# Interplay between multifocal optics and accommodation: implications for myopia progression

> **NIH NIH R01** · UNIVERSITY OF ROCHESTER · 2024 · $487,137

## Abstract

ABSTRACT
Myopia is a refractive error type of eye disorder where light is focused in front of the retina, requiring optical
corrections to recover the resulting loss in visual acuity. It is a broadly significant health condition: it is estimated
that by 2050 50% of the world population will be myopic. Moreover, even if myopia is compensated with
spectacles, contact lenses or surgery, high myopia is linked to a higher risk of retinal detachment, glaucoma,
and cataract. Strategies to halt the progression of myopia are therefore an urgent need. Myopia arises from a
mismatch between ocular axial length and optical power, but the signals that prompt excessive eye growth are
not well understood. Among various strategies developed for myopia control, the use of multifocal contact lenses
(MCL) is gaining significant traction. A generalized working principle behind MCL design is that induced myopic
defocus in the peripheral retina is protective for foveal axial growth. Initial clinical trials report encouraging
reduction of myopia progression in children fitted with MCLs (generally, center-distance and high add powers)
however they are still far from the desired effectiveness. Unlike MCL for presbyopia, MCLs for myopia control
are prescribed on subjects that can accommodate. However, we currently do not have a good understanding of
how accommodation interacts with MCLs in determining retinal image quality. This is a critical gap in knowledge
as accommodation affects the very central feature of MCL design — the degree and the sign of retinal defocus.
For example, depending on MCL design and individual physiological parameters, some subjects could rely on
the near zones of the MCL for near vision, potentially exposing the retina to hyperopic defocus and triggering
eye growth. We, a diverse team of optical engineers, physicists and neuroscientists will make use of adaptive
optics simulation technologies and psychophysical paradigms to map non-invasively MCL lens patterns onto the
subject’s pupil and systematically address key outstanding questions on the interplay between MCL design,
accommodation, image quality and visual function with MCLs in young myopes. The group has previously
developed adaptive optics technologies to test presbyopia corrections, novel methods based on wavefront
sensing to quantify the accommodative response, IOL designs for presbyopia and psychophysical paradigms
suited for young subjects. We are now using these capabilities, expanded to binocular simulation and testing, to
understand factors underlying accommodative and binocular mechanisms of MCL-based interventions to slow
down myopia. The long-term goal is to develop a mechanistic understanding that can help guide the design and
personalization of MCL myopia control interventions. We plan to 1) determine the accommodative response
with multifocal patterns in young myopes and emmetropes, 2) quantify the effects of various multifocal designs
on foveal visual function and 3) test the...

## Key facts

- **NIH application ID:** 10869932
- **Project number:** 5R01EY035009-02
- **Recipient organization:** UNIVERSITY OF ROCHESTER
- **Principal Investigator:** Susana Marcos
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $487,137
- **Award type:** 5
- **Project period:** 2023-07-01 → 2028-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10869932

## Citation

> US National Institutes of Health, RePORTER application 10869932, Interplay between multifocal optics and accommodation: implications for myopia progression (5R01EY035009-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10869932. Licensed CC0.

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