Contact lenses vs spectacles in myopes: is there any difference in accommodative and binocular function?

Theoretically, the accommodative and vergence demands are different between single-vision contact lenses and spectacle lenses. The aim of the present study was to determine whether these differences exist when these two correction methods are used in clinical practice. For this, different visual parameters that characterize the accommodative (accommodation amplitude, accommodative facility, and accommodative response) and binocular function (near and distance horizontal and vertical dissociated phorias, near and vertical associated phorias, near and distance negative and positive fusional vergence, vergence facility, near point of convergence, negative and positive relative accommodation, stimulus AC:A ratio and stereoacuity) were evaluated in a student population when their myopia was corrected with either spectacles or soft contact lenses (SCL).

All parameters were measured on two separate occasions in 30 myopic habitual contact lens and spectacle wearers of mean age 19 ± 2.4 years. Some parameters such as accommodation amplitude, accommodative response, and stimulus AC:A ratio were measured using two measurement methods which are commonly used in clinical practice. Three measurements were taken for each parameter and averaged. For the comparative statistical analysis, we used the Student’s t-test (p value < 0.05).

The following statistically significant differences were found with the use of SCL in comparison to spectacles: higher accommodative lags, higher negative relative accommodation, more esophoric near horizontal dissociated phoria, and lower negative fusional vergence in near vision.

The results found in this study show a definite trend towards poorer accommodative and vergence function with the use of contact lenses in comparison to glasses. This downward trend, though not statistically significant in accommodative function (lower PRA values and less lens amplitude of accommodation) might suggest that temporal insufficiency in the accommodation process could be occurring while contact lenses are used, thereby possibly creating a lag in accommodation to reduce associated overconvergence. This would be manifested in more esophoric values being found in the vergence function. The higher accommodative lags found in this study with SCL could indicate that prolonged use of SCL in near tasks may provoke a continuous hyperopic retinal defocus, a risk factor for the onset and progression of myopia, as indicated in numerous studies.