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Wednesday / December 19.
HomemilensesMyopia Control: Don’t Miss the Bus!

Myopia Control: Don’t Miss the Bus!

You’re running very late if you haven’t heard the current hype surrounding myopia. But are you aware of the spectacle and contact lens options available to slow and even halt myopia’s progression?

Traditionally, those who developed myopia were corrected with negative spectacle lenses that returned the eye’s focus to infinity, restoring clear distance vision. It was relatively simple optics.

Today however, we are no longer simply correcting myopia but drawing on amazing research and specialised optical designs to take control – effectively slowing down and ideally, stopping its progression.

The ideal time to get a myope into myopia controlling spectacle lens designs is when they first develop myopia…

MYOPIA CONTROL IN A NUTSHELL

Essentially, traditional optical designs place a sharp focus on the macula region of the eye. Such designs however, produce a ‘flat’ image plane. They do not take into account the curved nature of the peripheral retina, leading to so called ‘hyperopic defocus’. In this scenario, as we move away from the macula toward the peripheral retina, light is focussed behind the retina, instead of on it.

Clever researchers have shown us how – for whatever reasons and by whatever mechanisms – the retina in such cases, can grow toward the sharper focus that is now behind the retina. This causes the whole eye to develop axial elongation (grow longer). Alas, the macula area also moves, and the patient becomes more short sighted. It’s a vicious cycle.

Some myopia controlling spectacle and contact lens designs have varying focal length – as we move from the centre of the lens to the periphery. This results in an image shell that coincides with the retina, from the central macula area to the periphery. Evidence shows that such designs lead to less progression, and in some cases, halt the tendency for myopia progression. Other lens designs are aimed at altering accommodative-convergence imbalances, something we have long studied in myopia development.

So far, myopia controlling contact lenses – specially designed dual focus or multifocal lenses – tend to offer the best myopia control, as does orthokeratology, albeit through different mechanisms. However, for various reasons, not all patients (or their parents) want to pursue contact lens options. Therefore, if they want good distance vision, spectacle lenses are the best bet. Fortunately, spectacle designs for myopia control are also showing positive results. As designs evolve, are fine-tuned, and tailored toward individual needs, we can expect to see improved levels of myopia control.

IT’S OUR DUTY

Faced with rapid escalation of this ocular condition, and increasing evidence of our ability to slow or even halt its progression, it is now the duty of every practitioner to inform myopic patients (and their families) about all the options available to them. These include spectacles, contact lenses, atropine etc. While therapeutic interventions and other aspects of myopia are detailed elsewhere in this issue of mivision, this article reviews spectacle lenses and contact lenses that have been designed to control myopia.

CONTACT LENS OPTIONS

There are now several developers designing multifocal soft contact lenses and rigid gas permeable (RGP) orthokeratology (ortho-K) lenses in the quest to slow and control myopia progression.

Ortho-K lenses were among the first contact lenses to show the benefits of myopia control. Some are locally designed and manufactured (Forge OrthoK, Gelflex Ortho-K and BE System) while others come from international suppliers.

CooperVision’s MiSight daily disposable soft contact lens, now available in the ANZ region, has four years of promising myopia control data from various regions, which gives promise to this mode of correction.

Another soft lens option is the NaturalVue daily disposable multifocal from Visioneering Technologies, Inc. (VTI), now also available in Oceania. Others will follow and we expect the Mark’ennovy/Brien Holden Vision Institute extended depth of focus design (EDoF) silicone-hydrogel soft lens for myopia control, in due course.

Analysing the clinical study results from each of these developers can be confusing, as they seem to vary from study to study and region to region.

While the relative benefits and respective abilities of each contact lens design and modality to control myopia progression have been covered elsewhere in this issue of mivision, another great way to gather ongoing information, monitor studies and engage in the debate that surrounds myopia control, is via Myopia Profile’s website (www.myopiaprofile.com) and its Facebook page.

SPECTACLES LENSES

As mentioned, simply correcting myopia with an ideal design, coatings, and refractive index for a given frame and lens power is pretty easy and we have a multitude of choices.

What’s a little more challenging is deciding on the ideal myopia controlling spectacle lens design. At one stage, Zeiss was the only lens company offering a commercially available myopia control design.

MyoVision, developed some years ago in a collaborative project with the Brien Holden Vision Institute, showed real potential to slow myopia progression.

Now other manufacturers are bringing their take on myopia controlling spectacle lens designs to the market, and although this is happening gradually, momentum is building. As we see in the similarly increasing contact lens offerings for myopia control, each design philosophy varies, as do results.

Essilor’s Myopilux lens has been available to practitioners in Australia and New Zealand for two years. There are two versions to choose from, depending on the patient’s needs:

  • Myopilux Pro is a short progressive with a +2.00 add for esophoric myopes with an accommodative lag >0.50D. Prescribing is based on findings from the COMET 2 study1
  • Myopilux Max is an executive bifocal with +2.00 add and three prism base-in for each eye. It is recommended for any myope progressing more than 1.00D/ year, based on the Cheng, Schmid, Woo, and Drobe study2

Hoya will launch its myopia control spectacle lens offering, MyoSmart, in 2019. This design, using ‘Defocus Incorporated Multiple Segments Technology’, (DIMS), won the Grand Prize, Grand Award and Gold Medal at the 46th International Exhibition of Inventions at Geneva in April 2018. It was developed together with The Hong Kong Polytechnic University, and like the other lenses mentioned, study results are promising.

TIME TO TAKE CONTROL

The ideal time to get a myope into myopia controlling spectacle lens designs is when they first develop myopia – having never worn spectacles before, they usually adapt faster than those who are switched from regular myopia correcting designs to myopia controlling designs, due to the altered spatial perception that such optical designs induce. We are also more likely to slow/stop the progression sooner and at lower levels of myopia than later intervention would allow.

WHAT’S BEST?

As to ‘what’s best’, time will tell.

In the meantime, if one design doesn’t seem to work for a given patient then another might. A combination of spectacles, contact lenses, atropine, vision therapy, and prism may be indicated in specific cases. We also know that time spent outdoors is another factor in reducing myopia development and progression. Reducing screen time, and in the future, nutraceuticals or dietary changes could also be things to consider.

References 

  1. Progressive-Addition Lenses versus Single-Vision Lenses for Slowing Progression of Myopia in Children with High Accommodative Lag and Near Esophoria. Correction of Myopia Evaluation Trial 2 (COMET 2): Invest Ophthalmol Vis Sci. 2011 Apr; 52(5): 2749–2757. 
  2. Randomized trial of effect of bifocal and prismatic bifocal spectacles on myopic progression: two-year results. Cheng D, Schmid KL, Woo GC, Drobe B: Arch Ophthalmol. 2010 Jan;128(1):12-9.

Hope For a Highly Myopic Kid And His Presbyopic Mum

Dr. Oliver Woo from the Myopia Management Clinic at Eastwood in New South Wales, recently added NaturalVue Multifocal one day contact lenses (CLs) to the repertoire of options he uses to treat patients with myopia. Reporting on one of his initial cases he wrote:

When Master L’s mother brought him to see me, all the options to control his myopia had been tried (ortho-K, multifocal glasses and D-centered multifocal soft CLs). Nothing had worked to slow progression and he had been put on atropine (0.01 per cent) and prescribed single vision glasses to correct his refractive error.

A talented and gifted child, L’s high refractive error necessitated wearing spectacles all the time, which created some issues with physical activities.

His Rx had increased over -4.50D in just three years, which created a sense of urgency, prompting me to find a new approach.

L’s mother is also highly myopic and presbyopic, (-6.25D OU ADD+2.50) which is why she kept looking for options to help her son’s myopia progression. She had read about VTI’s NaturalVue (etafilcon A) multifocal one day CLs online and was encouraged by the clinical reports that showed very good results in controlling myopia. She decided to look for anyone in Australia who could prescribe VTI’s NaturalVue multifocal lenses for her son and I was the first optometrist outside the USA, and in Australia, that she found.

L’s current spectacle acuity: OD: 1.0 OS: 1.0 OU: 1.0.

His subjective Rx: OD: -9.00 -2.75 X 13 1.0; OS: -7.25 -2.75 X 160 1.0

Based on my evaluation, and the suggested starting powers from the NaturalVue calculator, I fit the child in NaturalVue multifocal trial lenses (OD: -9.50 OS: -8.00).

I checked visual acuity after 20 minutes of settling (OD: 1.0 OS: 1.0 OU: 1.0). The over Rx was OD: +0.25 -1.50 and OS: +0.25 -1.25. I also prescribed a pair of spectacles to use over his CLs, which were mainly for astigmatic correction. After three days of trial, L was impressed with the visual acuity and the comfort of the lenses as well.

Soon after, L’s mother called my practice and ordered VTI’s NaturalVue lenses for her son. I’m looking forward to seeing him in the next few weeks for the aftercare check up on his Rx and his axial length as well.

L’s mother, who had been wearing a different multifocal soft CLs with mixed results, also tried the NaturalVue multifocal. She was happy with the comfort and found they gave her good vision at all distances – near, intermediate and distance – after three days of trial.

Having used NaturalVue multifocal 1 day CLs for several weeks, I am very happy to have these lenses as another option for my patients for both myopia management and presbyopia correction.

Spectacle Lenses to Control Myopia

Bonastar’s KidsPro

Bonastar states that its KidsPro myopia control lens can slow the rate of myopia progression for children aged eight to 16.

This thin, light lens takes into consideration important parameters, including distance from the eye to the back vertex of the lens, pantoscopic frame tilt, pupil distance, and lens prescription.

The KidsPro Myopia Control lens features a wider reading zone, a wider far vision zone, and a softer design compared to conventional progressive lens. A shorter corridor enables an easy transition between the far vision zone and the reading zone for children.

Available in 1.50, 1.61, safe wear material from addition +0.75 to +2.00, and prescription ranges from -15.00D to +8.50D sphere to a -6.00 cylinder.

Contact Bonastar: (AUS) 02 9310 1688 

MyoSmart

MyoSmart spectacle lenses, with Defocus Incorporated Multiple Segments (D.I.M.S.) technology, curbs myopia progression by 59 per cent and is proven to halt myopia progression by 21.5 per cent by controlling eye growth. Featuring Eye Shield – an impact-resistant material with UV protection – this lens was awarded the prestigious Grand Prize, Grand Award and Special Gold Award at the 46th International Exhibition of Inventions by Geneva, Switzerland in 2018.

This easy to adapt, non-invasive solution for myopia control is available in Hong Kong and China, and will be released in Australia and New Zealand during 2019.

Contact: Hoya Account Manager 

References 

Lam CSY, Tang WC, Lee RPK, Chun RKM, To CH. A randomized clinical trial for myopia control – use of myopic defocus spectacle lens. 8th International Congress of Behavioural Optometry (ICBO), 26-29 of April 2018. Sydney, Australia. 

Rodenstock

A lightweight spectacle frame and individually adapted lightweight lenses are essential to achieve the best possible visual performance for children.

The Mono Plus 2 is a full back surface digital design single vision lens with a power boost. It is optimised using Listings law for eye rotation and EyeModel to calculate near scripts.

The Mono Plus 2 provides relaxed, fatigue free vision at near, particularly when children use digital devices. Children experience sharp, high contrast vision, right up to the rim of the frame.

Contact: Rodenstock Account Manager 

Myopilux

Essilor International Research and Development has studied myopia for more than 25 years. Our scientists have worked with researchers in Australia and around the world to develop Myopilux Pro and Myopilux Max.

Myopilux Pro is for esophoric myopes who are progressing and have a lag of accommodation greater than 0.50D. In a three year study, this short progressive reduced progression by up to 0.45D.

Myopilux Max is for any myope progressing at more than 1.00D per year. This prism controlled bifocal compensates for the exophoric shift induced by the near add.

Contact: Essilor Account Manager

Contact Lenses for Myopia Control

 

MiSight 1 Day

MiSight 1 day is the first one day lens developed for myopia management. Its ActivControl technology ensures consistent myopic defocus across all prescriptions, pupil sizes, and variations in lens centration.

Recognising that all myopia management treatments must be supported by strong evidence, in 2012 CooperVision initiated an international 10 year trial involving 144 children. The first three years were conducted as a randomised, double blind study and produced a 59 per cent slowing in myopia progression with a 52 per cent reduction in axial elongation, which compares favourably with other treatments.1

Recently released four year data shows a continuation of the treatment effect and a significant slowing in progression of children moved from the control group into MiSight 1 day.2

Contact: MiSight1day@au.coopervision.com 

References 

  1. Chamberlain P, Back A, Lazon P, et al. 3 year effectiveness of a dual-focus 1 day soft contact lens for myopia control. Presented at the 40th British Contact Lens Association Clinical Conference and Exhibition, 10 June 2017; Liverpool, United Kingdom. 
  2. Data on file, CooperVision 2018. 
Capricornia

Capricornia’s ortho-K range has been extended. Tried and tested since 1997, and with a straight forward software system, BE Ortho-K delivers predictable results when treating myopic adults.

PJ provides a new way to prescribe ortho-K. Automated software analysis of baseline, and post wear topography with a quick ordering system, simplifies ortho-K for practitioners just starting out, or experienced fitters with busy practices looking for an efficient fitting and ordering system. Assistance is available at the click of a button.

Contact: Capricornia (AUS) 07 3208 8500 

Paragon CRT

Paragon CRT contact lenses are worn overnight to treat myopia and offer patients freedom from glasses and daytime contacts. Paragon CRT was the first Food and Drug Administration approved lens of its kind for extended overnight wear. Over 1.5 million CRT lenses have been prescribed in over 50 countries worldwide.

In a recent survey of Paragon CRT patients, 92 per cent reported that CRT either met or exceeded expectations.1

Contact: www.paragonvision.com 

References 

  1. Paragon CRT patient survey. October 2018. Data on file at Paragon Vision Sciences. 
Gelflex Ortho-K & Emerald

Gelflex/ACL has offered products for myopia management for over twenty years and has manufactured contact lenses for over 40 years.

The Gelflex Ortho-k System and Emerald contact lenses are safe, reversible and correct vision overnight by gently re-shaping the cornea.

Gelflex/ACL offers products and technical support to help achieve crisp, clear vision for patients with myopia, without the need for glasses, daytime contact lenses or LASIK surgery.

Contact: Gelflex/ACL (AUS) 1800 335 559 

EyeSpace Forge Ortho-K

Forge ortho-K lenses are designed and ordered using the powerful contact lens design platform EyeSpace. EyeSpace links with your corneal topographer, generating computerised fluorescein simulations from the corneal height data, to enable precise, accurate design of rotationally symmetric, toric and quadrant specific variants of the Forge ortho-K design.

EyeSpace enables both beginner and experienced practitioners to accurately fit ortho-K lenses without the need for trial fitting. Forge ortho-K can be used to correct low myopia, high myopia and corneal astigmatism through the quick, simple, and automated calculation.

Contact: eyespacelenses.com 

Mylo

Mylo is an individually crafted silicone hydrogel contact lens specifically designed for myopia management. It is powered by the Brien Holden Vision Institute’s patented extended depth of focus (EDOF) technology, which slows myopia progression and supports a comfortable acclimation to the lens, enhancing the overall wearing experience.

This monthly disposable contact lens features high water content and low coefficient of friction, which combine to improve comfort throughout the day. Its wide range of parameters and low elastic modulus ensure an excellent fit and easy handling, especially for the youngest contact lens wearers.

Contact: Mark’ennovy (AUS) 0400 217 007 

Naturalvue

The NaturalVue (etafilcon A) multifocal one day contact lens is an innovative multifocal one day contact lens that’s indicated for use for presbyopia and myopia control. Incorporating Neurofocus Optics technology, inspired by advanced camera optics, NaturalVue Multifocal has one universal extended depth of focus centre distance design that provides spectacle level visual acuity at near, intermediate and distance.

Contact: VTI Vision (AUS) 1800 125 023 

Aosept Plus with HydraGlyde Solution

Ortho-K patients often demand more than a multipurpose solution due to excessive deposits, solution related allergies and reduced comfort or compliance issues.

Aosept Plus with HydraGlyde contains no added preservatives and is an easy one-step system (no tablet required) that improves compliance1 and is suitable for both hard and soft contact lenses.2

Its unique formulation contains a triple action cleaning system with hydrogen peroxide to clean and disinfect, a built-in surfactant to remove deposits, and a bubbling action to enhance surface protein removal.3

The HydraGlyde Moisture Matrix – a scientifically advanced proprietary synthetic block copolymer – embeds itself on and within the lens and reduces surface hydrophobicity.4

Contact: Alcon Account Manager 

References 

  1. Guthrie, S., et al, 2016. Is there a relationship between Care System and Compliance? Contact Lens Spectrum, 31:40-43 
  2. Aosept Plus Packaging Insert 
  3. Alcon data on file 2012, AOSEPT PLUS Powerful Triple Action 
  4. www.alcon.com/news/media-releases/alcon-launcheslatest- innovation-hydrogen-peroxidebased-contact-lens-care NP4 Number # :A21710708996