Myopia, and the slowing or halting of its progression, is the fastest growing area of our professional business. From an ethical standpoint it is something we should be discussing with all at risk patients and their parents, whether we intend to treat them ourselves or refer.
This makes it imperative to stay up to date on the latest research and approaches to management. This issue of milenses explores some of the spectacle and contact lens options currently available for myopia management.
Myopia is on the rise, but the good news is that so too are the number of management options and strategies available. Spectacle lenses, soft multifocal contact lenses, orthokeratology (OK) and atropine are all being used to manage this progressive condition, which has been described by Dwight Akerman, Chief Medical Editor, Review of Myopia Management, as a pandemic.
Philip Cheng, a Victorian optometrist at the sharp end of myopia management, explained his experience and philosophy as clinical director of his Myopia Clinic in Melbourne.
with global myopia numbers on the rise beyond what is normally expected, we should take every opportunity to explain what myopia is, why treatment is needed and offer an effective management strategy
“I look after hundreds of children across Victoria for myopia management. In recent times there’s been a shift towards initiating early intervention in low myopia. Patients are often children of parents who have high myopia and are eager to do the best for their kids to avoid a similar predicament, or may be younger siblings of children already on myopia control treatments such as OK. They have a higher risk profile of developing myopia,” he explained.
“By routinely measuring the axial length of every child in my clinic, an individual eye growth profile is attained. Evidence of significant axial elongation of ‘premyopes’ can help predict the imminent onset of myopia and give an indication of the rate of potential progression. We know there is no safe level of myopia. Every dioptre increases the risks of myopiarelated ocular pathologies, as well as the inconvenience of blurred vision. This means practitioners should aim for the earliest intervention possible.”
SOFT MULTIFOCAL CONTACT LENSES
Soft multifocal contact lenses are often used at the centre of an effective myopia management strategy. Prescribing these is relatively straight forward and can be a good way to get into myopia management, especially if your practice doesn’t prescribe OK or atropine.
A relatively new player on the Australasian scene is leading Japanese contact lens company, SEED Contact Lens ANZ, which recently introduced Seed 1dayPure Extended Depth Of Focus (EDOF) contact lenses. General Manager William Tse describes SEED 1dayPure as “a new generation of multifocal contact lenses” that incorporates Brien Holden Vision Institute’s patented EDOF design. While being marketed as a contact lens to benefit presbyopes, this unique design with a nonmonotonic power profile aims to deliver good retinal image quality for points on and anterior to the retina, while degrading quality for points posterior to the retina.
The rationale behind many such contact lenses, and indeed spectacle designs, is to reduce the stimulus for the peripheral retina to grow toward the peripheral hyperopic defocus present in traditional lens designs. In doing so, they slow (or even halt) axial length elongation, therefore reducing myopia progression.
Multifocal soft contact lenses are Mr Cheng’s treatment of choice for children with low myopia. Along with SEED 1 dayPure, two of the centre distance soft multifocal lenses he described using were CooperVision’s MiSight 1 day and the NaturalVue Multifocal.
For other patients he said “OK nighttime lenses remain a popular option for children with around -1.50 dioptres of myopia or greater, and those with mixed myopia and astigmatism. The amount of peripheral defocus created by OK treatment is dependent upon the level of myopia correction and lens design.”
Some young children, as well as parents who feel their children are not ready for contact lenses or using eye drops, will prefer glasses as a myopia treatment option. In response to this, Mr Cheng says, “multifocal glasses, despite being commonly prescribed by optometrists, are largely ineffective in slowing myopia progression by any clinically meaningful amount, as shown in the COMET studies.”
However, he believes D.I.M.S (Defocus Incorporated Multiple Segments) spectacle lenses, commercialised by Hoya as MiyoSmart, are a potential game-changer. Recently launched in our region, he had early access to this design and has already prescribed them to a number of patients. Mr Cheng says early impressions have been positive with patients adapting well. While acknowledging that it is too early to draw conclusions, he said axial length monitoring of patients so far shows promise in slowing their rate of progression.
Other more established options for myopia management include Zeiss’ MyoVision lens, which has been available since 2012, and the MyoVision Pro, its updated design launched in 2018.
Essilor has also been in the business of myopia correction for some time, with versions of Myopilux lenses on the market for many years. More recently the company announced one-year results of its new Stellest lens. Designed with HALT technology (Highly Aspherical Lenslet Target), the lens incorporates aspherical lenslets in eleven rings, radiating out from a central single vision zone. Interim results are very promising. No doubt we’ll see this lens appearing on the ANZ market in due course.
Remember that when prescribing spectacle lenses for myopia control, careful frame selection, dispensing and fitting are important, making it imperative that we take time to get it right. In concluding our discussion, Philip Cheng echoed comments made by Dwight Akerman, who has said that with global myopia numbers on the rise beyond what is normally expected, we should take every opportunity to explain what myopia is, why treatment is needed and offer an effective management strategy.
“It is helpful to have new treatment options for myopic children, many of whom are developing myopia earlier and progressing faster, perhaps in part due to an increase in screen time/near work and reduced outdoor time – factors exacerbated by the COVID-19 lockdowns and virtual learning from home,” Mr Cheng said.
As time goes by we will likely see even more high-tech, innovative spectacle and contact lens designs emerge. In the meantime, check out the following available options that will enable your involvement in this important, evolving area of eye care.
Contact Lenses for Myopia Control
MiSight 1 day
MiSight 1 day remains the only myopia management treatment of any kind with approval from the United States Food and Drug Administration. This milestone was achieved using excellent safety and efficacy data from one of the largest and longestrunning clinical studies of its type which began in 2012. MiSight 1 day is also now available in a 90-pack. Accreditation is required to prescribe MiSight 1 day.
Contact: CooperVision Account Manager
Gelflex for Orthokeratology
Offer your patients the visual freedom of being able to see throughout the day without the use of glasses or daily contact lenses.
Gelflex offers a three-tier product range featuring Gelflex Ortho-k, the Euclid Emerald Lens and Paragon CRT, providing a system that’s suitable for lens fitters of all levels of experience. Gelflex’s professional and experienced team supports practitioners with technical advice.
Contact: Gelflex (AUS) 08 9443 4944
EyeSpace Forge Ortho-K
EyeSpace is a powerful contact lens design and simulation software package that links with your corneal topographer to generate computerised fluorescein simulations of gas permeable contact lenses. EyeSpace enables both beginner and experienced contact lens practitioners to accurately fit Forge Ortho-K lenses, without the need for trial fitting.
The Forge Ortho-K lens is bespoke to the size, shape, and optics of the eye being fit. The size of the optic zone can be optimised to the magnitude of myopia and the pupil size, a necessity in myopia management.
The EyeSpace technical support team is available to help eye care practitioners increase their fitting accuracy, knowledge and build their contact lens practice.
Contact: Innovative Contacts (AUS) 08 8231 9341
SEED 1dayPure EDOF soft contact lenses use newly designed optics patented by Brien Holden Vision Institute. Unlike centre-near or centre-distance designs, it has a non-monotonic power profile that incorporates higher order aberrations to increase the depth of focus of the eye for better presbyopia management. Additionally, with the hypothesis that eye growth is guided by visual image quality, the global retinal image quality (RIQ) of the lens is optimised to deliver good RIQ for points on and anterior to the retina, and degraded for points posterior to the retina. Power range is from +5.00 to -12.00D, with three EDOF ranges to suit patients with different add requirements.
Contact: SEED Contact Lens (AUS) 1300 373 718
NaturalVue Multifocal 1 Day
NaturalVue Multifocal 1 Day contact lenses by Visioneering Technologies Inc. (VTI) are designed with a high amount of relative plus power in the periphery. This uninterrupted plus power progression induces peripheral blur in the brain, which we call Neurofocus Optics. With this, NaturalVue Multifocal contact lenses focus peripheral light rays in front of the retina to remove peripheral hyperopia. VTI states that NaturalVue (etafilcon A) Multifocal 1 Day contact lenses are proven clinically effective for myopia progression control.
Menicon Bloom Night
Menicon Bloom Night is the first CE-approved orthokeratology contact lens therapy for myopia control management.
Menicon Bloom Night therapy involves the overnight wear of a specially designed reverse geometry orthokeratology contact lens, manufactured in hyper oxygen-permeable Menicon Z rigid material that ensures optimal corneal oxygenation for comfortable and safe contact lens wear.
The fitting of Menicon Bloom Night is optimised by the use of Easyfit, a sophisticated software which accurately guides the optometrist through the fitting process.
Additionally, a specially designed smartphone App – Bloom, has been developed to enhance the monitoring and communication process between optometrists and patients.
Contact: Menicon Account Manager
Lenses for Myopia Control
Myopilux and Eyezen Boost
Essilor has studied myopia control for more than 25 years. Working with myopia scientists from around the world, including in Australia, the company’s research led to the release of Myopilux Plus and Myopilux Max.
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 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, this is the power used in studies where spectacle lenses slowed myopia progression.
With some studies indicating that higher doses of atropine may be required to help slow myopia progression and control axial length, practitioners using this therapy may find an increased need to support patient accommodation.
Eyezen Boost, with its boost powers of +0.40D, +0.60D or +0.85D, is a simple to use solution providing clear distance vision and assistance at near. As Eyezen is also available in Transitions, it answers to any need for glare reduction if pupil size is an issue.
Even if patients are using orthokeratology or soft multifocal contact lenses, there is still a need for them to have suitable glasses for the times when they’re not wearing their lenses. Myopilux and Eyezen Boost offer assistance for optometrists using these myopia control protocols.
Contact: Essilor Account Manager
Hoya’s much-anticipated MiyoSmart lens with D.I.M.S. technology is now available in Australia and New Zealand. This ground-breaking spectacle lens successfully manages and controls myopia in children, slowing myopia progression by 60%.*
MiyoSmart marks a new era in myopia management, offering optometrists the first ever spectacle lens option that is as efficacious as the current best practice of using various contact lenses and/or atropine.
This provides parents and children with a safe, non-invasive myopia management treatment that is effective as well as easy to live with.
MiyoSmart is available to accredited practices throughout Australia and New Zealand.
Contact: Hoya Account Manager
* Myopia progression (SER) by 59% and axial elongation (AXL) decreased by 60% compared with those wearing SV lenses.
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
Zeiss myopia management solutions provide the perfect balance between optical performance and credible scientific approaches for managing myopia progression with spectacle lenses.
The product portfolio is based on two lens designs: Zeiss MyoKids Pro, which applies the principles of accommodative lag management; and the next generation single vision lens, Zeiss MyoVision Pro, which applies the principles of peripheral defocus management.
Zeiss MyoKids is an innovative lens with a specific myopia management progressive design. The top half of the lens supplies clear vision in the distance, whereas the bottom active zone simultaneously supports near vision tasks and can help to reduce myopia progression.
Zeiss MyoVision Pro is a single vision lens with a specific myopia management design. The periphery of the lens is responsible for myopia control, whereas the central zone provides sharp vision, correcting myopia. Compared to standard single vision lenses, this design is more effective at managing myopic progression.
Zeiss AgeFit Junior technology forms part of both these designs, ensuring the optics are optimised for updated position of wear and frame data for children age six to 12 years old.
Contact: Zeiss Account Manager
Opticare recommends ClearPro Relax to help minimise the effects of near visual stress and digitally-induced eye strain. These premium lenses are designed to reduce headaches, nausea, blurred vision, dry eyes and other symptoms of Scotopic Sensitivity Syndrome when performing near and intermediate visual tasks.
ClearPro Relax is highly recommended for myopic patients. Available upgrades are Blue Guardian which blocks blue light and all other UVA and UVB rays to 420nm. Opticare’s SKYE Multicoat is another upgrade option for anti-glare.
Contact: Opticare (AUS) 1800 251 852