I am talking single vision here

I’ve been working on a lecture that deals with the question “Do Glasses Make My Eyes Worse?” but maybe I should amend it to do “Contacts Make My Eyes Worse?” or better yet, “Do Single Vision Lenses Contribute To Myopic Progression?”.

To be extra clear here, I’m talking single vision here. Not multifocal. But maybe that is the whole crux of the issue. Why aren’t we talking multifocals to all of our progressing myopes who want to wear contacts?

Based on my research

My cursory research turned up a 2006 ACHIVE study that basically said that kids who wear glasses have prescription changes that are nearly identical to kids who wear contacts. https://www.ncbi.nlm.nih.gov/pubmed/16432471 Ok, got it. I’ll make the correlation that single vision minus contacts aren’t any more or less impactful on myopic progression than single vision specs.

With that said the issues become, what effects are these single vision lenses having on our eyes. There is a mounting pile of evidence that indicates that they may actually be contributing to myopic progression, but even if you are not convinced of that, there is one thing for certain. Single vision lenses are not doing a damn thing to help control it!

If we are talking soft contacts, we need to be talking about multifocals if we want to control myopia. Control not cure being the key here.

What about progression

If we have seen our patients progress from slightly hyperopic, to emmetropic, to myopic and there are myopic risk factors in play, why are we not taking a firm stand and only prescribing options that control myopia?

If we intervene at -1, based on current scientific evidence, we are likely to help keep them to around a -3 versus a -6. Or better yet, with new optimized myopia control designs, what if we could keep that -1 to around a -1!

The risk of myopia related ocular issues, such as myopic maculopathy, retinal detachment, and glaucoma would be greatly reduced. That to me is truly providing the best possible care to our patients and helping them achieve a lifetime of healthy eyes and optimal vision.

Will we see a day where all progressing myopes single vision minus lenses would be considered malpractice? We are at a point where we have the research indicating that soft multifocal contact lenses do slow the progression of myopia 50-90%.

Additionally, we have a multitude of soft multifocal contact lenses that offer us a great variety in optical design, material design, and modality.

It’s time to speak up

At any rate, I hope this gets you thinking. I hope it gets your curious. I hope it gets you to investigate more on your own. Most importantly I hope that this helps get you to request that this research is done.

You have a voice, let the research community know that you need these studies to be done because the information is essential for you in your goal of providing the best care to your patients.

A final thought to ponder. The forward thinking Dr. Jeff Cooper dropped a memorable quote on an audience I was part of at a Vision By Design lecture a few years ago. It stuck with me and I often return to it to re-evaluate where the world is in myopia control.

“All truth passes through three stages. First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as being self-evident.” Arthur Schopenhauer 1818. It’s nearly 2020, has our vision of myopia control caught up to the times?