Accommodation over Time in Children Wearing Multifocal Soft Contact Lenses for Myopia Control

Abstract

Introduction The prevalence of myopia and its ocular complications increases each year worldwide and the complications of myopia are predicted to become the leading cause of blindness by 2050 (Holden Ophthamology 2016). Common therapies for myopia management include low-dose atropine, bifocals or Progressive Addition Lenses (PALs), orthokeratology (OK), and multifocal contact lenses (MFCL). One potential mechanism for OK and MFCLs to reduce myopia progression is by imposing peripheral myopic defocus on the retina. MFCL wear can reduce accommodation compared with single vision contact lenses (SVCL), potentially reducing peripheral myopic defocus and causing variable efficacies of MFCLs (Gong OVS 2017). The change in accommodation with MFCL use varies between MFCL designs. Auditory biofeedback training can decrease the accommodative lag during MFCL wear in young adults (Wagner Sci Rep 2020). We assessed: Differences in accommodative lag between children using low-dose atropine, OK, and MFCLs compared to a single vision spectacle control. Differences in accommodation between different MFCL designs. Differences in accommodation between viewing through SVCLs and MFCLs. The effect of biofeedback training on accommodation in children during MFCL wear. Methods Myopic children habitually using low-dose atropine, OK, or MFCLs as well as myopic children not undergoing myopia management (spectacle control) (19 male/ 24 female) were recruited from the Pediatric and Myopia Management Clinics at the University Eye Center, SUNY College of Optometry. Low dose atropine (n = 11), OK (n = 5), and spectacle control (n = 11) subjects’ accommodative lag was measured using an infrared (IR) photorefractor, using a stimulus at 0, 2.5, 3, and 4D. For the MFCL subjects (n = 17), accommodation through SVCLs and their habitual MFCLs before, after, and 1 week following biofeedback training were measured identically to the other subjects at the same distances. Differences in accommodative lag were measured using mixed effects multiple linear regression adjusting for accommodative stimuli. Results There was no significant difference between accommodation in the low-dose atropine (p = 0.8), OK (p = 0.3), and MFCL (p = 0.3) groups compared to the spectacle control. Eyes wearing MFCLs exhibited significantly increased lag of accommodation compared with SVCLs prior to the biofeedback training (SV vs. MFCL, p < 0.05). Specifically, eyes viewing through Biofinity MFCLs showed a significantly greater lag than MiSight (p < 0.05). Biofeedback training showed a tendency to decrease lag immediately following biofeedback training (p = 0.2) and significantly decreased lag 1 week later (p < 0.01). Both immediately and one week later, subjects that showed lower pretreatment accommodation had significantly greater decreases in lag following biofeedback training (p < 0.05). Conclusions Our findings show that pediatric subjects wearing MFCLs for myopia management show an increased accommodative lag compared to wearing SVCLs. The lag of accommodation while viewing with MFCLs differs between MFCL designs. Biofeedback training can significantly decrease lag in children during MFCL wear one week later, similar to previous findings (Wagner Sci Rep 2020). Subjects who displayed the greatest accommodative lag prior to the train showed the biggest improvements in accommodation before the biofeedback training, suggesting individuals with low accommodation while viewing through MFCLs use may yield the greatest benefit from biofeedback training. Biofeedback training may be effective in increasing the amount of peripheral myopic defocus during MFCL wear and thus increase the efficacy of MFCL wear for myopia management in children.