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Visual Acuity and Over-refraction in Myopic Children Fitted with Soft Multifocal Contact Lenses

Schulle, Krystal L. OD, FAAO1; Berntsen, David A. OD, PhD, FAAO1*; Sinnott, Loraine T. PhD2; Bickle, Katherine M. OD, MS, FAAO2; Gostovic, Anita T. OD, MS, FAAO1; Pierce, Gilbert E. OD, PhD, FAAO2; Jones-Jordan, Lisa A. PhD, FAAO2; Mutti, Donald O. OD, PhD, FAAO2; Walline, Jeffrey J. OD, PhD, FAAO2 for The Bifocal Lenses in Nearsighted Kids (BLINK) Study Group

doi: 10.1097/OPX.0000000000001207

SIGNIFICANCE Practitioners fitting contact lenses for myopia control frequently question whether a myopic child can achieve good vision with a high-add multifocal. We demonstrate that visual acuity is not different than spectacles with a commercially available, center-distance soft multifocal contact lens (MFCL) (Biofinity Multifocal “D”; +2.50 D add).

PURPOSE To determine the spherical over-refraction (SOR) necessary to obtain best-corrected visual acuity (BCVA) when fitting myopic children with a center-distance soft MFCL.

METHODS Children (n = 294) aged 7 to 11 years with myopia (spherical component) of −0.75 to −5.00 diopters (D) (inclusive) and 1.00 D cylinder or less (corneal plane) were fitted bilaterally with +2.50 D add Biofinity “D” MFCLs. The initial MFCL power was the spherical equivalent of a standardized subjective refraction, rounded to the nearest 0.25 D step (corneal plane). An SOR was performed monocularly (each eye) to achieve BCVA. Binocular, high-contrast logMAR acuity was measured with manifest spectacle correction and MFCLs with over-refraction. Photopic pupil size was measured with a pupilometer.

RESULTS The mean (±SD) age was 10.3 ± 1.2 years, and the mean (±SD) SOR needed to achieve BCVA was OD: −0.61 ± 0.24 D/OS: −0.58 ± 0.27 D. There was no difference in binocular high-contrast visual acuity (logMAR) between spectacles (−0.01 ± 0.06) and best-corrected MFCLs (-0.01 ± 0.07) (P = .59). The mean (±SD) photopic pupil size (5.4 ± 0.7 mm) was not correlated with best MFCL correction or the over-refraction magnitude (both P ≥ .09).

CONCLUSIONS Children achieved BCVA with +2.50 D add MFCLs that was not different than with spectacles. Children typically required an over-refraction of −0.50 to −0.75 D to achieve BCVA. With a careful over-refraction, these +2.50 D add MFCLs provide good distance acuity, making them viable candidates for myopia control.

1University of Houston College of Optometry, Houston, Texas

2The Ohio State University College of Optometry, Columbus, Ohio *

Submitted: July 16, 2017

Accepted: February 2, 2018

Funding/Support: National Institutes of Health grants U10-EY023204, U10-EY023206, U10-EY023208, U10-EY023210, P30-EY007551; Bausch + Lomb (contact lens solution); supported by UL1-TR001070 from the National Center For Advancing Translational Sciences.

Conflict of Interest Disclosure: None of the authors have reported a conflict of interest.

Author Contributions: Conceptualization: DAB, LAJJ, DOM, JJW; Data Curation: KLS, DAB, LTS, KMB, ATG, GEP, LAJJ, DOM; Formal Analysis: LTS, LAJJ; Funding Acquisition: DAB, LAJJ, DOM, JJW; Investigation: KLS, DAB, KMB, ATG, GEP, LAJJ, DOM, JJW; Methodology: DAB, LAJJ, DOM, JJW; Project Administration: DAB, LAJJ, DOM, JJW; Resources: DAB; Software: LTS, LAJJ; Supervision: DAB, LAJJ, DOM, JJW; Validation: LTS, LAJJ; Visualization: KLS, DAB; Writing – Original Draft: GEP, KLS, DAB, KMB, ATG; Writing – Review & Editing: LAJJ, KLS, DAB, LTS, KMB, ATG, GEP, DOM, JJW. Registration: NCT02255474 (registered September 23, 2014).

Bifocal Lenses in Nearsighted Kids (BLINK) Study Group:

Executive Committee: Jeffrey J. Walline (Study Chair), David A. Berntsen (UH Clinic Principal Investigator), Donald O. Mutti (OSU Clinic Principal Investigator), Lisa A. Jones-Jordan (Data Coordinating Center Director), Donald F. Everett (NEI Program Official).

Chair's Center: Kimberly J. Shaw (Study Coordinator), Juan Huang (Investigator), Bradley E. Dougherty (Survey Consultant).

Data Coordinating Center: Loraine T. Sinnott (Biostatistician), Pamela Wessel (Project Coordinator), Jihuyn Lee (Research Programmer, 2015 to present).

University of Houston Clinic Site: Laura Cardenas (Clinic Coordinator), Krystal L. Schulle (Unmasked Examiner), Dashaini V. Retnasothie (Unmasked Examiner, 2014 to 2015), Amber Gaume Giannoni (Masked Examiner), Anita Tic´ak Gostovic´ (Masked Examiner), Maria K. Walker (Masked Examiner), Moriah A. Chandler (Unmasked Examiner, 2016 to present), Mylan T. Nguyen (Data Entry, 2016 to 2017), Lea A. Hair (Data Entry, 2017 to present).

Ohio State University Clinic Site: Jill A. Myers (Clinic Coordinator), Alex D. Nixon (Unmasked Examiner), Katherine M. Bickle (Unmasked Examiner), Gilbert E. Pierce (Unmasked Examiner), Kathleen S. Reuter (Masked Examiner), Dustin J. Gardner (Masked Examiner, 2014 to 2016), Andrew D. Pucker (Masked Examiner, 2015 to 2016), Matthew Kowalski (Masked Examiner, 2016 to 2017).

Data Safety and Monitoring Committee: Janet T. Holbrook (Chair), Jane Gwiazda (Member), Timothy B. Edrington (Member), John Mark Jackson (Member), Charlotte E. Joslin (Member).

© 2018 American Academy of Optometry