Dynamics of the accommodative response and facility with dual-focus soft contact lenses for myopia control

Patterns of Myopia Progression in European Adults

Objective

Data regarding the progression of myopia and new-onset myopia in young adults are lacking. This study aims to describe the natural history of myopia development and progression in adults using anonymized electronic medical records from Irish optometric practices.

Design

Longitudinal study.

Subjects

Electronic medical record data were extracted from 40 Irish optometry practices with 18 620 (59.5% female) patients meeting the inclusion criteria.

Methods

Refractive error change was determined among patients with multiple eye examination visits during the period January 1, 2003 to December 31, 2022. Patients aged 18 to 39 years, inclusive, at baseline and attending >1 eye examination with an interval of ≥11 months between visits and that were myopic at the final visit were included in the analysis. Annualized myopia progression in diopter (D)/year was assessed using linear mixed models with age, sex, baseline spherical equivalent refraction, and previous myopic progression as fixed effect covariates. The proportion of patients with unstable myopia (progression worse than -0.25 D/year) was determined.

Main Outcome Measures

Proportion of adults across the age range 18 to 39 years with significant myopic progression.

Results

Significant myopia progression (progression <-0.25 D/year) was noted in 10.7% of all myopes. The proportion of myopes with significant progression was clearly related to age with 19.9% of myopes in the youngest age group experiencing progression compared with 6.8% in the oldest age group. Higher proportions of myopic progression were also observed in high myopes with 1 in 12 high myopes (8.0%) exhibiting persistent fast myopic progression as adults (worse than -0.50 D/year). Of patients with emmetropia or hyperopia at baseline in this clinic-based population, 28.5% and 0.8% became myopic during the follow-up period.

Conclusions

Although myopia has stabilized in most adults (>18 years of age), a sizeable proportion of younger adults and high myopes (of all ages) do progress at a clinically significant rate. Almost 3 times as many adults in youngest age group (18-24 years) experienced myopic progression when compared with the oldest age group (40-44 years). Consideration should therefore be given to exploring the efficacy and benefit of myopia management in this cohort of patients.

Financial Disclosures

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Dynamic Accommodation Responses in Subjects Wearing Myopia Control Spectacles Modifying Peripheral Refraction

Purpose

Peripheral optics have been suggested to play a role in myopia progression, with accommodation responses also considered a potential contributor. This study aimed to investigate whether modifications in peripheral optics through different spectacle lenses affect accommodation responses.

Methods

Dynamic accommodation responses were assessed using a double-pass instrument while switching the target from distance (3 m for 3 seconds) to near (0.22 m/4.5 D for adults, 0.18 m/5.5 D for children, 5 seconds) and then back to distance (3 m for 3 seconds). Three groups were studied. Group 1 included 13 adults (age = 28 ± 4.5 years). Participants wore one of three myopia control lenses (MiYOSMART [Hoya], Stellest [Essilor], or MyoCare [ZEISS]) randomly, along with their habitual glasses. The testing involved both central clear zones and peripheral side-vision zones, with habitual glasses served as reference. Group 2 underwent same procedure, but in children (age = 9.8 ± 1.7 years). Group 3 included 8 adults (age = 27.9 ± 5.3 years) wearing standard glasses partially excised with central holes (diameter = 12 mm). The lens refraction included plano, +3 D defocus, -3 D defocus, and -3 D oblique astigmatism.

Results

The accommodative lag was less than 0.5 D for all eyes under near stimulation. No significant differences in the amplitude of accommodation responses were observed among the myopia control lenses or the partially excised glasses.

Conclusions

No effect on accommodation responses was found in subjects wearing different types of myopia control lenses. This finding indicates that the induced changes in the ocular peripheral optics do not have an impact on accommodation.

Visual Quality and Accommodation With Novel Optical Designs for Myopia Control

Purpose

We evaluated through-focus visual performance and accommodative response in young subjects through three segmented multifocal designs for myopia control, mapped on the spatial light modulator of a monocular adaptive optics visual simulator (AOVS), and compared with single vision (SV).

Methods

The segmented multifocal patterns included a 4 mm diameter center distance zone and offset peripheral defocus (MP1), astigmatism and coma (MP2), or a combination (MP3). High-contrast logMAR visual acuity (VA) was measured with monochromatic stimuli (555 nm). Ocular aberrations were measured using the Hartmann-Shack aberrometry channel. Measurements were taken for distance viewing and five accommodative demands (AD, up to 4.5 D). Accommodative lag was calculated from the dioptric shift of the maximum retinal image quality metric from the corresponding wave aberrations.

Results

Best-corrected logMAR VA was -0.11 ± 0.02 (SV) and slightly reduced by multifocal patterns (-0.08 ± 0.03 [MP1], -0.07 ± 0.04 [MP2], -0.05 ± 0.04 [MP3]). Accommodative lag with SV was lower in emmetropes than myopes (by 0.43D for the largest demand). MP1 significantly decreased accommodative lag in myopes (P = 0.03), unlike MP2 or MP3. Multifocal patterns reduced pupil diameter in myopes at all distances. MP1 improved accommodative response in myopes without compromising distance vision.

Conclusions

AOVS helped to understand the interplay of physiological and lens design factors, potentially guiding custom corrections. A center distance with off-centered positive power in the lens periphery could feature suitable properties (peripheral focus and accommodative focus control) for myopia control.

Translational Relevance

We demonstrate a two-zone contact lens design that provides excellent visual quality and accommodative response, important properties for myopia control lenses.