Effect of High Add Power, Medium Add Power, or Single-Vision Contact Lenses on Myopia Progression in Children: The BLINK Randomized Clinical Trial | Ophthalmology | JAMA | JAMA Network
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Original Investigation
August 11, 2020

Effect of High Add Power, Medium Add Power, or Single-Vision Contact Lenses on Myopia Progression in Children: The BLINK Randomized Clinical Trial

Author Affiliations
  • 1The Ohio State University College of Optometry; Columbus
  • 2University of Houston College of Optometry; Houston, Texas
  • 3Private Practice, Houston, Texas
  • 4Johnson & Johnson Vision Care, Inc, Jacksonville, Florida
JAMA. 2020;324(6):571-580. doi:10.1001/jama.2020.10834
Key Points

Question  Can soft multifocal contact lenses with a high add power slow myopia progression in children more than medium add power or single-vision contact lenses?

Findings  In this randomized clinical trial that included 294 children aged 7 to 11 years with myopia (−0.75 D to −5.00 D), after 3 years, the use of high add power (+2.50 D) contact lenses resulted in myopia progression of −0.60 D, the use of medium add power (+1.50 D) contact lenses resulted in myopia progression of −0.89 D, and the use of single-vision contact lenses resulted in myopia progression of −1.05 D. The pairwise comparisons were statistically significant between high add power and single-vision contact lenses as well as between high add and medium add power contact lenses.

Meaning  Among children with myopia, treatment with high add power multifocal contact lenses compared with medium add power multifocal and single-vision contact lenses reduced the rate of myopia progression over 3 years, but further research is needed to understand the clinical importance of the observed differences as well as long-term outcomes.


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