Skip to main content
Top

05-02-2025 | Myopia | Editor's Choice | News

No rebound effect after myopic teens discontinue soft multifocal lenses

Author: Sara Freeman

print
PRINT
insite
SEARCH

medwireNews: Results of the BLINK2 study show that there is no loss of treatment effect after older children with myopia discontinue using high-add center-distance soft multifocal contact lenses.

Axial elongation and the likelihood for myopia progression returned to faster, but age-expected rates after the lenses stopped being worn, researchers report in JAMA Ophthalmology.

These data “support fitting children with multifocal contact lenses for myopia control at a younger age and, when possible, continuing treatment until the late teenage years when myopia progression has naturally slowed,” say David Berntsen (University of Houston College of Optometry, Texas, USA) and co-authors on behalf of the Bifocal Lenses in Nearsighted Kids (BLINK) Study Group.

They explain that myopia control is important as myopia progression can be associated with significant vision-impairing complications such as glaucoma, detachment of the retina, and myopic macular degeneration.

In the original BLINK randomized controlled trial, the use of high-add (+2.50 diopter [D]) multifocal lenses was shown to slow myopia progression at 3 years of use to a greater degree than either medium-add (+1.50 D) or single-vision contact lenses.

Now, in an extension study, the BLINK Study Group has determined what happens after 2 subsequent years of high-add multifocal lens wear, followed by 1 year of single vision lenses.

A total of 248 of the original BLINK study’s participants accepted the invitation to enroll into the BLINK2 study, 59% of whom were female and the median age was 15 years.

The main outcome measures were axial length and spherical equivalent refractive error (SER), assessed in both eyes of the participants at the BLINK2 baseline and then annually. At baseline, the mean axial length was 25.16 mm and the mean SER was −3.45 D.

After a mean follow-up of 2.9 years, axial length had increased by 0.03 mm/year overall, from a rate of 0.05 mm/year while wearing multifocal lenses to 0.08 mm/year while wearing single-vision lenses. Similarly, SER had increased by an overall –0.17 D/year, from respective rates of –0.05 D/year to –0.22 D/year.

“The rate of axial elongation and myopia progression during the BLINK2 Study did not depend on participants’ original treatment group assignment,” the researchers report. However, the findings were affected by participant age.

Older participants had slower axial growth throughout the study, which the researchers say was “[a]s expected.” The mean rate of axial elongation was 0.10, 0.08, and 0.06 mm/year for participants aged 16, 17, and 18 years, respectively, at the time of the contact lens switch.

Myopia progression was found to be faster in the younger than older participants throughout the study, but with smaller increases when switched to single vision lenses. Increases in SER rates at ages 16, 17, and 18 years were a respective –0.12, –0.17, and –0.23 D/year.

The researchers acknowledge that the differences in axial elongation and myopia progression were “clinically small” overall and were unaffected by the duration of multifocal lens use over the two studies. They acknowledge that the lack of a single-vision lens control group is a study limitation but explain that “it would be unethical to withhold multifocal lens treatment” following the “clinically meaningful” treatment effect in the original BLINK study.

In an invited editorial, Lori Ann Kehler and David Wallace, both from Vanderbilt University Medical Center in Nashville, Tennessee, USA, observe that “[w]hen treatment effects are small, the concept of rebound becomes less clinically meaningful.”

They also suggest that the findings are “likely not generalizable to younger children who may be discontinuing therapy” with multifocal lenses because many participants were older teenagers by the time they entered the final year of the extension study, and “[o]ne would not expect significant myopia progression for most participants at this age.”

Kehler et al note, however, that studies such as BLINK2 “provide important insight into the long-term impact of attempts at myopia control” and that the study “adds to the body of evidence suggesting that optical treatments like soft multifocal contact lenses, myopia control spectacles, and orthokeratology have less rebound than atropine and red light therapy.”

Whether childhood myopia control improvement leads to fewer long-term vision-impairing complications is unknown, the commentators remark, concluding that only “then we will know that these interventions are truly impactful.”

medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2025 Springer Healthcare Ltd, part of the Springer Nature Group

JAMA Ophthalmol 2025; doi:10.1001/jamaophthalmol.2024.5885
JAMA Ophthalmol 2025; doi:10.1001/jamaophthalmol.2024.6083

print
PRINT

Related topics