Impact of bifocal soft contact lenses and Midrimax on peripheral refraction and eye aberrations in children with myopia

Purpose of the work: to evaluate the effect of combined use of bifocal soft contact lenses (BSCL) and the combined drug Midrimax (Phenylephrine 5.0%; Tropicamide 0.8%) on peripheral refraction and wavefront aberrations of the eye. Material and methods. Prima BIO Bi-focal BSCL was prescribed to 43 children aged 10.42 ± 0.26 years with myopia of 3.43 ± 0.19 D. After 1 month, 23 children (group 1) were additionally prescribed Midrimax instillations. Results. The wavefront of the eye in BSCL undergoes significant changes: RMS HOAs increases by 4 times, tilt, vertical coma, horizontal trefoil by 1.5–2 times; positive spherical aberration (SA) increases on average by 20 times. In the BMCL, myopic defocus is formed in all zones of the near periphery of the retina, except for the N5° zone (instead of the hypermetropic defocus that existed without correction); in the N5° zone, hyperopic defocus is formed, which was absent without correction. The formation of myopic defocus is completely consistent with the multiple increase in positive SA and is explained by the design of the lens with a paracentral add zone. Continuous wearing of the BMCL for 6–12 months is accompanied by a decrease in hyperopic defocus of uncorrected eyes, and when combined with instillations of Midrimax — the formation of weakly myopic defocus in the N5° zone. After a month of continuous wearing of the BMCL, a decrease in the level of positive SA by 1.7–1.8 times was noted, which is consistent with an increase in manifest refraction and an increase in the tone of accommodation. Further instillations of the Midrimax resulted in a 3-fold increase in positive SA, indicating the elimination of excess tone. Conclusion. The identified changes in the wave front and peripheral defocus in the BMCL obviously explain the stabilizing effect of this optical and optical-pharmacological method of myopia control.

1. Haarman AEG, Enthoven CA, Tideman JWL, et al. The complications of myopia: A review and meta-analysis. Invest Ophthalmol Vis Sci. 2020; 61 (4): 49. https://doi.org/10.1167/iovs.61.4.49

2. Smith EL, Kee CS, Ramamirtham R, et al. Peripheral vision can influence eye growth and refractive development in infant monkeys. Invest Ophthalmol Vis Sci. 2005 Nov; 46 (11): 3965–72. doi: 10.1167/iovs.05-0445

3. Smith EL 3rd, Ramamirtham R, Qiao-Grider Y, et al. Effects of foveal ablation on emmetropization and form-deprivation myopia. Invest Ophthalmol Vis Sci. 2007; 48 (9): 3914–22. https://doi.org/10.1167/iovs.06-1264

4. Smith III EL, Arumugam B, Hung LF, et al. Eccentricity-dependent effects of simultaneous competing defocus on emmetropization in infant rhesus monkeys. Vision Res. 2020; 177: 32–40. https://doi.org/10.1016/j.visres.2020.08.003

5. Zheng X, Cheng D, Lu X, et al. Relationship between peripheral refraction in different retinal regions and myopia development of young chinese people. Front Med (Lausanne). 2022; 8: 802706. https://doi.org/10.3389/fmed.2021.802706

6. Delshad S, Collins MJ, Read SA, Vincent SJ. The time course of the onset and recovery of axial length changes in response to imposed defocus. Sci Rep. 2020; 10: 8322. https://doi.org/10.1038/s41598-020-65151-5

7. Pusti D, Patel NB, Ostrin LA, et al. Peripheral choroidal response to localized defocus blur: Influence of native peripheral aberrations. Invest Ophthalmol Vis Sci. 2024; 65 (4): 14. https://doi.org/10.1167/iovs.65.4.14

8. He JC. Theoretical model of the contributions of corneal asphericity and anterior chamber depth to peripheral wavefront aberrations. Ophthalmic Physiol Opt. 2014; 34 (3): 321–30. https://doi.org/10.1111/opo.12127

9. Kaphle D, Varnas SR, Schmid KL, et al. Accommodation lags are higher in myopia than in emmetropia: Measurement methods and metrics matter. Ophthalmic Physiol Opt. 2022; 42 (5): 1103–14. https://doi.org/10.1111/opo.13021

10. Tarutta E.P., Proskurina O.V., Markossian G.A., et al. A strategically oriented conception of optical prevention of myopia onset and progression. Russian Ophthalmological Journal. 2020; 13 (4): 7–16 (In Russ.). https://doi.org/10.21516/2072-0076-2020-13-4-7-16

11. Avetisov S.E., Myagkov A.V., Egorova A.V., Poskrebysheva Z.N., Zhabina O.A. Results of a two-year clinical study of myopia control with bifocal defocus-inducing soft contact lenses. Vestnik oftal’mologii. 2021; 137 (3): 5–12 (In Russ., In Engl.). https://doi.org/10.17116/oftalma20211370315

12. Song D, Qiu W, Jiang T, Chen Z, Chen J. Efficacy and adverse reactions of peripheral add multifocal soft contact lenses in childhood myopia: a meta-analysis. BMC Ophthalmol. 2024; 24 (1): 173. https://doi.org/10.1186/s12886-024-03408-7

13. Tarutta Е.Р., Proskurina O.V., Tarasova N.A., et al. Study design and immediate results of combined optopharmacological treatment of progressive myopia in children. Russian pediatric ophthalmology. 2023; 18 (3):127–33 (In Russ.). https://doi.org/10.17816/rpoj516533

14. Tarutta E.P., Milash S.V., Tarasova N.A., et al. Peripheral refraction and retinal contour in children with myopia by results of refractometry and partial coherence interferometry. Vestnik oftal’mologii. 2014; 130 (6): 44–9 (In Russ).

15. Neroev V.V., Tarutta E.P., Arutyunyan S.G., Khandzhyan A.T., Khodzhabekyan N.V. Wavefront aberrations and accommodation in myopes and hyperopes. Vestnik oftal’mologii. 2017; 133 (2): 5–9 (In Russ.). doi: 10.17116/oftalma201713324-9