Bifocal lens control of myopic progression in children

Bifocal spectacle lenses have been used as a strategy to slow myopic progression in children since the 1950s and perhaps earlier. The reported success of this strategy varies greatly, as does the design of studies reporting the outcomes of their use-from earlier retrospective analysis of records to later prospective clinical trials. Collectively, published data support the suggestion that bifocal lenses inhibit myopic development in children but only by a small amount and only in a subset of children. Possible reasons for the greatly varying outcomes include a lack of individualism of the treatment and failure to take the vergence system into account. This review summarises the results of bifocal and multifocal studies, describes how accommodation, convergence and their interaction are linked to myopic development and details how a bifocal treatment that takes this into account may be devised. Also discussed is whether alterations to peripheral retinal blur contribute to bifocal lens effects.