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Friday / July 10.
HomemilensesMyopia: Options for Optical Control

Myopia: Options for Optical Control

The field of myopia control is gaining momentum with conferences, social media forums, websites and journals increasingly focussed on the topic. This third, annual mivision myopia edition is testament to that.

We are fortunate to have an ever-growing range of spectacle and contact lenses to manage myopia progression. It’s a matter of keeping up with the latest technologies, providing advice and taking a holistic approach to patient care, while carefully monitoring the treatments we provide.

CONTACT LENSES FOR MYOPIA CONTROL

Contact lens (CL) options provide a variety of centre distance multifocal designs, with some adopting annular rings of alternating distance and near powers and various extended depth of focus (EDOF) designs. Some designs are even defined as having a ‘nonmonotonic, aperiodic, refractive power profile’ – you can be forgiven for being confused!

CooperVision’s MiSight centre distance multifocal CL is probably the best-known soft lens option, with five years of clinical data now being presented. We also have some relatively new offerings that include SEED 1dayPure, developed by the Brien Holden Vision Institute (BHVI) using its EDOF technology; mark’ennovy’s Mylo silicone hydrogel CL which also incorporates BHVI EDOF technology; and Visioneering Technologies’ NaturalVue Multifocal 1 Day contact lens, which uses its own proprietary version of EDOF technology.

The power profiles of these CLs can vary from 1.50D or 2.00D to as much as 4.00D across the lens. We are likely to see other soft lens offerings for myopia control in the future.

Another method of myopia control with CLs is through the application of a variety of high-Dk rigid gas permeable (RGP) orthokeratology (OK) designs. Some practitioners have been practising OK for fifteen years or more, providing interesting long-term data.

Although there is growing evidence that suggests these lens types do slow myopia progression, there is much debate regarding the best method of describing the myopia control effect of one lens versus another, or comparing one study with another. While some studies may refer to the percentage of myopia progression reduced, others will argue that this is not a valid, linear descriptor and that we should instead look at the absolute changes in axial length or axial length elongation over time.

SPECTACLE FOR MYOPIA CONTROL

There is an increasing array of spectacle lens designs for myopia control, which is good news for the many optometrists who seem to prefer this option.

Experienced Sydney myopia control practitioner Dr Oliver Woo, who spends considerable time training practitioners in myopia control in Australia and overseas, observes this could simply be due to marketing and education.

“A survey by CooperVision, during a myopia seminar in 2019, showed that multifocal spectacle lenses still seem to be the preferred spectacle lens technology for managing myopia (60%),” he told me. “In my experience – including monitoring both refractive and axial length changes – the myopia control efficacy in ophthalmic lenses is still lower than the myopia control we find with contact lenses. This could be due to the defocus design in ophthalmic lenses, lifestyle, number of hours wearing spectacles and importantly, selection of the spectacle frame and how the frame is fitted to the patient. Dispensing an appropriate frame to a young myopic child requires effort and follow up. If not done properly, we are unable to optimise the myopia control benefits.”

Dr Woo said parents also tend to prefer ophthalmic lenses over contact lenses for their young children during the early stage of myopia development, but are more open to considering contact lenses once their child reaches eight or nine years of age. This may relate to concerns regarding safety and compliance.

Dr Woo, who receives early access to many myopia control ophthalmic lenses prior to their market launch, is excited about the future in this space. “We’re going to see more options to combat and manage myopia coming with continued research. It’s good to have more choices, and our myopic patients will surely benefit.”

One innovative design on the horizon, which combines both multifocal and different defocus zones, is Hoya’s MyoSmart lens, developed in collaboration with The Hong Kong Polytechnic University after years of research, product design and testing. Known as the DIMS design (Defocus Incorporated Multiple Segments Technology), it won multiple awards in 2018. Although currently only available in Hong Kong and China, it is expected to land Downunder following the global launch in 2020.

No doubt there will be others to follow.

READY, SET, GO

It’s our duty to discuss myopia control with our myopic patients and their parents, and to provide them with options to suit their age, lifestyle and budget – or to refer them on to those who practise in this area.

In the following pages you’ll find the current offerings from suppliers. Contact them for more information, research studies and undertake training in order to provide your patients with the best available treatment approach.

It is becoming increasingly obvious that we must do whatever we can to slow the myopia behemoth.

Spectacle Lenses for Myopia Control

Myopilux Plus and Myopilux Max

Essilor has studied myopia control for more than 25 years. Working with myopia scientists from around the world, including in Australia, the organisation’s research has led to the release of Myopilux Plus and Myopilux Max in the ANZ market.

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

Myopilux Max is for any myope progressing at more than 1.00D per year. This executive bifocal includes 3ΔIn for each eye, which compensates for the exophoric shift induced by the near add. In a three year Canadian study, myopia progression was reduced by up to 0.85D.

Both lenses use a +2.00D addition – the power used in studies where spectacle lenses slowed myopia progression.

Contact: Essilor Account Manager 

Rodenstock

For vision correction to be effective, children need to wear a lightweight spectacle frame with individually adapted lightweight lenses.

The Mono Plus 2 is a full back surface digital design single vision lens with a power boost, that’s optimised using Listings law for eye rotation and EyeModel to calculate near scripts. It provides relaxed, fatigue-free vision at near, particularly when children use digital devices. Your young patients will experience sharp, high contrast vision right up to the rim of the frame.

Contact: Rodenstock Account Manager 

Zeiss Myopia Management Solutions

Zeiss offers two myopia management solutions to help actively manage myopia progression in children between six and 12 years of age.

The innovative Zeiss MyoKids lens is designed with the top half of the lens providing clear vision in the distance. The bottom active zone supports near vision tasks and can help reduce myopia progression.

With Zeiss’s MyoVision Pro single vision lens, the periphery of the lens is responsible for myopia control and the central zone provides sharp vision. Compared to standard single vision lenses, this design is more effective at managing myopic progression.

Contact: Zeiss Account Manager

Bonastar

Bonastar kidsPro myopia control lens can slow the rate of myopia progression for children aged from eight to 16. Thin and light, it takes into consideration important parameters, including distance from the eye to the back vertex of the lens, pantoscopic tilt of the frame, pupil distance, and lens prescription.

A shorter corridor enables an easy transition between the far vision zone and the reading zone for children.

Key features and benefits:

  • A shorter corridor,
  • A wider reading zone,
  • A wider far vision zone, and
  • A softer design compared to conventional progressive lenses.

Available in 1.50, 1.61 and 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 

Hoya MiyoSmart

Hoya’s MiyoSmart for managing myopia was developed in cooperation with the Hong Kong Polytechnic University (PolyU) using the myopic defocus theory. This innovative ophthalmic lens uses Defocus Incorporated Multiple Segments (D.I.M.S.) technology, which is clinically proven to be effective in myopia control, having been shown to slow myopia progression by approximately 60%.*1 In 2018, it was awarded the prestigious Grand Prize, Grand Award and Special Gold Award at the 46th International Exhibition of Inventions in Geneva, Switzerland.

Manufactured from an impact-resistant material with UV protection, this effective, easy to adapt and non-invasive solution for myopia management is scheduled for release in Australia and New Zealand during 2020.

Contact: Hoya Account Manager 

References 

* Myopia progression (SER) by 59% and axial elongation (AL) decreased by 60% compared with those wearing SV lenses. 

  1. Lam CSY, Tang WC, Tse DY, et al. Defocus Incorporated Multiple Segments (DIMS) spectacle lenses slow myopia progression: a 2-year randomised clinical trial British Journal of Ophthalmology. Published online first: 29 May 2019. doi: 10.1136/bjophthalmol-2018-313739

Contact Lenses for Myopia Control

Aosept Plus with Hydraglyde

Often your orthokeratology patients demand more than a multipurpose solution due to excessive deposits, solution-related allergies, reduced comfort or compliance issues. Aosept Plus with Hydraglyde contains no added preservatives and its easy one-step system (no tablet required) improves compliance.

Suitable for both hard and soft contact lenses,2 Alcon claims it is the gold standard of hydrogen peroxide-based solutions.

Its unique formulation contains a triple action cleaning system3 with:

  1. Hydrogen peroxide to clean and disinfect,
  2. A built-in surfactant to remove deposits,3 and
  3. Bubbling action to enhance surface protein removal.

Unique Wetting Agent to Improve Comfort 

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 et al 2016, Is there a relationship between care system and compliance 
  2. Aosept Plus packaging Insert 
  3. Alcon data on file 
  4. www.alcon.com/news/media-releases/alcon-launcheslatest- innovation-hydrogen-peroxide-based-contact-lenscare (accessed September 2017) 
ArtMost SoftOK Monthly Disposables

Orthokeratology (OK) has been shown to slow myopia progression, perhaps due to its unique relative peripheral hyperopic defocus optics.1,2

ArtMost SoftOK monthly disposable contact lenses were purpose designed to ‘simulate’ OK treatment zone optics. With ArtMost Planned Flexure technology – a very thin tear reservoir beneath the soft lens – these contact lenses provide wearer comfort, while Artmosts’ Preferential Visual Span design ensures good optical clarity for better distant vision, despite every lens having progressively increased high peripheral addition powers for sharp near vision.

Contact: Artmost Oceania (AUS) 02 9630 6103 

References 

  1. Earl L. Smith III et al. Relative Peripheral Hyperopic Defocus Alters Central Refractive Development in Infant Monkeys, Vision Research 49 (2009) 2386-2392 
  2. Frank Spors, et al. In-Vivo Evaluation of Peripheral Refraction with Single Vision and Multifocal Soft Contact Lenses, ARVO 2018 Poster 
NaturalVue Multifocal 1 Day

NaturalVue’s Multifocal 1 Day CLs with innovative Neurofocus Optics is a centre distance design with patented extended depth of focus (EDOF) optics. The design has a rapid, continuous and uninterrupted progression in plus power from the centre of the lens through the optic zone. This creates a virtual aperture1 with relative plus in the periphery, and is clinically proven to slow the progression of myopia.

The EDOF design works naturally with the brain to produce a continuous range of clear vision and stereopsis comparable to spectacle wear with an effective add up to +3.00DS. Available in 0.25D steps from +4.00 to -12.25DS.

Contact: Contact Lens Centre Australia (AUS) 03 9543 1811 

References: 

  1. VTI Data on file, 2015. N=59. Data assessed after one week of wear. Preference based on those who expressed a preference among brands tested. 
  2. Cooper J, Oʼconnor B, Watanabe R, et al. Case Series Analysis of Myopic Progression Control with a Unique Extended Depth of Focus Multifocal Contact Lens. Eye & Contact Lens: Science & Clinical Practice. 2017;44(5): e16-e24.
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% slowing in myopia progression with a 52% reduction in axial elongation. This compares favourably with other treatments. 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.

Contact: MiSight1day@au. coopervision.com 

Mylo

Capricornia Contact Lens has extended its range of lenses for myopia management with Mylo, an individually crafted soft contact lens designed for myopia management. This contact lens is powered by the extended depth of focus patented technology developed by Brien Holden Vision Institute to slow myopia progression.

A monthly disposable contact lens, Mylo features high water content, a low coefficient of friction and an optimised central thickness to procure an excellent Dk/t. Its wide range of parameters and low elastic modulus ensure an excellent fit and easy handling, especially for the youngest contact lens wearers.

Contact: Capricornia Contact Lens (AUS) 07 3208 8500 

Seed

Brien Holden Vision Institute has developed a new generation contact lens that incorporates higher order aberrations to deliver extended depth of focus (EDOF), with applications in presbyopia. Additionally, when in use, the retinal image quality with the lens is optimised to slow eye growth in myopia.

Seed has incorporated this innovative design into its new daily disposable ‘1dayPure EDOF’ lens. The new product is expected to arrive in Australia in the first half of 2020.

Contact: Seed (AUS) 1300 373 718 

Gelflex

Gelflex orthokeratology contact lenses offer your patients the visual freedom of being able to see throughout the day without the use of glasses or daily contact lenses. The three-tier product range features Gelflex Ortho-k, the Euclid Emerald Lens and Paragon CRT, providing a system suitable for lens fitters of all levels of experience. Supported with unparalleled technical advice from the Gelflex professional and experienced technical support team.

Contact: Gelflex (AUS) 08 9443 4944 

SynergEyes

The SynergEyes portfolio of hybrid contact lenses presents a practice building opportunity for eye care professionals looking to expand their CL portfolio with “uncompromised rigid gas permeable contact lens optics”. The Duette hybrid contact lenses with Tangible HydraPeg can be fitted to ametropes and ametropic astigmats, whereas the Duette progressive customised centre distance contact lens can be fitted to progressive myopes with and without astigmatism.

Visit: www.synergeyes.com.au