Correction of Myopia Evaluation Trial 2 (COMET2)

Correction of Myopia Evaluation Trial 2 (COMET2): A Randomized Trial of the Effect of Progressive Addition Lenses Versus Single Vision Lenses on Low Myopia Associated With Large Accommodative Lags and Near Esophoria in Children

The purpose of the study is to determine if progressive addition lenses (PALs) versus single vision lenses (SVLs) slow the progression of low myopia in children with poor accommodative responses (i.e., large accommodative lags) and near esophoria.

Study Overview

• Status: Completed
• Conditions: Myopia
• Intervention / Treatment: Device: Progressive Addition Lenses (PALs); Device: Single Vision Lenses (SVLs)

Detailed Description

Myopia is a significant public health problem that affects at least 34% of children in the United States and a much higher percentage in Asia. It is a predisposing factor for retinal detachment, myopic retinopathy, and glaucoma, thus contributing to loss of vision and blindness. As might be expected for such a prevalent condition, treatment costs are high. If interventions to retard myopia progression are successful, sight-threatening complications might be avoided and costs should be reduced.

The study has been designed as a simple trial that, other than the type of lenses being determined through the randomization process and the addition of accommodation testing using an autorefractor, largely approximates standard clinical practice.

Screening consists of non-cycloplegic procedures of subjective refraction, testing of oculomotor alignment, and testing of accommodative response using the Grand Seiko autorefractor.

Patients who appear to be eligible for the randomized trial will be tested with their eyes dilated to determine whether refractive error in each eye is within the eligibility range for the randomized trial. Patients will be randomized to either progressive addition lenses (PALs) with a +2.00 D addition or to single vision lenses (SVLs). Children will have three years of follow up, with visits every 6 months.

The primary outcome visit is timed 3 years from randomization, with the primary analysis being a comparison of the average change from baseline to 3 years in amount of myopia between children in the single-vision lens group and the children in the progressive-addition lens group. The primary outcome is change in spherical equivalent refractive error (SER) in diopters (D) as measured by cycloplegic autorefraction.

A separate ancillary study nested within the screening process will collect data on two additional methods of measuring accommodation, Monocular Estimate Method (MEM) retinoscopy and Nott retinoscopy. The aim of the ancillary study to help determine whether a simple, effective measure exists that can be easily used by clinicians to identify children with reduced accommodative response who, if they have low myopia and esophoria, might benefit from the treatment with PALs.

• Study Type: Interventional
• Enrollment (Actual): 118
• Phase: Phase 3

Contacts and Locations

Study Locations

• United States
  • Alabama
    • Birmingham, Alabama, United States, 35294
      • University of Alabama- Birmingham, School of Optometry
  • California
    • Fullerton, California, United States, 92831-1699
      • Southern California College of Optometry
  • Indiana
    • Bloomington, Indiana, United States, 47405
      • Indiana School of Optometry
  • Massachusetts
    • Boston, Massachusetts, United States, 02215-3468
      • New England College of Optometry
  • Ohio
    • Columbus, Ohio, United States, 43210-1280
      • Ohio State University College of Optometry
  • Pennsylvania
    • Lancaster, Pennsylvania, United States, 17601
      • Family Eye Group
    • Philadelphia, Pennsylvania, United States, 19141
      • Pennsylvania College of Optometry
  • Texas
    • Houston, Texas, United States, 77204-2020
      • University of Houston College of Optometry

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 8 years to 11 years (Child)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Refractive error determined by cycloplegic autorefraction which meets all of the following:

  1. Spherical equivalent: -0.50 to -3.00 D in both eyes
  2. Astigmatism <= 1.5 D in both eyes
  3. Anisometropia <= 1.00 D difference between eyes in spherical equivalent
• Visual acuity is at least 20/20 with best subjective refraction in both eyes
• Accommodative response at near (33 cm) is less than 2.0D by non-cycloplegic autorefraction
• Near esophoria (>= 2.0 PD) present by alternate prism and cover test (APCT) at near using best refractive correction determined from non-cycloplegic subjective refraction

Exclusion Criteria:

• Strabismus present by cover-uncover test at far, near, and/or near with +2.00D over best subjective refraction
• Current or prior use of PALs, bifocals, or contact lenses in either eye (prior or current use of SVLs is allowed)

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Triple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Progressive addition lenses (PALs); Varilux Ellipse progressive addition lenses (PALs) with a +2.00 D addition	Device: Progressive Addition Lenses (PALs); Varilux Ellipse progressive addition lenses (PALs) with a +2.00 D addition
Active Comparator: Single vision lenses (SVLs); Single vision lenses	Device: Single Vision Lenses (SVLs); Single vision lenses

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Distribution of Change in Spherical Equivalent Refractive Error From Baseline to 3 Years	Measured in diopters (D) using cycloplegic refraction sphere (amount of myopia) and cylinder (amount of astigmatism at an angle (axis)). Spherical equivalent (SE) is the sphere plus 1/2 the cylinder. For baseline and each time point, a SE was calculated for each eye for each of the five trials of cycloplegic autorefraction; the median for each eye was averaged to obtain the SE used for analysis. Change was calculated as SE at baseline minus SE at 3 years. A negative value indicates that the myopia worsened; a positive value indicates that it improved.	Baseline to 3 years
Mean Change in Spherical Equivalent Refractive Error From Baseline to 3 Years	Measured in diopters (D) using cycloplegic refraction sphere (amount of myopia) and cylinder (amount of astigmatism at an angle (axis)). Spherical equivalent (SE) is defined as the sphere plus 1/2 the cylinder. For baseline and each time point, a SE was calculated for each eye for each of the five trials of cycloplegic autorefraction; the median for each eye was averaged to obtain the SE used for analysis. Change was calculated as SE at baseline minus SE at 3 years. A negative value indicates that the myopia worsened; a positive value indicates that it improved.	3 years

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Distribution of Spherical Equivalent Refractive Error at 3 Years	Measured in diopters (D) using cycloplegic refraction sphere (amount of myopia) and cylinder (amount of astigmatism at an angle (axis)). Spherical equivalent (SE) is defined as the sphere plus 1/2 the cylinder. A SE was calculated for each eye for each of the five trials of cycloplegic autorefraction, and the median for each eye was averaged to obtain the SE used for analysis.	3 years
Mean Spherical Equivalent Refractive Error at 3 Years	Measured in diopters (D) using cycloplegic refraction sphere (amount of myopia) and cylinder (amount of astigmatism at an angle (axis)). Spherical equivalent (SE) is defined as the sphere plus 1/2 the cylinder. A SE was calculated for each eye for each of the five trials of cycloplegic autorefraction, and the median for each eye was averaged to obtain the SE used for analysis.	3 years
Distribution of Change in Spherical Equivalent Refractive Error From Baseline to 3 Years According to Baseline Characteristics	Measured in diopters (D) using cycloplegic refraction sphere (amount of myopia) and cylinder (amount of astigmatism at an angle (axis)). Spherical equivalent (SE) is defined as the sphere plus 1/2 the cylinder. For baseline and 3 years, a SE was calculated for each eye for each of the five trials of cycloplegic autorefraction; the median for each eye was averaged to obtain the SE used for analysis. Change was calculated as SE at baseline minus SE at 3 years. A negative value indicates that the myopia worsened; a positive value indicates that it improved.	Baseline to 3 years
Mean Change in Spherical Equivalent Refractive Error From Baseline to 3 Years According to Baseline Characteristics	Measured in diopters (D) using cycloplegic refraction sphere (amount of myopia) and cylinder (amount of astigmatism at an angle (axis)). Spherical equivalent (SE) is defined as the sphere plus 1/2 the cylinder. For baseline and 3 years, a SE was calculated for each eye for each of the five trials of cycloplegic autorefraction; the median for each eye was averaged to obtain the SE used for analysis. Change was calculated as SE at baseline minus SE at 3 years. A negative value indicates that the myopia worsened; a positive value indicates that it improved.	Baseline to 3 years
Mean Change in Spherical Equivalent Refractive Error From Baseline to 1 Year	Measured in diopters (D) using cycloplegic refraction sphere (amount of myopia) and cylinder (amount of astigmatism at an angle (axis)). Spherical equivalent (SE) is defined as the sphere plus 1/2 the cylinder. For baseline and 1 year, a SE was calculated for each eye for each of the five trials of cycloplegic autorefraction; the median for each eye was averaged to obtain the SE used for analysis. Change was calculated as SE at baseline minus SE at 1 year. A negative value indicates that the myopia worsened; a positive value indicates that it improved.	Baseline to 1 year
Mean Change in Spherical Equivalent Refractive Error From Baseline to 2 Years	Measured in diopters (D) using cycloplegic refraction sphere (amount of myopia) and cylinder (amount of astigmatism at an angle (axis)). Spherical equivalent (SE) is defined as the sphere plus 1/2 the cylinder. For baseline and 2 years, a SE was calculated for each eye for each of the five trials of cycloplegic autorefraction; the median for each eye was averaged to obtain the SE used for analysis. Change was calculated as SE at baseline minus SE at 2 years. A negative value indicates that the myopia worsened; a positive value indicates that it improved.	Baseline to 2 years
Excellent Spectacle Compliance	Spectacle compliance was assessed on a five-point Likert scale: always, 5; often, 4; sometimes, 3; rarely, 2; and never, 1. Excellent compliance indicates that for the specified period (during school, after school, on weekends), spectacles were estimated at all visits to have been worn either always or often.	Baseline to 3 years

Collaborators and Investigators

• Sponsor: Jaeb Center for Health Research
• Collaborators: National Eye Institute (NEI)
• Investigators: Study Chair: Jane E Gwiazda, Ph.D., New England College of Optometry; Principal Investigator: Wendy L Marsh-Tootle, University of Alabama at Birmingham School of Optometry; Principal Investigator: Ruth E Manny, University of Houston College of Optometry; Principal Investigator: Erik M Weissberg, New England College of Optometry; Principal Investigator: David I Silbert, Family Eye Group; Principal Investigator: Don W Lyon, Indiana University School of Optometry; Principal Investigator: Mitchell M Scheiman, Pennsylvania College of Optometry; Principal Investigator: Marjean T Kulp, Ohio State University; Principal Investigator: Susan A Cotter, Southern California College of Optometry at Marshall B. Ketchum University

Publications and helpful links

General Publications

• Correction of Myopia Evaluation Trial 2 Study Group for the Pediatric Eye Disease Investigator Group, Manny RE, Chandler DL, Scheiman MM, Gwiazda JE, Cotter SA, Everett DF, Holmes JM, Hyman LG, Kulp MT, Lyon DW, Marsh-Tootle W, Matta N, Melia BM, Norton TT, Repka MX, Silbert DI, Weissberg EM. Accommodative lag by autorefraction and two dynamic retinoscopy methods. Optom Vis Sci. 2009 Mar;86(3):233-43. doi: 10.1097/OPX.0b013e318197180c.
• Correction of Myopia Evaluation Trial 2 Study Group for the Pediatric Eye Disease Investigator Group. Progressive-addition lenses versus single-vision lenses for slowing progression of myopia in children with high accommodative lag and near esophoria. Invest Ophthalmol Vis Sci. 2011 Apr 25;52(5):2749-57. doi: 10.1167/iovs.10-6631.

Study record dates

Study Major Dates

• Study Start: April 1, 2005
• Primary Completion (Actual): March 1, 2010
• Study Completion (Actual): March 1, 2010

Study Registration Dates

• First Submitted: April 28, 2006
• First Submitted That Met QC Criteria: April 28, 2006
• First Posted (Estimate): May 3, 2006

Study Record Updates

• Last Update Posted (Estimate): July 19, 2016
• Last Update Submitted That Met QC Criteria: July 15, 2016
• Last Verified: July 1, 2016

More Information

Terms related to this study

• Keywords: Myopia; Refractive error; Progressive Addition Lenses (PALs); Single Vision Lenses (SVLs); Accommodative lags; Near esophoria
• Additional Relevant MeSH Terms: Eye Diseases; Refractive Errors; Myopia
• Other Study ID Numbers: NEI-123; 2U10EY011751 (U.S. NIH Grant/Contract); 5U10EY011751 (U.S. NIH Grant/Contract)