Childhood and lifetime risk comparison of myopia control with contact lenses.

Purpose: The relative risks of ocular pathology with increasing myopia have been described; the absolute lifetime risk of vision impairment from myopia is yet to be compared to the childhood and lifetime risks of contact lens wear for myopia control.

Methods: Using peer-reviewed data, the absolute risks of microbial keratitis (MK) in daily disposable soft, reusable soft and orthokeratology contact lens (CL) wear were calculated over both a childhood (age 8-18) and a lifetime (age 8-65) of CL wear. This was compared to the previously published cumulative risk of vision impairment by age 75 based on increasing myopia and axial length. Data were converted utilizing the Council of International Organizations of Medical Sciences (CIOMS) classification system for frequency of adverse events, with 95 % confidence intervals included.

Results: The lifetime risk of vision impairment in axial lengths over 26 mm and more than 6D of myopia is greater than the lifetime risk of MK in any CL modality, except for adult SCL extended wear. If axial length is below 26 mm and myopia lower than 3D, a lifetime of CL wear is more risky in comparison, except in the case of daily disposable wear. Ten years of childhood CL wear of any modality presents lower likelihood of MK than any comparable risk of vision impairment.

Conclusion: The comparative lifetime risks of contact lens wear commenced at age 8 for myopia control are less than the lifetime risks of vision impairment with myopia more than 6D or axial length more than 26 mm. When only childhood CL wear is considered, the risk comparison is clearly skewed towards the positive impact of CL wear, especially in daily disposable wear. Clinicians should be confident to proactively recommend myopia control CL wear to younger children, as both the safety profile and potential preventative ocular health benefits are evident.