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Nighttime contact lenses show promise in controlling nearsightedness

by Gina Morgano
April 21, 2009

Adam Wolken, 16, of Northbrook, may be nearsighted, but it doesn’t interfere with his athletic performance. He plays hassle-free, with no glasses or contacts hindering his perfect-vision game.

That’s because Adam is a participant in the SMART (Stabilization of Myopia by Accelerated Reshaping Technique) Trial, a national study led by Chicago researchers Drs. S. Barry Eiden and Robert Davis. The study is looking at whether certain contacts prevent nearsightedness from worsening as children age.

“(The contacts) changed a lot of things in my life,” Wolken said. “I can even go two or three different days without wearing them if I have to – like if I’m on a trip or something and don’t have access to them. I can play better because I don’t have to worry about my glasses.”

The five-year trial is only in its second year, but first-year results show promise, Eiden said.

The 300 participants will be 13 to 19 years old when the EyeVis Eye and Vision Research Institute trial is complete.

Half the subjects serve as the control group, wearing regular, soft contacts during the day. The others sleep in customized Corneal Reshaping Therapy lenses and use no contacts or glasses during the day.

“At the end of one year, the test group was absolutely rock solid, no progression (of nearsightedness) at all,” Eiden said. “The control group had two power steps of progression on average.”  One power step equals a change of .25 diopters in prescription strength.

The findings were presented to vision specialists in January at the Global Specialty Lens Symposium in Las Vegas.

The FDA approved corneal reshaping lenses in 2002. They were originally intended to treat myopia, or nearsightedness, with the added convenience of wearers being contact- and glasses-free while awake. The lenses eliminate the need for daytime vision correction by reshaping the cornea during sleep.

Contacts approved for overnight use have a slightly greater risk of infection than other contacts, but Eiden said both groups were infection-free during the first year. “There were no significant complications in either group,” he said.

The trial is the third study of its kind and is, by far, the largest. There are 10 national testing sites, including the researchers’ private practices in Deerfield and Oak Lawn and sites at the University of Michigan in Ann Arbor and the University of Missouri - St. Louis.

Gwen Wolken, Adam’s mother, found the study appealing  because her son would no longer have to worry about wind and particles interfering with his contacts.  It took about a week for her son to adjust to the lenses, she said, but now he loves them.

“He basically sees at about 20/15 during the day which is better than most,” she said. “We were just hoping for 20/20.” Wolken now sees better with the treatment than he does with his glasses.

Gwen Wolken said if  her younger son ever needs vision correction, he would go immediately into the therapy lenses.  “I wouldn’t even think twice about it,” she said. 

The onset of nearsightedness typically occurs around third or fourth grade, and eyes change most rapidly up until age 20 or 21, according to Eiden.  After that, a person’s prescription usually stays relatively stable.

If the study’s hypothesis holds up, children with mild nearsightedness could have healthier eyes as adults, with a greater chance of successful LASIK, vision-correcting surgery and less risk of retinal complications later in life, Eiden said.

Unlike surgery, however, the therapy is not a permanent cure for nearsightedness.  The study includes a regression phase in which participants leave their contacts out for seven to ten days, the time it takes eyes to revert back to normal. Wolken said he needs glasses for some of this phase, but, since he began using the contacts, his prescription has remained constant. 

Rebecca Liu, 20, a student at the University of California, Berkeley, is not in the study but has worn the lenses since seventh grade.

“I started off about maybe -2.75 (diopters), around there, and now my right eye is like perfect and my left is -.75 to -1.00,” said the former Naperville woman.

While she hasn’t gone excessive lengths of time without her contacts, Liu believes her vision has improved. Her new prescription  correlates to when she hasn’t worn her contacts for several nights.

Unlike Wolken, Liu cannot go multiple days without the treatment and still have perfect vision. “I got glasses a couple years ago,” she said, “because if I don’t wear my contacts for one night, then the chalkboard gets blurry.”

While the trial and anecdotal evidence exude potential, the therapy is still considered new and proves difficult to find. Most doctors’ offices do not offer the customized lenses. The contacts also carry a first-year expense of $1,000 to $2,000 for the initial fitting and follow-up care. Annual replacement costs, however, are comparable to other contacts, Eiden said. 

Optometrist Robert Grohe, an assistant professor and contact lens specialist at Northwestern University’s Feinberg School of Medicine, compares the therapy to braces. “The lenses sit in such a way that, like orthodontics, tends to manipulate the front of the eye,” he said.

Are they worth the investment?

“They do appear to have a very helpful affect on slowing down the progression of myopia in children,” Grohe said.

While the lenses are “definitely a way to modify myopia,” he said a variety of factors could influence their success, including biology and discipline of regime. There is still a long way to go before the contacts’ level of effectiveness is accurately known.