Eye care professionals (ECPs) and parents have significant influence over children’s eye health. Understanding their opinions about myopia and its management may provide helpful insights. A recent global survey of ECPs and parents, commissioned by CooperVision, examined their knowledge of myopia, current behaviours, and attitudes towards myopia control contact lenses. It also highlighted challenges in recommending management options to patients.
Myopia has become a global health concern, sparking development of new management products and spurring international efforts to advance myopia research and education. The prevalence of myopia is increasing worldwide, and in 30 years’ time, 4.8 billion people are predicted to be myopic, with almost one billion of these people having high myopia.1 The consequences of myopia are not only reduced vision and reliance on correction options, but also an increased risk of eye diseases such as myopic maculopathy – especially among those with higher levels of myopia.2,3
ECPs reported that parents were the biggest challenge faced when offering MM products
Several tools are available to aid ECPs with myopia management (MM), including extensive literature and new MM products. For example, the International Myopia Institute – a collaboration of scientists and ECPs – has issued guidelines describing best practice and ethical considerations, and the U.S. Food and Drug Administration has approved the use of MiSight 1 day contact lenses for slowing the progression of myopia and correcting vision in children.4,5*
ABOUT THE GLOBAL SURVEY
In August and September 2019, Decision Analyst (Arlington, Texas) conducted 25-minute, online surveys among 402 ECPs and 1,009 parents of myopic children in seven countries – the United Kingdom, Canada, Germany, Spain, Hong Kong, Australia and New Zealand. The sample populations were drawn from a Decision Analyst panel and partner panels.
ECPs were required to have been in practice for one to 50 years, have at least 10% of their patients being contact lens fits, and at least 10% being children (15 years or younger). The ECP had to see a minimum number of patients per month: at least 30 in the United Kingdom, Germany, Australia and New Zealand; at least 50 in Canada and Hong Kong; and at least 24 in Spain. Additionally, ECPs had to be open to the idea of fitting paediatric patients into a MM soft contact lens.
Parents were required to be aged 30 to 55 years and a primary caregiver of a myopic child aged six to 15 years. The child had to be a wearer of spectacles or contact lenses and had to have had an eye examination in the last two years.
On average, ECPs had 17 years of experience in practice (range: one to 39 years), saw 273 patients per month (30–1,200 patients), prescribed contact lenses in 30% of cases (10–100%), and 29% of their patients were children (10–100%).
Of the 1,009 parents who took part in the online survey, a quarter said that their child used soft contact lenses for myopia management.
The online survey found that ECPs were concerned about the impact of myopia on their patients’ eye health and were eager to provide management options. Threequarters agreed that myopia is a serious condition and, therefore, options to slow its progression should be offered to all myopic children. ECPs from Australia/ New Zealand were significantly more likely to agree with this than other ECPs (85% vs. 51–63%, P<0.05). ECPs agreed that it is especially important to manage myopia in children if the prescription is increasing significantly (63–99%) or if myopia is high for the age of the child (67–88%). Many ECPs (82%) worried about the progression of myopia in their paediatric patients causing significant detriment to eye health in later life. A large majority (92%) believed that it is important to slow myopia progression at an early age.
By contrast, parents may not be fully aware of the importance of myopia. Globally, parents were more familiar with the term ‘short-sighted’ [near-sighted] than with the term ‘myopia’ (93% vs. 74%; Figure 1). Parents in Spain, Hong Kong, and Australia/ New Zealand were more familiar with the term ‘myopia’ than their counterparts.
The survey revealed that ECPs use a variety of MM strategies, including a number of lifestyle recommendations. On average, ECPs recommended spending time outdoors and reducing screen time to 60% of their paediatric myopes, although this varied widely between regions (Figure 2). However, only 26% of parents could recall ECPs recommending more time outdoors. A majority of parents remembered recommendations that their child should reduce screen time (77%), avoid things that cause eye strain (67%), and avoid bad lighting (65%; Figure 3).
A large majority of ECPs were aware of various MM products and regularly recommended them to most patients. About nine in every 10 ECPs (n=402) were aware of options used for MM, the availability of which varied by country. Most ECPs (92%, n=352) had recommended a MM product for paediatric patients within the past month, with over half (55%, n=402) recommending MiSight 1 day. Nonetheless, 32% of ECP’s (n=352) paediatric patients received only a single-vision prescription, without any MM recommendation.
ECPs reported that parents were the biggest challenge faced when offering MM products, however they acknowledged good reasons for persevering. The challenges most commonly reported were parents not wanting to put their children in contact lenses (58%, n=402) and parents not understanding the risks of myopia to future eye health (54%). Nonetheless, ECPs said offering MM products was a rewarding experience because they felt they were making a difference to their patients’ future eye health and because they believed that it would also build patient loyalty. Likewise, a majority believed that offering MM products helped their practice to stand out (Figure 4).
top priorities that ECPs considered when choosing a MM product were clinical results (58%), ease of use for children (44%), and whether the product was approved (44%)
ECPs and parents considered several factors when deciding which MM products to use and when to use them. The top priorities that ECPs considered when choosing a MM product were clinical results (58%), ease of use for children (44%), and whether the product was approved (44%). Similarly, parents wanted something that was easy to use, comfortable, and would help protect their child’s eyes from future eye health problems (Figure 5). Most parents had heard about MM products from ECPs (76%) and stated that they wanted to learn more about at least one MM product (87%).
Confidence in Contact Lenses
Among ECPs who would consider MM contact lenses, usage would naturally vary depending on the patient age at which they would feel comfortable fitting contact lenses. Among 511 screened ECPs, 84% said they would consider fitting at least some myopic children into MM contact lenses (Figure 6), with interest being strongest in the UK (96%), Germany (89%), and Australia/New Zealand (91%). Half of ECPs (participants, n=402) would be confident fitting contact lenses to myopic children aged eight years and older, and three-quarters would be comfortable fitting those aged 10 years and older. On average, ECPs would be comfortable fitting their paediatric myopes with contact lenses from the age of nine years onwards (Figure 7).
Parents were not usually as confident as ECPs about myopic children wearing contact lenses. Approximately half of parents surveyed would be comfortable with their children wearing contact lenses from age 11 years and onwards (Figure 7). This increased to almost threequarters for children aged 14. On average, parents believed that an age of 11.7 years was appropriate for contact lens wear. However, parents’ confidence in contact lenses for children may increase when presented with MiSight 1 day.
ECPs and parents believed that MiSight 1 day provided a MM option that had several advantages and was safe and easy to use. After reviewing a description of MiSight 1 day, 84% of ECPs (n=402) were interested in prescribing the product to their patients, 74% felt that it was a far more convenient way to manage myopia than other products, and 71% believed that it would be safe for children as young as eight years old. They also believed that a myopia management programme featuring MiSight 1 day would be easy for patients and their parents to follow (72%).
Reviewing a description of MiSight 1 day greatly changed parents’ attitudes towards contact lenses for children. Beforehand, only 27% of parents expressed interest in learning more about MM soft contact lenses; however, afterwards, 74% said they would definitely buy MiSight 1 day, and 21% said they might buy the product. Important considerations in this decision appear to be the belief that MiSight 1 day would be able to make a positive difference in their child’s future eye health (81% of all parents surveyed), and that MiSight 1 day offered advantages over other MM options (78% of all parents surveyed). Similarly, three-quarters of parents believed that MiSight 1 day was easy to use and safe for children as young as eight years old.
Myopia is an important concern for many ECPs. Nearly all ECPs are aware of various MM products and regularly recommend them to most patients. ECPs want to slow myopia progression at an early age and are typically comfortable fitting contact lenses to children aged nine and older.
Age for Contact Lens Wear
The biggest challenges to offering MM products that ECPs report are parents’ concerns about their children wearing contact lenses and parents’ limited knowledge of the risks of myopia. Parents are typically comfortable with children wearing contact lenses from the age of 12 years, but parents may feel more comfortable when they are given more information. After reviewing a description of MiSight 1 day contact lenses, many parents want to use the product, and three quarters believe that MiSight 1 day is easy to use and safe for children as young as eight years. Their child’s future eye health is an important factor when considering a management option, which could be one reason why many parents responded positively to MiSight 1 day.
parents wanted something that was easy to use, comfortable, and would help protect their child’s eyes from future eye health problems
These findings confirm those of previous surveys. For example, a survey of British parents found that they are keen to hear about MM and are most likely to consider MM contact lenses if they know they might reduce the risk of ocular health problems in later life.6 Additionally, recommendation by an ECP helps to alleviate parents’ concerns about children wearing contact lenses. The surveys reveal, however, that notable proportions of myopic children are not offered any MM option.
When to Commence Management
Previous research found that the rate of myopia progression is the most commonly used indication of the need for myopia management. In a global survey, 75% (239/319) of ophthalmologists reported that progression rate indicated the need for myopia management. In the present survey, 63–99% of ECPs report that managing myopia in children is especially important if the prescription is increasing rapidly. Nonetheless, past progression may not accurately predict future progression, and, therefore, a case can be made for managing all progressing myopia patients.7 Indeed, it may be argued that all myopic children should receive myopia management, since nearly all young myopes progress – three quarters of ECPs agree.8
The survey found that most ECPs believe that it is important to slow myopia progression at an early age. This belief seems reasonable since progression rates are faster at younger ages and, thus, early onset is associated with a greater risk of high myopia.9,10 ECPs appear to be aware of this as many worry about the myopic progression in their paediatric patients causing significant detriment to eye health in later life. Bullimore & Richdale (2020) recommend managing myopia in schoolage myopes, which would include children from the age of six years,8 although most ECPs would be comfortable fitting child myopes with contact lenses from the age of nine years onwards.
On average, ECPs would be comfortable fitting their paediatric myopes with contact lenses from the age of nine years onwards
Parent and Patient Education
Given that more time outdoors is protective against myopia onset,11-15 and may even slow myopia progression16 – not to mention other potential health benefits – it is encouraging that ECPs report recommending spending time outdoors to most of their paediatric myopes. However, ECPs need to ensure that this recommendation is delivered in a memorable way since few parents recall being given this advice.
ECPs realise that, by providing myopia management, they could be making a difference to their patients’ future ocular health. Evaluation of data from large population-based studies of the prevalence of myopic maculopathy and vision impairment, and association with degree of myopia, suggests that slowing a patient’s myopia progression by one dioptre may reduce the risks of myopic maculopathy and visual impairment by 40% and 20%, respectively.17,18 However, ECPs continue to report that many parents are unaware of the risks of myopia to future eye health.
The main practical implication of the survey is that ECPs should educate parents about myopia and its management. And that parents are eager to learn about this subject. Education is needed among consumers to help them understand what myopia is, the future eye health risks their child could face, and what intervention options are available. Naturally, parents are concerned about risks to the health of their children, which is why clear explanations about myopia and its management are important.
Claire Venezia is Director Global Marketing for MiSight 1 day and Specialty Products at CooperVision, Inc.
Elizabeth Lumb is Head of Professional Services for MiSight 1 day, EMEA.
Justin Kwan is Senior Manager, Myopia Management, Professional and Academic Affairs, USA.
Thanks to Nathan Greenaway at Visioncare Research Ltd and Anna Sulley at CooperVision for their help in preparing this article.
- Holden BA, Fricke TR, Wilson DA, Jong M, Naidoo KS, Sankaridurg P, Wong TY, Naduvilath TJ, Resnikoff S. Global prevalence of myopia and high myopia and temporal trends from 2000 through 2050. Ophthalmology. 2016;123:1036–42.
- Jones D, Luensmann D. The prevalence and impact of high myopia. Eye Contact Lens. 2012;38:188–96.
- Bailey MD, Olson MD, Bullimore MA, Jones L, Maloney RK. The effect of LASIK on best-corrected high-and lowcontrast visual acuity. Optom Vis Sci. 2004;81:362–8.
- Gifford KL, Richdale K, Kang P, Aller TA, Lam CS, Liu YM, Michaud L, Mulder J, Orr JB, Rose KA, Saunders KJ. IMI–Clinical Management Guidelines Report. Invest Ophthalmol Vis Sci. 2019;60:M184–203.
- Jones L, Drobe B, González-Méijome JM, Gray L, Kratzer T, Newman S, Nichols JJ, Ohlendorf A, Ramdass S, Santodomingo-Rubido J, Schmid KL. IMI–Industry Guidelines and Ethical Considerations for Myopia Control Report. Invest Ophthalmol Vis Sci. 2019;60:M161–83.
- Bull Z, Gaskin C, Lumb E. Parent and practitioner opinions on myopia management–part 1. Optician. 2019;2019:218220–1.
- Hernandez J, Sinnott LT, Brennan NA, Cheng X, Zadnik K, Mutti DO. Analysis of CLEERE data to test the feasibility of identifying future fast myopic progressors. Invest Ophthalmol Vis Sci. 2018;59:3388.
- Bullimore MA, Richdale K. Myopia Control 2020: Where are we and where are we heading?. Ophthalmic Physiol Opt. 2020;40:254–70.
- Donovan L, Sankaridurg P, Ho A, Naduvilath T, Smith III EL, Holden BA. Myopia progression rates in urban children wearing single-vision spectacles. Optom Vis Sci. 2012;89:27–32.
- Chua SY, Sabanayagam C, Cheung YB, Chia A, Valenzuela RK, Tan D, Wong TY, Cheng CY, Saw SM. Age of onset of myopia predicts risk of high myopia in later childhood in myopic Singapore children. Ophthalmic Physiol Opt. 2016;36:388–94.
- Jones LA, Sinnott LT, Mutti DO, Mitchell GL, Moeschberger ML, Zadnik K. Parental history of myopia, sports and outdoor activities, and future myopia. Invest Ophthalmol Vis Sci. 2007;48:3524–32.
- Rose KA, Morgan IG, Ip J, Kifley A, Huynh S, Smith W, Mitchell P. Outdoor activity reduces the prevalence of myopia in children. Ophthalmology. 2008;115:1279–85.
- He M, Xiang F, Zeng Y, Mai J, Chen Q, Zhang J, Smith W, Rose K, Morgan IG. Effect of time spent outdoors at school on the development of myopia among children in china: a randomized clinical trial. JAMA. 2015;314:1142–8.
- Wu PC, Tsai CL, Wu HL, Yang YH, Kuo HK. Outdoor activity during class recess reduces myopia onset and progression in school children. Ophthalmology. 2013;120:1080–5.
- Deng L & Pang Y. Effect of outdoor activities in myopia control: meta-analysis of clinical studies. Optom Vis Sci. 2019;96:276–82.
- Wu PC, Chen CT, Lin KK, Sun CC, Kuo CN, Huang HM, Poon YC, Yang ML, Chen CY, Huang JC, Wu PC. Myopia prevention and outdoor light intensity in a school-based cluster randomised trial. Ophthalmology. 2018;125:1239–50.
- Bullimore MA & Brennan NA. Myopia control: why each diopter matters. Optom Vis Sci. 2019;96:463–5.
- Bullimore MA & Ritchey E. Myopia control: An evidence based comparison of the beneﬁts and the risks. Optom Vis Sci. 2019;96: E-abstract 190031.
- Chamberlain P, Peixoto-de-Matos SC, Logan NS, Ngo C, Jones D, Young G. A 3-year randomized clinical trial of MiSight lenses for myopia control. Optom Vis Sci. 2019;96:556–67.
* USA Indications for use: MiSight 1 day (omafilcon A) soft (hydrophilic) contact lenses for daily wear are indicated for the correction of myopic ametropia and for slowing the progression of myopia in children with non-diseased eyes, who at the initiation of treatment are eight to 12 years of age and have a refraction of -0.75 to -4.00 diopters (spherical equivalent) with ≤ 0.75 diopters of astigmatism. The lens is to be discarded after each removal. These indications for use are specific to the US market.
MiSight 1 day (omafilcon A) soft (hydrophilic) contact lenses for daily wear are indicated for correcting ametropia and for control of the progression of myopia. MiSight 1 day is a registered trademark of CooperVision Inc.