Eye-care practitioners should not worry about "myopic creep" when considering whether to prescribe contact lenses for younger children, suggest the results of a 3-year study comparing myopic progression in children aged 8 to 11 years who were randomly assigned to wear single-vision glasses or soft contact lenses.
Eye-care practitioners should not worry about "myopic creep" when considering whether to prescribe contactlenses for younger children, suggest the results of a 3-year study comparing myopic progression in children aged8 to 11 years who were randomly assigned to wear single-vision glasses or soft contact lenses.
The comparison of myopic progression rates was conducted as part of the Adolescent-Child Health Initiative toEncourage Vision Empowerment study. The study enrolled 484 children at 5 clinical centers; the subjects had from1 to 6 D of spherical component myopia with less than 1 D astigmatism, said Jeffrey J. Walline, OD, PhD,assistant professor at the College of Optometry, Ohio State University, Columbus. The average age was 10.4years, and about one-third of the children were in the younger range (aged 8 to 9 years). Approximately half ofthe subjects were white and about one-quarter were either black or Hispanic, with a small percentage ofAsians.
At randomization, 237 children were assigned to spectacles and 247 to contact lenses. During the study, about 17children in each group switched to the other form of correction, but analysis was performed on anintent-to-treat basis, Dr. Walline said. Parents were allowed to chose which of two contact lens models theirchild would receive (Acuvue 2 or 1-Day Acuvue, Vistakon); 93% chose the 1-Day Acuvue.The investigators examined 467 (96.5%) of the subjects at the final visit. At the end of three years, thespectacle wearers progressed –1.08 D, and the contact lens wearers progressed –1.27 D. The axialgrowth was 0.59 mm in the spectacle group and 0.63 mm in the contact lens group. The change in the steep cornealmeridian was 0.05 D for the spectacle wearers and 0.10 D for the contact lens group.
"Statistically, there is a significant interaction between time and treatment," Dr. Walline said. "What thattells us is that the rate of progression on average is about 0.06 D greater for the contact lens wearers than itis for the spectacle wearers. However, if you just look at the difference after 3 years, the adjusted differenceis about 0.22 D, which is not statistically significant.
"This tells us that there is not a clinically meaningful difference in the change in refractive error, axiallength, or corneal curvature between soft contact lens wearers and spectacle wearers," Dr. Walline said. Eyephysicians' concerns about increasing myopia progression in young children who are fitted with contact lenses atearlier ages are not necessarily true, he continued.
"These doctors should consider fitting children at younger ages, especially active children or children who areconcerned about their appearance with glasses, because we've found that these are the ones who benefit most fromcontact lens wear," he said.