Is a bifocal or progressive addition spectacle lens worth prescribing for myopia management?

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CW posted aquestionabout spectacle lens options to the Myopia Profile Facebook community. He wondered if bifocals and progressive addition lenses (PAL) were worth the extra cost for parents of myopic children, as the myopia control efficacy is relatively low compared to other options like contact lenses.

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双焦点/渐进式添加镜头与单视镜

Part of the thought process in deciding on a myopia control strategy involves weighing up the cost against the benefit. In the first instance, the myopia needs to be corrected with either spectacles or contact lenses. When spectacles are the only option available for a myopic child - and this could be for a variety of reasons such as cost, unsuitability or lack of parental interest in contact lenses - the clinician must choose between the following readily accessible options: single vision, progressive addition or bifocal spectacle lenses.

一个常见的理由是，两者中的任何一个都比单一视觉镜头（SV）更好。但是，CW对这些镜头的额外成本是否证明可能是近视控制的益处是合理的。

Cheng等人表明，棱柱性双焦点透镜对具有正常双眼视力（BV）状态的患者有效，而双焦点对于低适应性滞后的儿童的起作用不佳。1在多项研究中，平均而言，与单一视力相比，双焦点和进行性添加镜头镜头每年减少0.25D。1-3While this doesn't sound very exciting in isolation, over the three year study of Cheng et al,1A +1.50的双焦点增加了0.86d的最终近视和棱柱双焦点（+1.50在每只眼中添加3个BI）降低1.01d。要更多地了解为什么使用棱镜，请阅读我们的博客Progressives, bifocals, binocular vision and more.

如我们所知，少数近视少的1D意味着近视肌瘤疾病的终身风险降低了40％，因此值得介入的努力。在我们的博客中阅读更多为什么每个屈光都很重要。

双焦点比进行渐进的添加镜头好吗？也许。渐进式添加镜头可能对在单一视力校正中表现出食管和适应性滞后的儿童可能是最有价值的。3

Which add to use for bifocal/progressive additional lens

Studies commonly use +1.50D and +2.00D Adds.4Leung and co-authors suggested +2.00D as it appears to be more effective than +1.50D in slowing myopia progression.3在评论中，KG建议在单一视力校正中评估患者的BV状态以选择适当的添加以开处方。有关此建议的更多建议，请阅读我们的博客prescribing adds for accommodative lag和开处方为食管。鉴于肌层更有可能患有BV异常，因此这是一个很好的考虑策略。5,6

鉴于患者的双眼视力状态，渐进式和双焦点眼镜镜头最适合近视控制 - 无论是在功效方面，都可以确保视觉舒适性和对镜头的接受。如果不是隐形眼镜，请为患有食管和适应性滞后的儿童选择渐进式添加镜头。在其他双眼视力表现中选择双焦点或棱镜双焦点。有关此的更多指导，请查看我们的Clinical Decision Trees,where Question 3 includes spectacle lens prescribing in view of binocular vision status.

A small aside: It is worthwhile noting that the way a patient responds to the add in bifocals/PALs isn't necessarily the same as for an add applied in a multifocal soft contact lens (MFCL). The add in bifocals/PALs helps decrease accommodation lag for near work,2尽管已显示MFCL的添加可以增加近距离的住宿滞后7可能是由于年轻的眼睛放松住宿，并在附近使用“添加区域”。如果您想了解更多有关此的信息，请查看Which MFCL - efficacy and function.

Latest spectacle designs

We now have new spectacle lens options for myopia control becoming available, which on early indications show better efficacy than progressive and bifocal spectacle lenses. The first of these is the Defocus Incorporated Multiple segment (DIMS) lens, commercialized by Hoya and already available in some Asian countries, that promisingly appears to provide a level of myopia control similar to contact lens options – even for those patients with normal binocular vision. Read more about this inSpectacle lenses for myopia control: new designs and latest studies.

Take home messages:

  1. Progressive addition and bifocal spectacle lenses can provide a useful myopia control effect, when correctly applied based on a child's binocular vision status. Bifocals with prismatic correction appear to work best of the standard spectacle lens options, and for most binocular vision presentations.
  2. Spectacles are usually considered after the patient or parents have turned down contact lens options, however myopia control specific spectacle lens designs are on the horizon, and even available in some countries now.
Kimberley 120x120

关于Kimberley

Kimberley Nguis a clinical optometrist from Perth, Australia, with experience in patient education programs, having practiced in both Australia and Singapore.

Connie headshot 120x120

关于Connie

康妮·甘is a clinical optometrist from Kedah, Malaysia, who provides comprehensive vision care for children and runs the myopia management service in her clinical practice.

参考

  1. Cheng D，Woo GC，Drobe B，Schmid KL。双焦点和棱镜双焦点眼镜对儿童近视进展的影响：一项随机临床试验的三年结果。JAMA眼科。2014年3月1日； 132（3）：258-64。(link)
  2. Gwiazda J，Hyman L，Hussein M，Everett D，Norton TT，Kurtz D，Leske MC，Manny R，Marsh-tootle W，ScheimanM。渐进式添加镜头的随机临床试验与单一视觉镜头在近视镜头上的近视镜头有关孩子们。调查性眼科与视觉科学。2003年4月1日； 44（4）：1492-500。(link)
  3. Leung JT，Brown B.香港中国学童的近视的进展因佩戴进度镜头而放缓。验光和视觉科学。1999年6月1日； 76（6）：346-54。(link)
  4. Cheng D，Woo GC，Schmid KL。双焦点透镜控制儿童近视进展。临床和实验验光。2011年1月； 94（1）：24-32。(link)
  5. Gwiazda J，Thorn F，Bauer J，Held R.近视儿童对Blur的适应性不足。调查性眼科与视觉科学。1993年3月1日； 34（3）：690-4。(link)
  6. 格赖斯Gwiazda J, K, Thorn F. Response AC/A ratios are elevated in myopic children. Ophthalmic and Physiological Optics. 1999 Mar;19(2):173-9.(link)
  7. Gong CR, Troilo D, Richdale K. Accommodation and Phoria in Children Wearing Multifocal Contact Lenses. Optometry and Vision Science. 2017;94:353-360.(link)
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