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HomemilensesA Farsighted Approach to Myopia Management

A Farsighted Approach to Myopia Management

The recent Myopia Management Conference in The Netherlands showed myopia continues to be a hot topic, releasing hundreds of papers dealing with many aspects of myopia research and clinical management.

Our homegrown Myopia Profile portal provided regular, succinct summaries of some of the most important papers, and continues to be a leading resource for those engaged in myopia management.

There’s a general view that every eye care practitioner (ECP) needs to be involved in myopia management. At the very least, ECPs should discuss the issues and refer any patients showing signs of myopia progression, while monitoring those at risk.

The efficacy of some of the numerous options and interventions are covered by our leading experts in various articles in this annual mivision myopia edition.

Here we’ll focus on some of the many spectacle and contact lens options currently on the market. There are also some exciting new options that are likely to arrive in 2023. These include new myopia controlling soft lenses, spectacle lenses and the emerging, repeated low-level red-light (RLRL) therapy.

THE MAIN MARKET PLAYERS

There has been much publicity surrounding the release of CooperVision’s seven-year data on its well-established MiSight daily disposable contact lens. Jacqui Regan, CooperVision’s ANZ MiSight 1 day Brand Manager, speaking to the findings from the seven-year clinical trial said, “Twelve-months following treatment cessation, mean axial elongation data indicate no evidence of rebound effect, meaning the myopia control gains are retained”.1,2* 

This bolsters the already impressive data revealed from detailed analysis of the MiSight myopia control modality.

In general, more and more data comparing various myopia control options – including myopia controlling spectacles and contact lenses – shows a similar level of control can be achieved.

Pauline Kang, Director of Learning and Teaching at the School of Optometry and Vision Science at the University of NSW, who has strong research interests in myopia control and the mechanisms underlying the development and progression of myopia in children said, “our understanding of best practice for the management of progressive myopia is continually evolving”.

“Latest research indicates similar treatment efficacies with minimal rebound effects across optical and pharmacological myopia control treatments, including orthokeratology, soft contact lenses, spectacles, and atropine.

“Modifying orthokeratology lens designs and increasing treatment wear time presents alternative approaches to enhancing outcomes with existing myopia treatment options.

“Research into novel spectacle and contact lens designs and light exposure treatments are continuing to emerge, presenting new potential treatment options for clinicians.”

LENS OPTIONS AVAILABLE LOCALLY

With these continuing advances in mind, let’s consider some of the numerous lens options currently available in Australia and New Zealand.

Spectacle Lenses 

Hoya’s MiyoSmart is an innovative, specialised, myopia controlling spectacle lens featuring award-winning D.I.M.S. (Defocus Incorporated Multiple Segments) technology developed by Hoya, together with its research collaborator, the Hong Kong Polytechnic University. Professor Carly Lam and fellow researchers recently provided promising data for up to six years, published in Investigative Ophthalmology & Visual Science.

There are a variety of other myopia control specific spectacle options, some already well established. These include Zeiss’ MyoKids and MyoVision Pro, while Essilor has Myopilux and Eyezen.

Essilor’s latest offering, its long awaited Stellest lens, incorporates HALT technology (Highly Aspherical Lenslet Target) and was recently launched in our region.

New designs are in development. Some are already available. Some have been released in other regions and may reach our shores in 2023 and beyond. Watch this space.

Contact Lenses 

In addition to the well-established MiSight contact lens mentioned earlier, consider the SEED, 1day Pure EDOF (extended depth of focus) lens. This lens is based on technology developed at Brien Holden Vision Institute in Sydney and optimises vision while discouraging axial elongation. It does this by delivering good global retinal image quality (RIQ) for points on, and anterior to, the retina, while degrading RIQ posterior to the retina. SEED is now available through Capricornia.

Other centre distance multifocal soft lenses used by practitioners include the monthly Biofinity multifocal ‘D’ lenses, with variable add power options.

Visioneering Technologies Inc. (VTI), NaturalVue Multifocal 1 Day Contact Lens is also showing promising results. It features Neurofocus Optics Technology with an EDOF, centre distance design. These lenses are available through Corneal Lens Corporation New Zealand and Contact Lens Centre Australia.

Johnson & Johnson Vision is rolling out its Abiliti myopia program internationally, but details and availability are yet to be announced in our region.

Orthokeratology remains a proven and popular myopia management choice among contact lens experts.

Innovative Contacts provides its software/ topography-based, custom designed Forge Ortho-K, while Gelflex offers Gelflex Ortho-K, the Euclid Emerald Lens, and distributes CooperVision’s Paragon CRT. Menicon has its Bloom Ortho K, while Capricornia continues to offer the proven, long-established Mountford-Noack BE system OK lenses and CLC/CLCA offers Brighten Optix.

Check out the following product section for more details on some of the many available myopia management options and stay up-to-date with this important and rapidly evolving field.

References 

  1. Chamberlain, P. Arumugam B, et al. Myopia Progression on Cessation of Dual-Focus Contact Lens Wear: MiSight 1 day 7 Year Findings. Optom Vis Sci 2021; 98:E-abstract 210049. 
  2. Hammond D, Arumugam B, et al. Myopia Control Treatment Gains are Retained after Termination of Dualfocus Contact Lens Wear with No Evidence of a Rebound Effect. Optom Vis Sci 2021;98:E-abstract 215130 
  3. Investigative Ophthalmology & Visual Science June 2022, Vol.63, 4247 

* Preliminary international study data shows that, on average, for children that discontinued treatment at age 14–19 following three or six years of MiSight 1 day wear, the eye growth reverted to age-expected average myopic progression rates. 

Contact Lenses for Myopia Control

Mylo

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

A monthly disposable contact lens, Mylo features high water content, 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 

MiSight 1 day

CooperVision MiSight 1 day contact lense s are now available in higher prescriptions. The expanded range covers -0.25D to -10.00D (0.50D steps after -6.00D), which means that MiSight 1 day now covers 99.97% of prescriptions for Asian children and 99.9 7% for Caucasian children who have myopia and less than 1D of astigmatism.1

MiSight 1 day contact lenses are backed by the longest-running soft contact lens study among children.

Contact: CooperVision Account Manager 

Reference 

  1. CVI Data on file, 2022. SERE coverage of childhood myopia prescriptions with MiSight 1 day for 104,810 eyes in Asia (China, Korea) and 116,336 eyes in Europe and USA aged 8-18 years. 
Menicon Bloom

Menicon Bloom is a complete treatment plan for childhood myopia that features two contact lenses that are CE-approved specifically for myopia control: Menicon Bloom Night, an innovative orthokeratology contact lens, and Menicon Bloom Day, a soft daily disposable contact lens.

Combined with specially formulated Menicon Bloom lens care solutions, state-of-the-art fitting software and the innovative Menicon Bloom App, Menicon offers a holistic treatment plan to help slow down the progression of childhood myopia.

Contact: Menicon Account Manager 

Forge Ortho-K

Orthokeratology is a major intervention for myopia reduction in children. Several cohort studies have shown that orthokeratology is effective in the retardation of myopia progression, with a two-year reduction rate ranging from 30–59%. Recent research has shown that the customisation of orthokeratology lenses may enhance the myopia control effect.1-6

EyeSpace can offer a free demo of Forge Ortho-K for orthokeratology myopia management. This product is easy to use, fully customisable and comes with a complete support, training and resource suite.

Visit: innovativecontacts.com.au 

References 

  1. Cho, P. & Cheung, S. W. Retardation of myopia in Orthokeratology (ROMIO) study: a 2-year randomized clinical trial. Investigative Ophthalmology & Visual Science 53, 7077–7085 (2012). 
  2. Kakita, T., Hiraoka, T. & OSHIKA, T. Influence of overnight orthokeratology on axial elongation in childhood myopia. Investigative Ophthalmology & Visual Science 52, 2170–2174 (2011). 
  3. Walline, J. J., Jones, L. A. & Sinnott, L. T. Corneal reshaping and myopia progression. British Journal of Ophthalmology 93, 1181–1185 (2009). 
  4. Santodomingo-Rubido, J., Villa-Collar, C., Gilmartin, B. & Gutiérrez-Ortega, R. Myopia control with orthokeratology contact lenses in Spain: a comparison of vision-related quality-of-life measures between orthokeratology contact lenses and single-vision spectacles. Eye Contact Lens 39, 153–157 (2013). 
  5. Loertscher, M., Backhouse, S. & Phillips, J. R. Multifocal Orthokeratology versus Conventional Orthokeratology for Myopia Control: A Paired-Eye Study. J Clin Medicine 10, 447 (2021). 
  6. Pauné, J., Fonts, S., Rodríguez, L. & Queirós, A. The Role of Back Optic Zone Diameter in Myopia Control with Orthokeratology Lenses. J Clin Medicine 10, 336 (2021).
NaturalVue

NaturalVue Multifocal 1 Day contact lenses, by Visioneering Technologies Inc, are designed with a high amount of relative plus power in the periphery.

This uninterrupted plus power progression induces peripheral blur in the brain, referred to by VTI as Neurofocus Optics. Proven clinically effective for myopia progression control, NaturalVue Multifocal contact lenses with Neurofocus Optics focus peripheral light rays in front of the retina to remove peripheral hyperopia.

Contact: Contact Lens Centre Australia (03) 9543 1811 

Gelflex

Gelflex offers a complete range of gas permeable and custom designed soft contact lenses tailor-made for your patients.

With 12 DAC lathes, including two ALM, three Axis, four Axis and a CNC Mill, Gelflex has the capacity to manufacture a comprehensive array of designs for almost every condition to exact specifications.

Gelflex orthokeratology (OK) lenses provide visual freedom, allowing patients to enjoy most daytime activities without glasses or contact lenses. Worn while sleeping, OK lenses gently reshape the cornea to correct vision.

Contact: Gelflex (AUS) 03 9792 3127 

Lenses for Myopia Control

Hoya MiyoSmart

Hoya has released the results of a six-year follow-up study on MiyoSmart, its spectacle lens with Defocus Incorporated Multiple Segments (D.I.M.S) technology.

Conducted on 90 children in Asia, the study looked at the progression of myopia in children who wore Hoya Vision Care’s MiyoSmart spectacle lens over the longest period yet. It found that the MiyoSmart spectacle lens myopia control effect is sustained over time for children wearing the lens, with an average cumulative myopia progression less than 1.00D and axial elongation 0.6mm over six years in children that wore MiyoSmart for the duration of the study.

It also confirmed that patients who stopped wearing the MiyoSmart spectacle lens showed no rebound effects when compared with the initial myopia rates of progression during the two-year randomised control trial or with the general population.

Contact: Hoya Account Manager 

Reference 

  1. Lam CSY, Tang WC, Zhang A, Tse D, To CH. Myopia control in children wearing DIMS spectacle lens: 6 years results. The Association for Research in Vision and Ophthalmology (ARVO) 2022 Annual Meeting, May 1-4, Denver, US. 
MyOnic Freeform Lenses

For myopia control treatment, Opticare’s MyOnic Freeform lenses use para-central hyperopic defocus to reduce axial length growth. The MyOnic uses digital technology to create a hyperopic shift outside the foveal region.

Opticare also supplies the freeform progressive Relax lens, which uses conventional Addition to relax accommodation for near tasks.

Contact: Opticare (AUS) 1800 251 852 

Essilor Stellest

Essilor Stellest lenses, the new myopia control lens that slows down myopia progression in children, provide an innovative solution for optometrists to correct vision and help fight myopia progression in children.

Clinical trial results show that after two years, Essilor Stellest lenses slow down myopia progression by 67% on average, compared to single vision lenses, when worn 12 hours a day.*

Essilor Stellest lenses don’t compromise on the aesthetics of the lens and cover a large range from plano to -10.00D sph and plano to -4.00D cyl. Made in Airwear, Essilor Stellest also provides the safety a child needs in the rough and tumble of the playground.

Contact: Essilor Account Manager 

Reference 

*Two-year prospective, controlled, randomised, double-masked clinical trial results on 54 myopic children wearing Stellest lenses compared to 50 myopic children wearing single vision lenses. Results based on 32 children who declared wearing Stellest lenses at least 12 hours per day every day. Bao, J. et al. (2021). One-year myopia control efficacy of spectacle lenses with aspherical lenslets. Br. J. Ophthalmol. doi:10.1136/ bjophthalmol-2020-318367.