Purpose: Higher myopic refractive errors are associated with serious ocularcomplications that can put visual function at risk. There is respectiveinterest in slowing and if possible stopping myopia progression before itreaches a level associated with increased risk of secondary pathology. Thepurpose of this report was to review our understanding of the rationale(s)and success of contact lenses (CLs) used to reduce myopia progression.Methods: A review commenced by searching the PubMed database. Theinclusion criteria stipulated publications of clinical trials evaluating theefficacy of CLs in regulating myopia progression based on the primaryendpoint of changes in axial length measurements and published in peerreviewedjournals. Other publications from conference proceedings or patentswere exceptionally considered when no peer-review articles were available.Results: The mechanisms that presently support myopia regulation withCLs are based on the change of relative peripheral defocus and changing thefoveal image quality signal to potentially interfere with the accommodativesystem. Ten clinical trials addressing myopia regulation with CLs werereviewed, including corneal refractive therapy (orthokeratology), peripheralgradient lenses, and bifocal (dual-focus) and multifocal lenses.Conclusions: CLs were reported to be well accepted, consistent, and safemethods to address myopia regulation in children. Corneal refractive therapy(orthokeratology) is so far the method with the largest demonstrated efficacy inmyopia regulation across different ethnic groups. However, factors such aspatient convenience, the degree of initial myopia, and non-CL treatments mayalso be considered. The combination of different strategies (i.e., centraldefocus, peripheral defocus, spectral filters, pharmaceutical delivery, andactive lens-borne illumination) in a single device will present further testablehypotheses exploring how different mechanisms can reinforce or competewith each other to improve or reduce myopia regulation with CLs.
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