International survey of contact lens fitting for myopia control in children

Highlights

• A survey of contact lens prescribing for myopia control in children was conducted annually in 31 countries between 2011 and 2018, inclusive.

• Myopia control fits represented 2.3% of all contact lens fits to children, although the extent of myopia control fitting has slowly increased over time.

• A similar proportion of females (58.1%) ws fitted with myopia control lenses versus non- myopia control lenses (62.3%).

• The median age of myopia control and non- myopia control fits is 13 and 15 years, respectively, with most myopia control fitting activity taking place among children aged 8–15 years.

• Of all contact lenses fitted for the purpose of myopia control to children, 52.1% were undertaken using rigid lenses; this compares with 12.0% for non-myopia control fits with rigid lenses.

Abstract

Purpose

To determine the extent of contact lens fitting for myopia control (MC) in children (defined as ≤ 17 years of age) worldwide and to characterize the associated demographics and fitting patterns.

Methods

Survey forms were sent to contact lens fitters in 66 countries between January and March every year for eight consecutive years (2011–2018, inclusive). Practitioners were asked to record data relating to the first 10 contact lens fits performed after receiving the survey form. Data were analysed for those countries reporting ≥ 100 contact lens fits to children.

Results

Data were analysed for 535 MC fits and 23,295 other (non-MC) lens fits undertaken in 31 countries reporting ≥ 100 contact lens fits to children, with 52.1% of MC fits and 12.0% of non-MC fits being with rigid lenses (p < 0.0001). Overall, MC lenses represented 2.3% of all contact lens fits to children, with significant differences between nations (p < 0.0001), ranging from no MC fits recorded in the Czech Republic, Greece, Japan, South Korea and Puerto Rico, to 24.9% in Austria. There has been an increase in contact lens fitting for MC over the survey period (p < 0.0001). MC contact lenses were fitted to younger children compared to non-MC lenses (MC, median 13 years vs. non-MC, median 15 years) (p < 0.0001). There was no sex bias in the fitting of MC lenses (p = 0.89).

Conclusions

MC lenses are currently being prescribed for younger children in equal measure in terms of soft vs. rigid lenses and males vs. females. The extent of MC fitting is low and varies between nations. The gradual increase in MC fitting throughout the survey period perhaps reflects growing concerns among practitioners over the myopia epidemic.

Introduction

The term ‘myopia control’ (MC) has been coined to describe the practice of introducing an intervention to arrest the progression of myopia. There are four fundamental approaches to MC – surgical, pharmacological, behavioural, and optical. Surgical approaches have focused on posterior scleral cross-linking and appear to be applied to high levels of myopia [[1], [2], [3]]. Pharmacological approaches have centered around the use of the anti-muscarinic agents atropine [4] and pirenzepine [5]; these drugs have been demonstrated to partially arrest the progression of myopia in children, although the precise mechanism by which this occurs is unclear. Behavioural change relates to the notion that spending more time outdoors in sunlight can arrest the rate of progression of myopia [6].

Optical approaches include the use of bifocal or multifocal spectacles [7], and concentric ring bifocal or peripheral-add multifocal soft contact lenses that incorporate additional plus power in the lens periphery [8]. Orthokeratology contact lenses have also been reported as being able to arrest myopia progression, in addition to the classical myopia correction effect of this modality [9]. It should be noted that in most parts of the world, MC using spectacles, contact lenses and pharmaceutical agents (atropine and pirenzeprine) is considered an ‘off-label’ (unregulated) use of a medical device or drug. Positive spherical aberration induced by these optical configurations is one possible mechanism that is thought to create a reduction in the stimulus for eye growth [10].

The increasing prevalence of myopia around the world – especially in Asian regions [11] – and the awareness of ocular pathology associated with high myopia [12], have heightened interest in clinical management strategies to arrest myopia progression. This paper examines trends in, and factors associated with, contact lens fitting for MC in children (≤ 17 years of age [13]) in 31 countries over an eight year period (2011–2018, inclusive). Such information can provide (a) a valuable yardstick for contact lens clinicians, against which they can assess their own prescribing approaches to MC, and (b) useful guidance to the contact lens industry on the clinical utilization of this relatively new product category.