9 minute read
Myopia Management with spectacle lenses
Myopia Management with spectacle lenses
The 6-year follow-up clinical study of Miyosmart spectacle lenses
Advertisement
Last year, the results of the 6-year follow-up clinical study of Miyosmart spectacle lenses (manufactured by Hoya) for myopia control were presented at the Association for Research in Vision & Ophthalmology (ARVO) Annual Meeting in Denver in May 2022. Clinical data on myopia control are also available now for spectacle lenses as an alternative to previous myopia management options such as soft contact lenses, OrthoK, or atropine. The significance of using myopia control spectacle lenses and the key findings from the clinical study were explained to us by Pascal Blaser, Global Medical Affairs Manager of Hoya Vision Care, in an interview.
By Daniel Groß and Silke Sage
Why is myopia management becoming increasingly important in the daily routine of optometrists?
Since the World Health Organisation (WHO) published its first report on myopia and high myopia in 20151, more and more attention from eye care professionals has been drawn to myopia in children. Through reports in the press and on television, parents, too, have become more aware. Particularly in the past few years, the visual habits of children have changed a lot due to COVID-19. With the increasing interest in myopia management, there is a need for more advice concerning children's vision, and eye care professionals can now offer new expertise. Of course, the success of myopia management in children could also increase patient loyalty and open the opportunity to provide eye care service to the whole family. Up to now, most children with myopia were simply fitted with conventional single-vision spectacle lenses. This has changed over the last few years, and we are now able to offer more evidence and clinically proven products to the children concerned.
What does promising myopia management look like to you?
Myopia management only works in the long run if we all work together in a serious and evidence-based way. This is how we gain the trust of parents and ophthalmologists, who usually issue prescriptions for children. Myopia management must also be supported by the whole team in a clinic or shop. It is also helpful to introduce a myopia consultation concept in addition to continuing education for the team. The whole team should speak the same language and offer the child a smooth experience.
How has myopia management as a service evolved since you first started to acquaint optometrists with the topic?
From my experience with contact lenses, in the future, the service on myopia management, too, should be charged separately from the cost of the spectacle lens. The myopia management service includes, in addition to refraction, binocular vision, axial length, risk analysis, and regular eye health monitoring. As many professional organizations recommend regular refraction with cycloplegia for children, cooperation with the ophthalmologist can be strengthened by separating the product cost from the service.
Pascal Blaser
Untreated myopia can increase the risk of eye disease later on, especially in the case of high myopia and increased eye length. Is this argument even more important to parents than correcting myopia at a young age?
This certainly depends very much on parents’ understanding of myopia. If parents are shortsighted, especially highly, they know myopia’s drawbacks and how it can impinge on the quality of life. Not only has the axial length measurement been accepted by parents, but the growth curves available today can also be understood by parents, they are already familiar with similar curves for height and weight of child explained by the pediatricians personal child health record. If you look at the growth curves of body weight, you can easily make comparisons. The more the excess weight – or in this case, the axial length corresponding to age – the higher the possibility of consequential damage may be in the future.
How well has the spectacle lens become established as a recognized treatment for children with progressive myopia?
For years, my colleagues and I have tried to establish the contact lens as an option in myopia management, but we often have safety complaints from ophthalmologists. Now, for the first time with the Miyosmart spectacle lens, we have a safe, non-invasive, and effective option for myopia management. As we had already predicted, a spectacle lens, commonly used with young children, will become the standard treatment for progressive myopia. However, the great interest from optometrists, orthoptists, and ophthalmologists from the very start when this product was introduced to the market really came as a surprise.
What has the feedback been so far about the practical experience (with Miyosmart) from opticians, optometrists, orthoptists – as well as from ophthalmologists?
Personally, I was inquisitive to see how children would respond to the Miyosmart in practice. I had been trying it out for several years among my acquaintances, and there had never been any problems. However, things are often different on a larger scale – the recommended frame and centering parameters need to be considered. However, from our regular Miyosmart expert meetings and discussions, the feedbacks clearly exceed my expectations. Initial input from all professional groups is also very positive across the board. The first follow-up checks after six months show that the expected effect is comparable to or even better than in the 2-year Randomized Controlled Trial (RCT) from Hong Kong.
Hoya was the first introducing the myopia control spectacle lens with defocus lenslets, and other manufacturers are now following suit. Does the saying “competition stimulates the market” ring true for you?
Of course, such a success story motivates competitors to jump on the bandwagon, and we see more and more ideas and concepts coming into the market. That's fine as long as we talk about genuine, evidence-based products. Some manufacturers promote a myopia management product without clinical evidence and market the product simply by advertising many hypes. Therefore, a serious and sustainable approach and appropriate communication are essential to avoid pushback from ophthalmologists – similar to what happened to blue light at some point. I believe we have demonstrated professionalism from the start and that has been recognized and accepted by ophthalmologists and orthoptists. Of course, Hoya wants to sell the Miyosmart, but myopia management is a marathon, so we must drive it in a sustainable way. After all, there are massive amounts of myopic children to take care of.
How does Hoya support eye care professionals who are offering myopia management in their shops for the first time?
To this end, through in-depth discussions with our experts, we have implemented several ideas, and many more have been planned for the future. We offer opticians the opportunity to grow their children's eyewear business through myopia management. With this in mind, in Germany we have established contacts with frame suppliers and can now offer complete optical eyewear solutions, including frames and Miyosmart spectacle lenses as a package – for example, the Milo&Me. We launched this new partnership, and the first collection was at the Opti in Munich 2022. This idea was very well received. Our collaboration with Haag-Streit and Lenstar biometer has been known for some time. The axial length measurement instrument and the software provide better visualization and significantly simplify the consultation process. We are expanding our professional affairs team to improve the collaboration between opticians and ophthalmologists further. My new colleagues and I aim to strengthen the understanding and adoption of our product among ophthalmologists.
Recently, doubts have increasingly been expressed about the reliability of the available data for European children's eyes. What is your response to this?
Yes, true, I have increasingly become aware of this request too. Why should we worry that the defocus effect in Caucasians will differ from that in Asians? Of course, we know that in Asian eyes, the excessive axial length growth in myopic children is more pronounced; therefore, the axial length among Asian children is more significant than that in Caucasians. However, the effect of slowing down myopia progression and bringing the eye growth to normal physiological emmetropic growth will probably be similar: not in absolute values of axial length, but in terms of achieving the treatment goal. In the same way, as the father of a myopic daughter, I don't understand the criticism that in Germany, we don't have a high prevalence of myopic children in general, nor (fortunately) many people with pathological shortsightedness in particular. She has an eye that has grown too long, and the potential risk of possible myopia-related adverse events later in live is 100%. I will care about my daughter.
The 6-year follow-up clinical study on Miyosmart spectacle lens was presented at the Association for Research in Vision & Ophthalmology (ARVO) Annual Meeting in Denver in May 2022. What are the key findings?
Firstly, we, Hoya, are proud to present the first 6-year long-term study on myopia control spectacle lenses. We can now scientifically investigate different scenarios we have encountered in practice over such a period of time. The key findings show us how myopia progresses when wearing Miyosmart or single-vision spectacle lenses, whether the treatment effect lasts as long as the lens is worn, and whether reverting to single-vision lenses leads to a rebound effect. The results are extremely promising. The treatment effect lasted over the entire study period and at a level that the International Myopia Institute recognizes as normal eye growth.2 The children who switched after two years showed a significant and immediate effect, which persisted for the remaining four years. In the children who stopped wearing Miyosmart, myopia progressed at the same age-appropriate level as in non-treated myopic children. No accelerated progression was shown over the first two years as a control group. This indicates for me, that there is no rebound effect.3
What innovations are there still to come at Hoya for myopia management?
Together with the partnerships with frame and equipment manufacturers, Hoya will continue to provide comprehensive support to ECPs in myopia management. We are partnering with researchers globally to conduct a series of studies on myopia management. Our training programs for ophthalmologists, orthoptists, and optometrists; expert discussions; and our team will further be expanded. An endcustomer campaign is currently being planned, and you can look forward to furthering innovations and developments. ◆
1 https://bhvi.org/news/the-impact-of-myopia-and-high-myopia/ (access date 30.11.2022)
2 Gifford KL, Richdale K, Kang P, et al. IMI – Clinical Management Guidelines Report. Invest Ophthalmol Vis Sci, 2019;60(3): M184-M203. doi:10.1167/iovs.18-25977.
3 L am CSY, Tang WC, Zhang A, et al. Myopia control in children wearing DIMS spectacle lenses: 6-year results. The Association for Research in Vision and Ophthalmology (ARVO) 2022 Annual Meeting, May 1-4, Denver, USA.
Picture: Lightfield Studios/stock.adobe.com
