A Randomized Clinical Trial of Progressive Addition Lenses versus Single Vision Lenses on the Progression of Myopia in Children

Published on Apr 1, 2003in Investigative Ophthalmology & Visual Science4.799
· DOI :10.1167/IOVS.02-0816
Jane Gwiazda33
Estimated H-index: 33
(New England College of Optometry),
Leslie Hyman54
Estimated H-index: 54
(SBU: Stony Brook University)
+ 7 AuthorsM. Scheiman4
Estimated H-index: 4
(Salus University)
Sources
Abstract
PURPOSE. The purpose of the Correction of Myopia Evaluation Trial (COMET) was to evaluate the effect of progressive addition lenses (PALs) compared with single vision lenses (SVLs) on the progression of juvenile-onset myopia. METHODS. COMET enrolled 469 children (ages 6-11 years) with myopia between -1.25 and -4.50 D spherical equivalent. The children were recruited at four colleges of optometry in the United States and were ethnically diverse. They were randomly assigned to receive either PALs with a +2.00 addition (n = 235) or SVLs (n = 234), the conventional spectacle treatment for myopia, and were followed for 3 years. The primary outcome measure was progression of myopia, as determined by autorefraction after cycloplegia with 2 drops of 1% tropicamide at each annual visit. The secondary outcome measure was change in axial length of the eyes, as assessed by A-scan ultrasonography. Child-based analyses (i.e., the mean of the two eyes) were used. Results were adjusted for important covariates, by using multiple linear regression. RESULTS. Of the 469 children (mean age at baseline, 9.3 ± 1.3 .3 years), 462 (98.5%) completed the 3-year visit. Mean (±SE) 3-year increases in myopia (spherical equivalent) were -1.28 ± 0.06 D in the PAL group and -1.48 ± 0.06 D in the SVL group. The 3-year difference in progression of 0.20 ± 0.08 D between the two groups was statistically significant (P = 0.004). The treatment effect was observed primarily in the first year. The number of prescription changes differed significantly by treatment group only in the first year. At 6 months, 17% of the PAL group versus 30% of the SVL group needed a prescription change (P = 0.0007), and, at 1 year, 43% of the PAL group versus 59% of the SVL group required a prescription change (P = 0.002). Interaction analyses identified a significantly larger treatment effect of PALS in children with lower versus higher baseline accommodative response at near (P = 0.03) and with lower versus higher baseline myopia (P = 0.04). Mean (± SE) increases in the axial length of eyes of children in the PAL and SVL groups, respectively, were: 0.64 ±0.02 mm and 0.75 ± 0.02 mm, with a statistically significant 3-year mean difference of 0.11 ± 0.03 mm (P = 0.0002). Mean changes in axial length correlated with those in refractive error (r = 0.86 for PAL and 0.89 for SVL). CONCLUSIONS. Use of PALS compared with SVLs slowed the progression of myopia in COMET children by a small, statistically significant amount only during the first year. The size of the treatment effect remained similar and significant for the next 2 years. The results provide some support for the COMET rationale-that is, a role for defocus in progression of myopia. The small magnitude of the effect does not warrant a change in clinical practice.
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PURPOSE. To determine whether the use of progressive addition spectacle lenses reduced the progression of myopia, over a 2-year period, in Hong Kong children between the ages of 7 and 10.5 years. METHODS. A clinical trial was carried out to compare the progression in myopia in a treatment group of 138 (121 retained) subjects wearing progressive lenses (PAL; add 1.50 D) and in a control group of 160 (133 retained) subjects wearing single vision lenses (SV). The research design was masked with ran...
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PURPOSE. To describe baseline refractive and ocular component measures in children with myopia enrolled in the Correction of Myopia Evaluation Trial (COMET). COMET is a multicenter, randomized clinical trial to evaluate whether progressive-addition lenses slow the progression of juvenile-onset myopia compared with single-vision lenses. METHODS. Four hundred sixty-nine children with myopia between 1.25 and 4.50 D spherical equivalent and without eye or systemic conditions known to affect refracti...
#1Leslie Hyman (SBU: Stony Brook University)H-Index: 54
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The Correction of Myopia Evaluation Trial (COMET) is a multicenter, randomized, double-masked, controlled clinical trial evaluating whether there is a difference in the progression of myopia between children wearing progressive addition lenses (PALs) versus conventional single vision lenses (SVLs), as measured by cycloplegic autorefraction. Axial length, measured by A-scan ultrasonography, is an additional outcome measure. To meet the recruitment goal of 450 participants, eligible children ages ...
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