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Multifocal Soft Contact Lenses and Asthenopic Symptom Reduction in Myopes With Accommodative Lag
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In a cohort of pre–presbyopic myopes with accommodative lag (≥ +0.75 D), the use of multifocal contact lenses reduced asthenopic complaints as assessed by the Convergence Insufficiency Sympton Survey, despite no reduction in the lag of accommodation.
- These results suggest that, in contact lens wearers with asthenopic complaints, binocular and accommodative functioning should be assessed and that use of center-near, low-add, multifocal contacts may reduce symptoms.
abstract
This abstract is available on the publisher's site.
Access this abstract now Full Text Available for ClinicalKey SubscribersPURPOSE
To evaluate the efficacy of multifocal soft contact lenses to reduce asthenopic symptoms in myopes with accommodative lag.
METHODS
Twenty-four myopic participants, aged 18-35 years, with mean spherical equivalent (MSE) of ≤ -0.75D, were recruited in a randomised, double-blind crossover study. All participants were existing contact lens wearer with near orthophoria or esophoria, presenting with subjective asthenopic symptoms at baseline [Convergence Insufficiency Symptom Survey (CISS) score ≥ 21] and a lag of accommodation ≥ +0.75 D. All participants were initially fitted with single vision contact lenses for a one month period. Participants were then randomly assigned 1:1 to wear low add or high add multifocal soft contact lenses for a further month. After this period, the groups were reversed. Data were collected at baseline and following one month's wear of each lens. Change in CISS score was evaluated as the primary outcome measure, while secondary outcome measures were changes in accommodative lag and heterophoria status.
RESULTS
Baseline CISS score was (mean ± SD) 25.04 ± 4.58. Post-intervention scores were as follows: single vision: 24.46 ± 4.59, low add: 12.17 ± 6.89, high add: 13.71 ± 7.23. Both low add and high add multifocal soft contact lens wear was associated with an improvement in CISS score compared to baseline CISS and single vision (all p < 0.01). No significant difference was found between the CISS score for the baseline CISS and single vision (p = 1.00). No significant difference was found in lag of accommodation between lens conditions (all p > 0.05), however, there was an exophoric shift in near heterophoria between single vision and both multifocal contact lenses (low add: (mean difference 1.33 Δ, p = 0.02; high add: mean difference 1.23 Δ, p = 0.02) but not between habitual spectacle or any other modality (all p > 0.05).
CONCLUSIONS
The use of multifocal soft contact lenses for a one-month period was associated with reduced severity of asthenopic symptoms in pre-presbyopic myopes with accommodative lag. Whilst improvement of symptoms does not appear to be mediated by a significant reduction in accommodative lag, changes in heterophoria may play a role in reducing asthenopic symptoms.
Additional Info
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The efficacy of multifocal soft contact lenses for the alleviation of asthenopic symptoms in myopes with accommodative lag
Cont Lens Anterior Eye 2021 Sep 09;[EPub Ahead of Print], ACH Ong, FE Cruickshank, AL Sheppard, LN DaviesFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
This study was conducted at a Singapore-based private optometry practice, and it investigated the effectiveness of a commercially available multifocal soft contact lenses in reducing asthenopic symptoms in pre-presbyopic myopes with a lag of accommodation. The 24 study participants were existing contact lens wearers who had myopia of 0.75 D or more (spherical equivalent), 1.00 D or less astigmatism, lag of accommodation more than 0.75 D by monocular estimate method dynamic retinoscopy, orthophoria or esophoria at near by Maddox Wing test, and a Convergence Insufficiency Symptom Survey (CISS) score of at least 21. Participants were 18 to 35 years old.
After baseline data collection at the first study visit, participants were fitted with single-vision spherical Alcon Air Optix Aqua soft contact lenses. After 1 month of wearing those lenses, participants returned for the second study visit, at which time study tests were repeated and they were randomized to either low add (up to 1.25 D) or high add (+2.25 to +2.50 D) simultaneous vision center-near design multifocal lenses (Alcon Air Optix Aqua). After an additional 1 month, low add wearers were crossed over to high lenses, and high add wearers were crossed over to low add lenses. The study concluded after 1 month of wearing those lenses.
The mean CISS symptom score did not show a statistically significant change from baseline (25.04) to single-vision lens wear (24.46) but did show significant changes with both low add wear (12.17) and high add wear (13.71). The results suggest that multifocal soft contact lenses can be a useful method for reducing asthenopia in cases with orthophoria or esophoria at near and lag of accommodation. The mean near esophoria was significantly less with both the low add and the high add than with single-vision lenses, suggesting that the study participants were using the near addition. The mean CISS score was lower with the low add than with the high add; this could perhaps be explained by the amounts of esophoria usually being fairly low, as the mean near phoria with single-vision contact lenses was 2.2 prism diopters.