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Importance: Slowing myopia progression could decrease the risk of sight-threatening complications.Objective: To determine whether soft multifocal contact lenses slow myopia progression in children, and whether high add power (+2.50 D) slows myopia progression more than medium (+1.50 D) add power lenses.Design, Setting, and Participants: A double-masked randomized clinical trial that took place at 2 optometry schools located in Columbus, Ohio, and Houston, Texas. A total of 294 consecutive eligible children aged 7 to 11 years with -0.75 D to -5.00 D of spherical component myopia and less than 1.00 D astigmatism were enrolled between September 22, 2014, and June 20, 2016. Follow-up was completed June 24, 2019.Interventions: Participants were randomly assigned to wear high add power (n = 98), medium add power (n = 98), or single-vision (n = 98) contact lenses.Main Outcomes and Measures: The primary outcome was the 3-year change in cycloplegic spherical equivalent autorefraction, as measured by the mean of 10 autorefraction readings. There were 11 secondary end points, 4 of which were analyzed for this study, including 3-year eye growth.Results: Among 294 randomized participants, 292 (99%) were included in the analyses (mean [SD] age, 10.3 [1.2] years; 177 [60.2%] were female; mean [SD] spherical equivalent refractive error, -2.39 [1.00] D). Adjusted 3-year myopia progression was -0.60 D for high add power, -0.89 D for medium add power, and -1.05 D for single-vision contact lenses. The difference in progression was 0.46 D (95% CI, 0.29-0.63) for high add power vs single vision, 0.30 D (95% CI, 0.13-0.47) for high add vs medium add power, and 0.16 D (95% CI, -0.01 to 0.33) for medium add power vs single vision. Of the 4 secondary end points, there were no statistically significant differences between the groups for 3 of the end points. Adjusted mean eye growth was 0.42 mm for high add power, 0.58 mm for medium add power, and 0.66 mm for single vision. The difference in eye growth was -0.23 mm (95% CI, -0.30 to -0.17) for high add power vs single vision, -0.16 mm (95% CI, -0.23 to -0.09) for high add vs medium add power, and -0.07 mm (95% CI, -0.14 to -0.01) for medium add power vs single vision.Conclusions and Relevance: Among children with myopia, treatment with high add power multifocal contact lenses significantly reduced the rate of myopia progression over 3 years compared with medium add power multifocal and single-vision contact lenses. However, further research is needed to understand the clinical importance of the observed differences.Trial Registration: ClinicalTrials.gov Identifier: NCT02255474. [ABSTRACT FROM AUTHOR]

Purpose: To determine the proportion of infants in a pediatric medical practice who have high levels of hyperopia in addition to evaluating the ability of the PowerRefractor (PR) [with and without accessory +4.50 diopter (D) spectacles] compared with cycloplegic retinoscopy to detect highly hyperopic refractive errors., Methods: The cycloplegic refractive error (2 drops tropicamide 1% given 5 min apart) of 200 normal birth weight infants was measured by retinoscopy and the Plusoptix PR. If initial readings were ≥ +2.00 D, PR measurement was repeated with accessory +4.50 D spectacles to extend its operating range. Examinations were conducted during well-baby visits at 2 months of age at the office of a local pediatrician group practice., Results: Of the 200 infants, 7.5% had a spherical equivalent refractive error of +5.00 D or more in both eyes. The use of +4.50 D accessory glasses during PowerRefraction significantly improved the ability to detect higher levels of hyperopia. Areas under receiver operating characteristic curves that were 0.69 to 0.51 when no glasses were worn improved to 0.87 to 0.98 when the glasses were worn (cutpoints between +3.50 and +5.00 D by retinoscopy). Significant underestimation of higher levels of hyperopia by the PR compared with retinoscopy was eliminated when +4.50 D accessory glasses were worn., Conclusions: Accessory +4.50 diopter sphere spectacles appeared to successfully extend the operating range of the PR with cycloplegia, allowing for detection of high levels of hyperopia that occurred in a large proportion of 2-month old infants with adequate sensitivity and specificity compared with cycloplegic retinoscopy.

Purpose: To quantify the degree of association between juvenile myopia and parental myopia, near work, and school achievement., Methods: Refractive error, parental refractive status, current level of near activities (assumed working distance-weighted hours per week spent studying, reading for pleasure, watching television, playing video games or working on the computer), hours per week spent playing sports, and level of school achievement (scores on the Iowa Tests of Basic Skills [ITBS]) were assessed in 366 eighth grade children who participated in the Orinda Longitudinal Study of Myopia in 1991 to 1996., Results: Children with myopia were more likely to have parents with myopia; to spend significantly more time studying, more time reading, and less time playing sports; and to score higher on the ITBS Reading and Total Language subtests than emmetropic children (chi(2) and Wilcoxon rank-sum tests; P < 0.024). Multivariate logistic regression models showed no substantial confounding effects between parental myopia, near work, sports activity, and school achievement, suggesting that each factor has an independent association with myopia. The multivariate odds ratio (95% confidence interval) for two compared with no parents with myopia was 6.40 (2.17-18.87) and was 1.020 (1.008-1.032) for each diopter-hour per week of near work. Interactions between parental myopia and near work were not significant (P = 0.67), indicating no increase in the risk associated with near work with an increasing number of parents with myopia., Conclusions: Heredity was the most important factor associated with juvenile myopia, with smaller independent contributions from more near work, higher school achievement, and less time in sports activity. There was no evidence that children inherit a myopigenic environment or a susceptibility to the effects of near work from their parents.