Authors' objectives: HTW aimed to identify and summarise evidence that addresses the following question: what is the clinical and cost effectiveness of myopia-control spectacle lenses and contact lenses to slow the progression of myopia in children and adolescents (up to and including 18 years old), compared to standard care?

Authors' results and conclusions: HTW identified a Cochrane meta-analysis of 40 randomised controlled trials investigating myopia-control spectacle lenses and myopia-control contact lenses to slow the progression of myopia in children compared to single-vision spectacle lenses or single-vision soft contact lenses. An additional meta-analysis, systematic review and seven randomised controlled trials were identified since the Cochrane review. The primary outcome 'progression of myopia' was defined as both change in spherical equivalent refraction and change in axial length. At one year, all interventions except for rigid gas-permeable contact lenses were statistically superior to standard of care in reducing myopia progression. However, although statistically significant, the reduction in myopia progression with multifocal spectacle lenses was deemed not clinically significant. At two years, only orthokeratology was reported as being both statistically and clinically significant compared to standard of care for change in axial length only. Only a few interventions were assessed at three years follow up, with only multifocal soft contact lenses being reported as statistically superior to standard of care in reducing myopia progression. None of the results were clinically significant at three years. A cost-utility analysis was conducted by HTW to compare peripheral plus spectacle lenses, multifocal soft contact lenses and orthokeratology against single-vision correction. Multifocal soft contact lenses and orthokeratology may be cost-effective options to slow the progression of myopia at cost-effectiveness thresholds conventionally applied in the UK.

Authors' recommendations: The evidence supports the routine adoption of orthokeratology and multifocal soft contact lenses to slow the progression of myopia in children and adolescents. Evidence shows that orthokeratology and multifocal soft contact lenses significantly reduce spherical equivalent refraction progression and axial length elongation over at least two years of follow up. Economic modelling estimates that orthokeratology and multifocal soft contact lenses may be cost effective compared with single-vision correction, driven by the assumption of quality-of-life gains from a reduction in long-term myopia progression and its complications.

Authors' methods: The Evidence Appraisal Report is based on a literature search (strategy available on request) for published clinical and economic evidence on the health technology of interest. It is not a full systematic review but aims to identify the best available evidence on the health technology of interest. Researchers critically evaluate and synthesise this evidence. The Cochrane review we identified only included randomised controlled trials, and similar inclusion/exclusion criteria to our appraisal. We therefore searched for secondary evidence, randomised controlled trials and economic evidence as a means to supplement the Cochrane review.

Project Status: Completed

Year Published: 2023

URL for published report: https://healthtechnology.wales/reports-guidance/control-contact-lenses-and-spectacles/

English language abstract: An English language summary is available

Publication Type: Rapid Review

Country: Wales, United Kingdom

Organisation Name: Health Technology Wales

Contact Address: c/o Digital Health Care Wales, 21 Cowbridge Road East Cardiff CF11 9AD

Contact Name: Susan Myles, PhD

Contact Email: healthtechnology@wales.nhs.uk