Could the BLINK clinical trial series be about to show us the way to prevent nearsightedness (myopia)? Optometry researchers bring us closer to a cure for bad eyesight.
What on earth is your tween or teen doing to make their eyesight worse? Too much studying at night? Too much TV? Too much gaming? The bad news is, it’s not something you can fix as simply as instating a light-out policy. It happens because they are in the midst of an intense growth phase – eyes and all. Myopia usually starts showing up around age eight and stabilizes by approximately 16 years old. As kids’ eyes grow, the fault that causes short-sightedness gets bigger.
The good news is, ophthalmologists say they might be able to slow down the myopia, preventing short sightedness, with something as straightforward as soft contact lenses.
Houston, Texas-based investigative optometrists relayed last week, January 16, 2025, in JAMA Ophthalmology, that teens who wore multifocal soft contact lenses for two years slowed the progression of myopia (short-sightedness). When the kids switched to single vision lenses the myopia started to advance again, but at an age appropriate rate. It didn’t speed up to make up for the delay.
BLINK and You’ll Miss It
The study, known as BLINK2, was a follow up to an initial clinical trial: Bifocal Lenses in Nearsighted Kids or BLINK. This was a randomized controlled trial that tested the hypothesis that bifocal contact lenses could slow down the progression of myopia or nearsightedness in kids. That’s right, there could be a way to prevent or slow down myopia.
Published in 2020, the study demonstrated that if you fit kids aged around 10 years old with soft, bifocal contact lenses, and they wear them as much as possible during waking hours (on average 11 hours a day), after three years, their myopia will proceed slower than kids who wore single vision lenses. The kids, their parents and the optometrists who tested their vision at each check point did not know whether the child was wearing single vision lenses of bifocals.
Researchers based at Ohio State University and the University of Houston recruited 294 children aged between seven and eleven years old. The children had to have myopia of between -0.75 D and -5.00 D with astigmatism below 1.00 D cylinder and no prior use of vision correction. Doctors assigned around 90 children randomly to each of three groups. One group was the control group, they were fitted with single vision soft contact lenses. The second and third groups were the experimental group. One set were fitted with multifocal soft lenses at +1.50 D and the other with multifocal soft lenses adding +2.50 D.
A cure for myopia?
After three years the investigators found that children fitted with multifocal contact lenses had better vision than kids who got single lenses. While kids who got single vision lenses advanced by an average of -1.05 D, kids who wore multifocal progressed less. The medium strength lens gave a change of – 0.89 D while the high strength correction yielded -0.6 D.
Not only did the multifocal lenses slow down the progression of myopia, but they had a dose-dependent effect. That means the more correction, the stronger the slowing effect. The researchers do admit that the difference in vision is pretty small and may or may not be clinically meaningful. Three years is not a long time, however, when you consider that they could be growing for another seven years. Perhaps a study end date of 10 years would show a bigger final difference.
Taking a Long View
A slowing of myopia wasn’t the only thing the researchers spotted. They also found that wearing the multifocal contact lenses slowed down axial growth of the eye. What does that mean? Well, the researchers hypothesized that the direction of eye growth was partly responsible for the changes in eyesight, and that our eyes grow in response to where the light is focused in the eye.
They wondered if using these multifocal lenses to focus some light in front of the retina would slow down the growth of the eye.
Our eyes are not perfectly round, those with astigmatism might have been told they have eyes the shape of American footballs or rugby balls. In fact, even people who don’t have astigmatism don’t really have spherical eye balls. As children when we grow, our eyes grow too, but they don’t grow evenly in every direction.
Our eyes evolved so that our cornea and lens can work together to catch light and focus it on our retina so that our light-detecting cells can capture it and send the messages through to our brain. Some people have eyes that are shaped so that the retina is too far back from where the light is perfectly focused, so when it finally hits their retina it’s no longer in focus. We wear artifical lenses (spectacles, contacts) to help focus the light into the zone that best helps project a clear image onto our retina.
If we could find a way to help the growing eye to keep the right proportions as it grows perhaps, optometrists wonder, we could prevent myopia from progressing.
Shaping the future of Myopia
The researchers theorize that for some reason children with short-sightedness have eyes that grow more from front to back. Over time, this increasing distance between the sweet spot of the focal point and the retina makes their vision get progressively worse.
The BLINK study found that wearing multifocal contact lenses starting at around age 10, slowed down the front to back (axial) growth of the eye. At the end of the three-year study, the eyes of children with the strongest multifocal correction lenses had grown an average of 0.23 mm less than kids who wore single vision lenses.
This was a big difference, over the three years eyes with single vision correction got 0.63mm longer from front to back, while kids eyes with high-powered multifocal lenses grew only 0.42mm- that’s a 30% difference. This seemed to back up the idea that the change in distance due to growth causes myopia to get worse, but also led to more questions.
BLINK 2 – After 5 years Myopia Stalls?
So were the results of the 2020 trial permanent? Reversible? Did the kids eyes stop growing altogether? Did they go through a growth spurt to catch up? Did the leneses prevent myopia from getting worse? This is where BLINK2 comes in.
Following the seeming success of BLINK over three years, the eye doctors needed to find out what happens next? If kids take out their lenses, will their eyes go through a catch up growth spurt? Do the kids keep the vision advantage? Did the lenses cause any long-term problems?
In a press release for the NIH, principal investigator David A. Berntsen, O.D., Ph.D., chair of clinical sciences at the University of Houston College of Optometry explained, ‘There was concern that the eye might grow faster than normal when myopia-control contact lenses were discontinued.’
A Second Look
The Texas team and their Ohio colleagues picked up their measuring tools once again to track how their teens fared with and without their multifocal lenses
This time the researchers gave the kids who took part in the BLINK trial and made it to the end multifocal contact lenses. Two hundred and forty-eight kids with a median age of 15 wore the multifocal lenses for the next two years.
After two years the kids had their vision tested and their eyes measured. They then wore single vision lenses for the next twelve months and had their measurements taken again.
The doctors discovered that all the kids benefitted from wearing multifocal contact lenses. The kids who had worn them during the BLINK trial gained the most benefit. Their eyes were shorter, and their myopia progressed more slowly. Kids who stopped wearing the lenses in their late teens halted the progression of myopia. Teens who switched to single vision lenses a little younger found that their eyes started to grow again but at the normal rate for a kid their age.
Preventing Myopia
‘Our findings show that when older teenagers stopped wearing these lenses, the eye returned to the age-expected rate of growth.’ Said Berntsen, explaining that while their myopia did progress once they stopped wearing the lens, their vision was still better than it would have been had they never worn multifocal lenses.
‘Our findings suggest that it’s a reasonable strategy to fit children with multifocal contact lenses for myopia control at a younger age and continue treatment until the late teenage years when myopia progression has slowed,’ said BLINK 2 study chair Jeffrey J. Walline, O.D., Ph.D., associate dean for research at the Ohio State University College of Optometry, Columbus.
Could something as simple as bifocal lenses between ages 7 and 16 prevent myopia? We’ll have to wait and see.
References
Contact lenses used to slow nearsightedness in youth have a lasting effect. National Institutes of Health (NIH). January 16, 2025. Accessed January 20, 2025. https://www.nih.gov/news-events/news-releases/contact-lenses-used-slow-nearsightedness-youth-have-lasting-effect
Berntsen DA, Tićak A, Orr DJ, et al. Axial Growth and Myopia Progression After Discontinuing Soft Multifocal Contact Lens Wear. JAMA Ophthalmology. Published online January 16, 2025. doi:10.1001/jamaophthalmol.2024.5885
Walline JJ, Walker MK, Mutti DO, et al. Effect of High Add Power, Medium Add Power, or Single-Vision Contact Lenses on Myopia Progression in Children: The BLINK Randomized Clinical Trial. JAMA. 2020;324(6):571. doi:10.1001/jama.2020.10834
Could the BLINK clinical trial series be about to show us the way to prevent nearsightedness (myopia)? Optometry researchers bring us closer to a cure for bad eyesight. What on earth is your tween or teen doing to make their eyesight worse? Too much studying at night? Too much TV? Too much gaming? The bad news is, it’s not something you can fix as simply as instating a light-out policy. It happens because they are in the midst of an intense growth phase – eyes and all. Myopia usually starts showing up around age eight and stabilizes by approximately 16 years old. As kids’ eyes grow, the fault that causes short-sightedness gets bigger. The good news is, ophthalmologists say they might be able to slow down the myopia, preventing short sightedness, with something as straightforward as soft contact lenses. Houston, Texas-based investigative optometrists relayed last week, January 16, 2025, in JAMA Ophthalmology, that teens who wore multifocal soft contact lenses for two years slowed the progression of myopia (short-sightedness). When the kids switched to single vision lenses the myopia started to advance again, but at an age appropriate rate. It didn’t speed up to make up for the delay. The study, known as BLINK2, was a follow up to an initial clinical trial: Bifocal Lenses in Nearsighted Kids or BLINK. This was a randomized controlled trial that tested the hypothesis that bifocal contact lenses could slow down the progression of myopia or nearsightedness in kids. That’s right, there could be a way to prevent or slow down myopia. Published in 2020, the study demonstrated that if you fit kids aged around 10 years old with soft, bifocal contact lenses, and they wear them as much as possible during waking hours (on average 11 hours a day), after three years, their myopia will proceed slower than kids who wore single vision lenses. The kids, their parents and the optometrists who tested their vision at each check point did not know whether the child was wearing single vision lenses of bifocals. Researchers based at Ohio State University and the University of Houston recruited 294 children aged between seven and eleven years old. The children had to have myopia of between -0.75 D and -5.00 D with astigmatism below 1.00 D cylinder and no prior use of vision correction. Doctors assigned around 90 children randomly to each of three groups. One group was the control group, they were fitted with single vision soft contact lenses. The second and third groups were the experimental group. One set were fitted with multifocal soft lenses at +1.50 D and the other with multifocal soft lenses adding +2.50 D. After three years the investigators found that children fitted with multifocal contact lenses had better vision than kids who got single lenses. While kids who got single vision lenses advanced by an average of -1.05 D, kids who wore multifocal progressed less. The medium strength lens gave a change of – 0.89 D while the high strength correction yielded -0.6 D. Not only did the multifocal lenses slow down the progression of myopia, but they had a dose-dependent effect. That means the more correction, the stronger the slowing effect. The researchers do admit that the difference in vision is pretty small and may or may not be clinically meaningful. Three years is not a long time, however, when you consider that they could be growing for another seven years. Perhaps a study end date of 10 years would show a bigger final difference. A slowing of myopia wasn’t the only thing the researchers spotted. They also found that wearing the multifocal contact lenses slowed down axial growth of the eye. What does that mean? Well, the researchers hypothesized that the direction of eye growth was partly responsible for the changes in eyesight, and that our eyes grow in response to where the light is focused in the eye. They wondered if using these multifocal lenses to focus some light in front of the retina would slow down the growth of the eye. Our eyes are not perfectly round, those with astigmatism might have been told they have eyes the shape of American footballs or rugby balls. In fact, even people who don’t have astigmatism don’t really have spherical eye balls. As children when we grow, our eyes grow too, but they don’t grow evenly in every direction. Our eyes evolved so that our cornea and lens can work together to catch light and focus it on our retina so that our light-detecting cells can capture it and send the messages through to our brain. Some people have eyes that are shaped so that the retina is too far back from where the light is perfectly focused, so when it finally hits their retina it’s no longer in focus. We wear artifical lenses (spectacles, contacts) to help focus the light into the zone that best helps project a clear image onto our retina. If we could find a way to help the growing eye to keep the right proportions as it grows perhaps, optometrists wonder, we could prevent myopia from progressing. The researchers theorize that for some reason children with short-sightedness have eyes that grow more from front to back. Over time, this increasing distance between the sweet spot of the focal point and the retina makes their vision get progressively worse. The BLINK study found that wearing multifocal contact lenses starting at around age 10, slowed down the front to back (axial) growth of the eye. At the end of the three-year study, the eyes of children with the strongest multifocal correction lenses had grown an average of 0.23 mm less than kids who wore single vision lenses. This was a big difference, over the three years eyes with single vision correction got 0.63mm longer from front to back, while kids eyes with high-powered multifocal lenses grew only 0.42mm- that’s a 30% difference. This seemed to back up the idea that the change in distance due to growth causes myopia to get worse, but also led to more questions. So were the results of the 2020 trial permanent? Reversible? Did the kids eyes stop growing altogether? Did they go through a growth spurt to catch up? Did the leneses prevent myopia from getting worse? This is where BLINK2 comes in. Following the seeming success of BLINK over three years, the eye doctors needed to find out what happens next? If kids take out their lenses, will their eyes go through a catch up growth spurt? Do the kids keep the vision advantage? Did the lenses cause any long-term problems? In a press release for the NIH, principal investigator David A. Berntsen, O.D., Ph.D., chair of clinical sciences at the University of Houston College of Optometry explained, ‘There was concern that the eye might grow faster than normal when myopia-control contact lenses were discontinued.’ The Texas team and their Ohio colleagues picked up their measuring tools once again to track how their teens fared with and without their multifocal lenses This time the researchers gave the kids who took part in the BLINK trial and made it to the end multifocal contact lenses. Two hundred and forty-eight kids with a median age of 15 wore the multifocal lenses for the next two years. After two years the kids had their vision tested and their eyes measured. They then wore single vision lenses for the next twelve months and had their measurements taken again. The doctors discovered that all the kids benefitted from wearing multifocal contact lenses. The kids who had worn them during the BLINK trial gained the most benefit. Their eyes were shorter, and their myopia progressed more slowly. Kids who stopped wearing the lenses in their late teens halted the progression of myopia. Teens who switched to single vision lenses a little younger found that their eyes started to grow again but at the normal rate for a kid their age. ‘Our findings show that when older teenagers stopped wearing these lenses, the eye returned to the age-expected rate of growth.’ Said Berntsen, explaining that while their myopia did progress once they stopped wearing the lens, their vision was still better than it would have been had they never worn multifocal lenses. ‘Our findings suggest that it’s a reasonable strategy to fit children with multifocal contact lenses for myopia control at a younger age and continue treatment until the late teenage years when myopia progression has slowed,’ said BLINK 2 study chair Jeffrey J. Walline, O.D., Ph.D., associate dean for research at the Ohio State University College of Optometry, Columbus. Could something as simple as bifocal lenses between ages 7 and 16 prevent myopia? We’ll have to wait and see. Contact lenses used to slow nearsightedness in youth have a lasting effect. National Institutes of Health (NIH). January 16, 2025. Accessed January 20, 2025. https://www.nih.gov/news-events/news-releases/contact-lenses-used-slow-nearsightedness-youth-have-lasting-effect Berntsen DA, Tićak A, Orr DJ, et al. Axial Growth and Myopia Progression After Discontinuing Soft Multifocal Contact Lens Wear. JAMA Ophthalmology. Published online January 16, 2025. doi:10.1001/jamaophthalmol.2024.5885 Walline JJ, Walker MK, Mutti DO, et al. Effect of High Add Power, Medium Add Power, or Single-Vision Contact Lenses on Myopia Progression in Children: The BLINK Randomized Clinical Trial. JAMA. 2020;324(6):571. doi:10.1001/jama.2020.10834
BLINK and You’ll Miss It
A cure for myopia?
Taking a Long View
Shaping the future of Myopia
BLINK 2 – After 5 years Myopia Stalls?
A Second Look
Preventing Myopia
References
