Myopia progression trials have tested many optical treatments, and two of the best known are COMET, which studied progressive addition spectacles, and BLINK, which studied multifocal contact lenses.
Also, reading them side by side shows how the field moved from small effects with glasses to larger ones with soft multifocal lenses (see pathologic myopia).
COMET: The Spectacle Trial in Myopia Progression Trials
The Correction of Myopia Evaluation Trial enrolled 469 children aged 6 to 11 years with myopia between -1.25 and -4.50 diopters, and randomized them to progressive addition lenses or single vision lenses for three years (see the references).
In addition, the theory was that reducing accommodative lag would slow eye growth.
COMET Results
Progressive lenses slowed myopia progression by 0.20 diopters over three years, a statistically significant difference that is clinically small.
In addition, the effect was larger in children with a high accommodative lag and near esophoria, about 0.6 diopters, which led to a follow-up trial in that subgroup (see the references).
The effect did not last once children grew older, and the lenses are rarely used for myopia control alone.
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From Choroida — the team behind this siteBLINK: The Contact Lens Trial in Myopia Progression Trials
Also, the Bifocal Lenses In Nearsighted Kids trial enrolled 294 children aged 7 to 11 years with myopia between -0.75 and -5.00 diopters.
They were randomized to high add multifocal, medium add multifocal, or single vision soft contact lenses for three years (see the references).
BLINK Results
- High add power lenses slowed progression by about 0.46 diopters over three years against single vision lenses
- Axial elongation was reduced by about 0.23 millimeters
- Medium add lenses gave a smaller effect
The effect was consistent in all age groups, and was a clear step up from COMET.
Myopia Progression Trials: Why the Results Differ
The multifocal contact lenses place a strong myopic defocus in the periphery while giving a clear center.
They are worn at all times.
In addition, progressive spectacle lenses give a small near add that does little to the periphery.
Children often look through the distance zone.
Safety and Practicalities
- Contact lenses carry a small risk of keratitis, so hygiene and follow-up are essential
- Children need training, and parents help
- Spectacle options such as defocus lenses are simpler for young children
Other Evidence From Myopia Progression Trials
A Cochrane review found that low-dose atropine, orthokeratology, and multifocal contact lenses all slow progression, with atropine and the optical designs giving the largest effects (see the references and low-dose atropine for myopia control).
Also, each treatment has its own pros and cons.
Myopia Progression Trials: Practical Use
Choose a myopia control method based on age, motivation, and risks, measure axial length to follow, and consider combination treatment for fast progressors.
An Example Case
A 10-year-old girl with -2.50 diopters in each eye has progressed by 1.00 diopter in the past year.
Her parents choose daily disposable high-add multifocal contact lenses based on the BLINK evidence.
The axial length is also measured at the start and at six-month intervals.
Over two years her progression slows to 0.4 diopters a year, and she has no complications.
Practical Steps in the Clinic
- Measure cycloplegic refraction and axial length at baseline
- Choose the method according to age, ability to handle lenses, and family preference
- Review every six months, with measurements of axial length
- Consider adding low-dose atropine when progression remains fast
Counselling Families
Explain that these treatments slow the rate of myopia and do not stop it, that wearing the lenses all day matters, and that outdoor time also helps.
Tell families that good lens care reduces the small risk of infection, and ask them to call at once for redness or pain.
Key Points to Remember
- COMET showed a small benefit from progressive spectacles
- BLINK showed a larger benefit from high-add soft multifocals
- Axial length is the best measure of response
- Combining treatments may add benefit
Limits of the Trials
Both studies used refraction as the main outcome.
The BLINK trial also measured axial length, which gives a more direct sign of eye growth.
Results are for three years, and it is not known if the effect lasts after treatment stops, or if it lowers the later risk of eye disease.
Looking Ahead
Spectacle lenses with small lenslets have since shown a larger effect than progressive lenses, and trials of red light and combined treatment are under way.
Longer follow-up will show whether slowing early progression reduces the risk of high myopia complications.
For the latest studies, see the PubMed results for myopia progression trials.
Document what you see
Two smartphone imaging tools built for everyday clinic use — one for the slit lamp, one for the fundus.
From Choroida — the team behind this siteReferences
- Gwiazda J, Hyman L, Hussein M, et al. A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression of myopia in children. Invest Ophthalmol Vis Sci. 2003;44:1492-1500.
- Walline JJ, Walker MK, Mutti DO, et al. Effect of high add power, medium add power, or single-vision contact lenses on myopia progression in children: the BLINK randomized clinical trial. JAMA. 2020;324:571-580.
- Walline JJ, Lindsley KB, Vedula SS, et al. Interventions to slow progression of myopia in children. Cochrane Database Syst Rev. 2020;1:CD004916.
- American Academy of Ophthalmology. Basic and Clinical Science Course, Section 3: Clinical Optics. AAO; current edition.
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