The staying power of bifocal contact lens benefits in young kids After treatment, nearsightedness progresses at age-expected rate

The staying power of bifocal contact lens benefits in young kids

After treatment, nearsightedness progresses at age-expected rate

Young nearsighted kids who wear bifocal contact lenses that slow uncoordinated eye growth do not lose the benefits of the treatment once they stop wearing the lenses, new research shows.

The study is a follow-up to a clinical trial published in 2020 showing that soft multifocal contact lenses with a heavy dose of added reading power dramatically slowed further progression of myopia in kids as young as 7 years old. Researchers wondered if discontinuing that treatment might cause a rebound of faster-than-normal eye growth that wipes out the benefit.

In the new trial, nearsighted kids wore high-add bifocal lenses for two years followed by one year with single-vision contact lenses. Results showed no evidence that the treatment effect declined, and myopia progression then continued at age-expected rates.

"We want doctors to understand that you don't lose the benefits that you gain with this treatment," said senior author Jeffrey Walline, professor of optometry at The Ohio State University and chair of the project, known as the BLINK (Bifocal Lenses in Nearsighted Kids) Study.

"But more importantly, what we want to do with this research is give patients healthier eyes at a lower cost with more options. And then in adulthood, we want them to be able to function fully and with clear vision."

The new follow-up study, known as BLINK2, is published today (Jan. 16, 2025) in JAMA Ophthalmology. Both trials were conducted at Ohio State and the University of Houston.

In nearsightedness, or myopia, the eye grows and is stretched into an elongated shape. This abnormality increases the risk for cataracts, detached retina, glaucoma and myopic macular degeneration, all of which can lead to loss of vision, even when wearing glasses or contact lenses.

Myopia is also common, affecting at least one-third of adults in the United States, and is becoming more prevalent - because, the scientific community believes, children are spending less time outdoors now than in the past. Nearsightedness tends to begin between the ages of 8 and 10 and progresses up to about age 18, when the eye might continue to grow but not become more myopic in most people.

Multifocal contact lenses for nearsighted patients correct for clear distance vision and include focal power that allows middle-aged eyes to read near work clearly.

In the original study, 294 nearsighted children aged 7-11 years were randomized into one of three groups of contact-lens wearers. Those who wore the lenses with the highest added power, 2.50 diopters, had shorter eyes and slower rates of myopia progression than the kids in the other two groups after three years.

Of the original participants, 248 continued in BLINK2, during which all - then aged 11 to 17 years - wore the high-add lenses for two years followed by single-vision contact lenses for the third year, a method used to see if the benefit remained after discontinuing the bifocal treatment.

At the end of BLINK2, eye growth returned to age-expected rates and there were no signs of faster-than-normal eye growth. Participants who had been in the original BLINK high-add group continued to have shorter eyes and less myopia at the end of BLINK2, meaning those who started high-add bifocal lenses in BLINK2 did not catch up to those who received the treatment when they were younger.

"After the children discontinue using the contact lenses, their myopia progression increases, but just to normal standards you would expect if you hadn't treated them. And that happens no matter what age they are when they stop wearing the bifocal lenses," said Walline, also acting dean in Ohio State's College of Optometry.

This research and other studies have led to advances in the treatment landscape for nearsighted children: Options include multifocal contact lenses, contact lenses that reshape the cornea during sleep called orthokeratology, and atropine eye drops.

"This is a burgeoning area," Walline said. "The standard of care has switched from providing kids with single-vision glasses or contact lenses to things that slow down the progression of myopia, or the growth of the eye."

Walline and his colleagues are now pursuing funding for a clinical trial to see if it's possible to delay the onset of myopia in young children by administering atropine eye drops before nearsightedness is detectable.

"What we know is that the earlier you become myopic, the more myopia you're expected to have as an adult. So if we can delay the onset, then we can make a big difference," he said.

BLINK was funded by the National Institutes of Health's National Eye Institute and supported by Bausch + Lomb, which provided contact lens solutions.

David Berntsen, Golden-Golden Professor and chair of clinical sciences at the University of Houston College of Optometry, was the first author of this study. Additional co-authors were Anita Tićak and Amber Gaume Giannoni of the University of Houston, and Danielle Orr, Loraine Sinnott, Donald Mutti and Lisa Jones-Jordan of Ohio State.

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