New interventions to help slow myopia progression
There is a broad consensus among experts that eye care professionals (ECPs) have a responsibility to prescribe interventions to slow down myopia progression, in line with the recent call for a global standard of care in myopia management.
Myopia is a type of uncorrected refractive error – one of the leading causes of visual impairment in the world. According to the Brien Holden Vision Institute, by 2050, about 50% of the world’s population is expected to be myopic, representing a 117% increase since 2000.
The increasing prevalence of myopia around the world, and especially in Asia-Pacific, is alarming. In addition to causing immediate vision impairment, myopia, even at low (below -3.00 diopters) and moderate levels (between -3.00 to -6.00 diopters), can increase the risk of serious disorders such as myopic macular degeneration, retinal detachment, glaucoma, and cataract, and is a leading cause of visual impairment and blindness. Studies have found that the risk of visual impairment increases 3.4 times with high myopia between -6.00 diopters and -10.00 diopters, and 22 times when above -10.00 diopters.
What causes myopia?
Tacy Song, Head of Professional Services Myopia at CooperVision Asia Pacific, said that myopia is traditionally viewed as a condition resulting from a combination of genetic, ethnic, and environmental risk factors.
“While refractive error is a key parameter in measuring myopia progression, axial length is becoming increasingly important in a clinical setting. Many practices have started updating their equipment to meet the newer advancements in myopia management which measures axial elongation or axial length; the greater the axial length, the longer the eyeball, and the greater the myopia,” said Tacy.
She further explained, “The eye tends to grow most rapidly during childhood, and myopia onset at a younger age is associated with more rapid progression. Therefore, early detection and correction are crucial in effectively controlling myopia.”
The earlier myopia develops, and the longer it is left untreated, the greater the risk of developing high myopia and other sight-threatening complications later in life.
Slowing down myopic progression
Spectacles have long been a primary treatment for visual correction of myopia: the single-vision glasses work by refocusing the light entering the eye and enabling clear vision.
“However, this is simply a stopgap solution that does not address the underlying condition, i.e., the abnormal elongation of the eyeball. To keep their blurred vision under control, children using single-vision glasses must periodically increase the prescription of their glasses as their myopia progresses.
“Current treatments usually only slow myopia progression. Fortunately, the latest advancements in medical science make it possible for ECPs to prescribe treatments that not only correct blurred vision but control the abnormal eye growth and slow down the progression of myopia in children,” Tacy said.
The longest soft contact lens study for myopia control
Tacy cited the recent findings from CooperVision’s pivotal MiSight-1-day contact lens clinical trial – the longest soft contact lens study for myopia control – which shows promising results with regards to the efficacy and safety of myopia management contact lenses in children.
“The study, which was conducted on children across the ages of 8 to 17 years, demonstrates that dual focus contact lenses work for nearly all children with myopia, with 90% of myopic eyes responding to the MiSight-1-day treatment. At all observed ages, the dual focus contact lenses slowed myopia progression by approximately 50%. Specifically, it slowed the change in axial length.”
Interestingly, the study also demonstrated the contact lenses work at any age a child starts treatment.
“MiSight-1-day is proven to retain myopia control benefits after treatment has ended. Twelve-month post-treatment evidence indicates myopia control gains were retained with MiSight-1-day. Studies on other treatment modalities such as atropine and orthokeratology have shown a post-treatment rebound effect.
“What makes these findings particularly relevant for ECPs and optometrists is they now have an additional tool in their artillery to address and slow down myopia progression in children. The MiSight-1-day contact lenses provide a dual purpose: they provide clear vision and help control the progression of myopia. The “ActivControl Technology” used in the lenses is of a special optical design that can provide clear vision while also reducing the signal that encourages the elongation of the eye,” Tacy supplied.
Responsibility of ECPs in myopia management
In 2021, the World Council of Optometry (WCO) passed a resolution that publicly declares support for myopia management as a standard of care. While myopia management is still a new concept in the Asia-Pacific region, there is broad consensus that ECPs have a responsibility to not only correct refractive error but also prescribe interventions to help slow down the progression of myopia.
WCO’s resolution outlines three areas optometrists should address as first port-of-call in myopia correction and control:
a. Mitigation – attempting to prevent or delay onset of myopia by providing advice on visual environment and watching for pre-myopia
b. Measurement – providing regular comprehensive vision and eye health examinations for myopic children including measuring refraction and axial length where possible
c. Management – addressing patients’ needs to correct and control myopia with evidence-based interventions, for improved quality of life and better eye health today and into the future.
A crucial aspect of treating childhood myopia, according to Tacy, is patient management.
“Before any intervention, we need to educate parents about childhood myopia, and the importance of early detection and early intervention. This is where ECPs have an opportunity to play the role of specialists and be more proactive in raising the topic of myopia management to parents and persuade them to permit their child to undergo regular eye exams,” she advised.
“Once the myopia is detected, ECPs must be equipped to help parents and their children control myopia, such as counseling children and parents on lifestyle habits and eye hygiene that slow down myopia, different treatment approaches, and prescribing the appropriate treatment based on the child’s needs. Anyone undergoing myopia control treatment should be assessed at least every six months to check on the treatment’s efficacy and safety.”
When equipped to detect and manage myopia at an early stage in children, ECPs could potentially help millions of adults avoid serious eye complications in the future, while saving hundreds of billions of dollars in treating and correcting serious eye conditions.
