenses combine excellent visual performance, high fit success, and a stable, comfortable wearing experience over 30 days of daily wear. With their water-gradient surface, favorable safety profile, and ease of fit, they represent a reliable and beneficial option for clinicians to consider when selecting multifocal lenses for presbyopic patients.

Objective: This study aims to assess the influence of a newly developed pupil-optimized multifocal soft contact lens (MFSCL) in comparison to single-vision contact lenses (SVCL) on visual performance among adolescent myopes. Materials and Methods: Myopic adolescents, aged 14 to 18 years, who were habitual SVCL users, were subjected to a trial involving MFSCL with a mid-addition power. Various visual parameters including distance and near visual acuity (VA), maximum reading speed (MRS), reading acuity, contrast sensitivity, and stereoacuity under photopic conditions were measured for MFSCL and compared to SVCL. Results: No statistically significant differences were observed between SVCL and MFSCL in terms of near VA, MRS, contrast sensitivity, and stereoacuity (p &gt; 0.05 for all). However, a decrease in distance VA was noted with MFSCL (p = 0.021). Moreover, reading acuity, which denotes the smallest print size comprehensible without significant errors, was found to be smaller when using MFSCL (p &lt; 0.001). Conclusion: In adolescent myopic patients, mid-add power in MFSCL did not significantly impact near VA and contrast sensitivity when compared to SVCL, while a decrease in distance VA was observed. Moreover, MFSCL did not affect reading speed but did enable the reading of smaller font sizes.

To explore links between subjective comfort and vision in habitual multifocal soft contact lens (MFCL) wearers when refit with daily disposable MFCLs, to determine which factors are relevant for success with MFCLs and evaluate consistency between MFCLs of different designs. This work examined subjective measures in a randomised, participant masked, bilateral wear crossover study at five optometry practices. Fifty-eight habitual MFCL wearers wore stenfilcon A multifocal (stenA-MF; CooperVision Inc) and delefilcon A multifocal (delA-MF; Alcon) for two-weeks. Subjective ratings included satisfaction with comfort and vision and agreement questions. Agreement with "I would like to wear this MFCL in the future" was taken to indicate success with each MFCL; agreement was significantly higher with stenA-MF. There was strong correlation between agreement responses for "I would like to wear this MFCL in the future" and "MFCL met my needs for vision" with both lenses (p<0.01). However, it was only with stenA-MF, which had higher agreement responses to both statements (p<0.05), that responses to these two statements correlated with satisfaction with end-of-day (EOD) comfort (p<0.01). These differences in correlations between the two lenses are seemingly driven by greater satisfaction with stenA-MF for near and intermediate vision (p<0.05). Subjective vision and comfort were only correlated when vision met the needs of most participants. Meeting participants' needs for vision correlated strongly with wanting to wear a MFCL. Results indicate that meeting vision needs is more important than meeting comfort needs when influencing whether presbyopic patients continue wearing MFCLs.

This pilot study compared subjective and objective vision of children wearing single-vision and +2.00, +3.00, and +4.00 D add power soft multifocal contact lenses to determine whether the higher add power-thought to provide better myopia control-resulted in visual compromise. This study aimed to determine the maximum add power children wearing center-distance soft multifocal contact lenses could accept objectively and subjectively. Myopic children were assigned in random order to wear omafilcon A single-vision or multifocal "D" contact lenses with +2.00, +3.00, or +4.00 D add power for 1 week each. High-contrast distance and near visual acuity, low-contrast distance visual acuity, and contrast sensitivity were measured at each visit along with a quality of vision questionnaire to assess their vision. The Friedman test was performed to evaluate the impact of add power on all outcome measures. Eleven subjects were enrolled, and nine subjects completed the study. The median age of completed subjects was 11 years. Median logMAR low-contrast distance visual acuity was reduced in the +3.00 (+0.20) and +4.00 (+0.28) D add lenses compared with the +2.00 (+0.16) D add and single-vision lenses (+0.10, P < .001). All three multifocal lenses resulted in reduced contrast sensitivity (+1.35 to +1.40) compared with single-vision lenses (+1.60, P < .001). In general, +3.00 and +4.00 D add lenses resulted in worse glare/starbursts, ghost images, computer vision, changing fixation distance, and overall vision, but results varied. There were no differences among the lenses with respect to subjective assessments of distance vision, near vision, strain or tiredness, contact lens comfort, or sporting activities. The +3.00 D and higher add powers result in more objective and subjective vision-related issues than single-vision lenses, but the +2.00 D add multifocal lenses were well tolerated.

Results of this randomized, double-masked clinical trial demonstrate the effectiveness of the MiSight soft contact lens in slowing myopia progression over multiple years. The purpose of this study was to quantify the effectiveness of MiSight daily disposable soft contact lens in slowing the progression of juvenile-onset myopia. Myopic children (spherical equivalent refraction, -0.75 to -4.00 D; astigmatism, <1.00 D) aged 8 to 12 years with no prior contact lens experience were enrolled in a 3-year, double-masked, randomized clinical trial at four investigational sites in four countries. Subjects in each group were matched for age, sex, and ethnicity and were randomized to either a MiSight 1-day contact lens (test) or Proclear 1-day (control; omafilcon A) and worn on a daily disposable basis. Primary outcome measures were the change in cycloplegic spherical equivalent refraction and axial length. Of the subjects enrolled, 75.5% (109/144) completed the clinical trial (53 test, 56 control). Unadjusted change in spherical equivalent refraction was -0.73 D (59%) less in the test group than in the control group (-0.51 ± 0.64 vs. -1.24 ± 0.61 D, P < .001). Mean change in axial length was 0.32 mm (52%) less in the test group than in the control group (0.30 ± 0.27 vs. 0.62 ± 0.30 mm, P < .001). Changes in spherical equivalent refraction and axial length were highly correlated (r = -0.90, P < .001). Over the course of the study, there were no cases of serious ocular adverse events reported. Four asymptomatic corneal infiltrative (one test, three control) events were observed at scheduled study visits. Results of this clinical trial demonstrate the effectiveness of the MiSight daily disposable soft contact lens in slowing change in spherical equivalent refraction and axial length.

AimsTo evaluate the 1-year efficacy of two new myopia control spectacle lenses with lenslets of different asphericity.MethodsOne hundred seventy schoolchildren aged 8–13 years with myopia of −0.75 D to −4.75...