Product profile

Myopia is a significant global public health and socioeconomic problem and has been steadily increasing in recent decades, writes Andy Sanders

It is estimated that by 2050, around 50 per cent of the world’s population will be myopic1. With increased myopia, the risk of sight-threatening conditions increases almost exponentially – with even lower levels of myopia being of concern. Research suggests that ocular diseases potentially leading to sight impairment or blindness is doubled with a refractive error as low as -2.00D

Historically, practitioners have focused on correcting myopia with standard spectacles or contact lenses that correct the refractive state of the eye, but don’t manage the progression of myopia which typically increases from around six years of age to adulthood. Large segment bifocals have been prescribed with some success in cases where children are esophoric at near. Additionally, short corridor progressives and more recently low add boost lenses have been utilised, which are clearly cosmetically more appealing but appear to have relatively low efficacy3 .

There are several theories as to the aetiology of myopia, however, the mechanisms involved in the onset and progression remain unclear. These proposed theories include mechanical tension, accommodation lag and peripheral refraction or relative peripheral hypermetropic defocus theory (RPHD). Each of these theories may not be exclusive of each other and, in addition, there are complex physiological and biological processes involved which are affected by environmental and genetic factors3 .

CLINICALLY-PROVEN TREATMENT The novel MiYOSMART spectacle lens is a collaborative development between the prestigious Hong Kong Polytechnic University and Hoya Vision Care (Figure 1). This innovative, non-invasive spectacle lens design features Defocus Incorporated Multi Segment (DIMS) Technology and has been clinically proven, via a two-year randomised controlled trial with a one-year follow-up, to be safe and effective in the management of myopia; on average reducing myopia progression by 60 per cent4 .

The MiYOSMART spectacle lens features a clear central hexagonal area measuring 9.4mm in diameter, giving the patient the prescribed myopic correction. This is surrounded by a treatment zone of 33mm consisting of micro-lenslets, each with 3.50D defocus power measuring 1.03mm in diameter distributed exactly 1.5mm centre to centre. Unlike standard spectacle lenses, which produce peripheral hypermetropic defocus, which is hypothesised to drive eye growth myopia progression5, the MiYOSMART spectacle lens creates peripheral myopic defocus reducing the progression trigger.

The honeycomb type structure of the defocus zone (Figure 2) gives an average ratio of myopic correction to defocus of 50:50, so when the patient looks directly through the defocus zone, visual acuity remains almost unchanged4. It should be noted that the lenslets, whilst having a power of 3.50D, do not represent or perform like a bifocal addition.

This description might well conjure up images of a compound eye type appearance but in Hoya’s view, nothing could be further from the truth. The technological beauty of this lens remains invisible – only becoming apparent when the lens is moved around as if trying to find progressive lens markings. This is partly because the lenslets have a peak of less than 0.8 microns and the lenses come as standard with a special easy clean anti-reflection coating.

PRESCRIBING TOOLS AND SUPPORT Being made of polycarbonate the lens is impact resistant and safe for the rough and tumble of daily life children may experience, additionally providing UV protection. Prescribing the lenses is straightforward and they are measured in the same way as progressive lenses. First, an appropriate frame needs to be selected that has a B size of more than 25mm allowing at least 12mm above pupil centre.

Figure 2: MiYOSMART lenses have a honeycomb-like structure

Myopic maculopathy 2 x 10 x 41 x

Retinal detachment 3 x 9 x 22 x

127 x

44 x

PSC cataract 2 x 3 x 6 x Data not available

Glaucoma 2 x 3 x 3 x Data not available

Figure 1: A novel, non-invasive spectacle lens design

Production HOYA Rx SuperLab Thailand Price €

1.59 polycarbonate SF 0.00 D up to -10.00 max cyl -4.00 Up to three prism dioptres per lens

75mm: plano → -6.00 cyl. -400 70mm: -6.25 → -7.50 cyl. -400 65mm: -7.75 → -8.50 cyl. -400 60mm: -8.75 → -10.00 cyl. -400

Figure 3: Lens availability and diameter

This ensures there is an appropriate level of defocus in the superior and inferior of the pupil.

The ideal vertex distance is 10mm or less and in the worn position, the frame should have a pantoscopic tilt close to zero and a frame face form angle no more than five degrees. Whilst these measurements are a crucial starting point, glasses will often go out of adjustment over time so parents should be advised to return to the practice with their children should this happen, as is the case with standard glasses. It should, however, be noted that during the randomised controlled trial3, there were no specific instructions given for frame adjustment to parents other than to visit as they would have in the past to their regular eyecare practitioner.

Hoya produces a range of support materials including an essentials guide for eyecare professional that outlines the protocols associated with the myopia management journey. Unlike other spectacle lens designs, we believe this to be a medical intervention strategy not a 'fit and forget' vision solution. As such, prescribers should give additional advice such as limiting time spent using closelyviewed material, including digital devices, taking breaks from near work activities and recommending time spent outdoors6 .

AVAILABILITY AND ACCREDITATION MiYOSMART is available up to a 75mm blank in a wide power range from plano through to -10.00D with opposite cyls to -4.00D (Figure 3). Prism is also available up to three prism dioptres. For verification, the lenses are checked by the eyecare practitioner on the focimeter at the optical centre. However, moving the focimeter to the defocus zone and focusing the lenslets shows the unique pattern of defocus. using extensive research and innovative technologies to provide products that the optical community needs to meet customer expectations. MiYOSMART has a clear prescribing protocol and Hoya has developed a three-stage accreditation process, featuring presentations from Professor Carly Lam, principal co-investigator at the Hong Kong Polytechnic University and Bruce Evans, director of research at the Institute of Optometry in London.

The presentations and Q&As cover the topic of myopia, the different interventions available, and the fitting and roll-out of the lens, including how it should be used. These are followed by two exams that must be passed to receive the certification. The first has a pass mark of 80 per cent and the second a 100 per cent pass mark. The accreditation programme, and ultimately the MiYOSMART spectacle lens, can be accessed via Hoya’s training platform at hluktrainingresource.thinkific. com (Figure 4).

Additional myopia management training modules are in development to ensure the most up-to-date information is available to all myopia visionaries.

Hoya’s business development managers are supporting practices, providing both online and face-to-face workshops relating to the introduction of the lens to parents and patients. Accredited practices receive full launch packs, which include a detailed ECP guide with FAQs.

SUMMARY Hoya is committed to supporting eyecare professionals in raising awareness around myopia, and the need for parents to focus on their children’s eyecare by visiting their local opticians. Nothing is more important than the health and well-being of our children. Now and into the future, we want to see the next generation thrive. MiYOSMART DIMS technology has already received a number of awards and recognition, including the prestigious Grand Prize, Grand Award and Gold Medal at the 46th International Exhibition of Inventions of Geneva in April 2021, and the Silmo d’Or award in October 2020. There are currently more than 500,000 children benefiting from wearing MiYOSMART spectacle lenses across multiple countries7 . Could you patients benefit too?

Figure 4: Scan this QR code to access Hoya’s accredited training platform

REFERENCES

1. Holden BA et al. Global prevalence of myopia and high myopia and temporal trends from 2000 through 2050. Ophthalmology 123;5:1036-104. https:// pubmed.ncbi.nlm.nih.gov/26875007 2. Table values rounded to the nearest integer.

Sources: a) Gifford K. Preparing your practice for the myopia control stampede. Contact Lens Spectrum 2016;31:20-23,25, 55; b) WHO. The impact of myopia and high myopia. Report of the Joint World Health

Organization. Brien Holden Vision Institute Global

Scientific Meeting on Myopia, University of New

South Wales, Sydney, Australia, 16-18 March 2015; c) Flitcroft DI. The complex interactions of retinal, optical, and environmental factors in myopia aetiology. Prog. Retin. Eye Res. 2012;31:622-660; d) Saw S et al. Myopia and associated pathological complications. Ophthal. Physiol. Opt. 2005;25:381391; e) Lai T. Retinal complications of high myopia.

Medical Bulletin 12;9:09/2007. 3. Nameth J et al. Update and guidance on management of myopia. European Society of

Ophthalmology in cooperation with Int853883. ernational Myopia Institute. European Journal of

Ophthalmology 31;3:853-883. https://journals. sagepub.com/doi/10.1177/1120672121998960 4. Lam CSY et al. Defocus Incorporated Multiple

Segments (DIMS) spectacle lenses slow myopia progression: a two-year randomised clinical trial. British Journal of Ophthalmology.

Published Online First: 29 May 2019. doi:10.1136/ bjophthalmol-2018-313739 5. Huang J et al. Efficacy comparison of 16 interventions for myopia control in children: a network meta-analysis. Ophthalmology 2016;123:697-708. 6. Wu PC et al. Myopia prevention and outdoor light intensity in a school based cluster randomized trial.

Ophthalmology 2018;125:1239-50. 7. Hoya Data on file, September 2021.

Andy Sanders is professional services director for Hoya Lens UK and Ireland.

Bausch + Lomb, ocular specialists in eye care for over 165 years, has been at the forefront of visionary innovations in eye care. Our Bausch + Lomb mission of “helping people see better to live better” is supported through our extensive portfolio of vision care products that we continue to enhance with new innovations and our commitment to building and nurturing our partnerships with the professionals who provide eye care to the public. We seek to encourage growth of a loyal contact lens customer wearer base for our practice partners through the use of our comprehensive lens and lenscare portfolio and most recently with the fitting of our innovative contact lens brand, Bausch + Lomb ULTRA® . Bausch + Lomb ULTRA® is the latest innovation in reusable contact lenses across a complete family*53,55,56,57 giving it a strong advantage as eye care professionals familiar with the material have a range offering to meet many of their patients’ vision needs and are therefore able to keep patients in the same material from when they are young to old. Additionally, this lens family provides all the comfort80 you would expect from a premium brand, but at a competitive price, thereby making it an attractive offering for patients. If I’m fitting an astigmatic 35-year-old, I’m thinking that I want this patient to carry on for the next 15, 20, 25 years, possibly even more. If I can keep them in that particular brand and lens that I know works for them, that the vision is good, stable, and there is a good multifocal I can go to as they get older, that ticks all the boxes for me and that would be my first choice.” David Barker, Director and Optometrist Rawlings Opticians, Croydon

This innovative contact lens is based on the well-established performance of both the Bausch + Lomb ULTRA® Multifocal and Toric lens designs. Thereby combining the seamless vision presbyopic patients want with the lens stability for their astigmatic needs1,2,6 and enabling eye care professionals to address the needs of this target segment, providing growth opportunities for their contact lens wearer base. Additionally, with the lenses being available in stock and ready to ship upon order, this has helped practices offer patients good customer service by reducing their waiting time and fulfilling their vison needs sooner.

As a practitioner, I have been longing for a [monthly] disposable lens for my presbyopic astigmatic patients and, finally, it’s here! I’m pleased to say that this lens doesn’t disappoint. The fitting process is easy to follow, and the patients love their enhanced clarity in their vision.” Adrian Baxendale, Hepworth and Hall Opticians The ULTRA® and Biotrue® ONEday family of lenses have changed my contact lens practice more than any other lens in the past. Why do I say this? A. The expert and enthusiastic recommendation of the

Bausch + Lomb consultant... who has continued to be in close contact and has offered any help that is required. B. The extensive range available. C. The availability of Bausch + Lomb ULTRA® Multifocal for Astigmatism The lenses have proved their worth in that many patients have commented how much more comfy they are, both early in the day and at the end of the day and indeed at the end of the month.” Andrew Rider, Eyecatchers Ltd, Harrogate

Training and education We continue to provide training and educational support to keep up with clinical insights through our on-demand CET and non-CET webinars on our Let’s Rethink Optometry Together educational platform: www.gotostage.com/channel/bausch KOL insights sharing By engaging with our KOL’s in a round table discussion we have been able to share some valuable insights and feedback on the performance of Bausch + Lomb ULTRA® Multifocal for Astigmatism and how best to introduce this lens into practices. View the article and video extracts here: www.bausch.co.uk/ultra-mfa

Practice sustainability building During lock-down, where the need to remain sustainable became most pertinent for practices, we offered practices free freight on all orders through our Bausch + Lomb Direct Service. This service supports practices e-commerce offering by providing an enhanced online ordering and direct-to-patient delivery service for all Bausch + Lomb soft contact lens and lens care products. This service also enables practices to fully manage their Bausch + Lomb patients online, 24/7, with full customer service support and without having to be in their practice. There is also the option to utilise the subscription model from this service, to build patient loyalty to the practice. To find out more visit: https://bauschandlomb.adarodirect.com Practice support tools To support the patient contact lens journey through every practice partnering with Bausch + Lomb, we provide practice tools such as social media content with images and patient email templates to help raise awareness that the practice has a new contact lens available to address patients’ prebyopic astigmatic vision needs. Other key tools available are a consumer video for waiting rooms, a 100% satisfaction contact lens guarantee and a wearing and caring contact lens guide tear-off pad for patients. Encouraging patient footfall into practice Following lock-down, we have supported our practice partners with an engaging native advertising campaign that targets consumers based on their contact lens needs and drives relevant traffic to the practices to trial Bausch + Lomb contact lenses. Participating practices have also had point of sale materials to use in practice to elevate the campaign messaging.

During the initial lockdown we anticipated that with people working from home, they would not require as many lenses as they normally would, due to wearing their glasses more. As it turned out that to retain some normality, patients continued wearing their contact lenses. Prompt home delivery from Bausch + Lomb Direct was crucial as patients could have easily ordered them online with all their other shopping. A big THANK YOU to Bausch and Lomb for helping us retain patient loyalty!” Minaz Mamdani, Optometrist, Mamdani Opticians

To find out more please contact your Bausch + Lomb Territory Business Manager or Customer Services on: N 0845 602 2350 E cs.vc.uk@bausch.com

* Latest technology in soft reusable lenses across a complete contact lens family. 1. ULTRA® Comfort Experience™ for Presbyopia Data Analysis Phase 1 + 2. 2017. 2. Bausch + Lomb ULTRA® Multifocal for Astigmatism stabilisation study. 6. The 2020 Study of US. Multifocal contact lens market. 11. Millward Brown., 2010. Biotrue® Product Test (#640). 53. Pence, N.,2014. Contact Lens Design and Materials. Contact Lens Spectrum [e-journal]. https:// www.clspectrum.com/supplements/2014/october-2014/breaking-the-cycle-of-discomfort/contact-lens-design-amp-materials [Accessed 8/12/2020]. 55. Sulley, A., 2005. Practitioner and patient acceptance of a new silicone hydrogel contact lens. Optician 6017 (230), pp 15-17. 56. Barr, J., 2004. An avalanche of products, compliance and the FCLCA. Contact Lens Spectrum [e-journal]. https://www.clspectrum.com/issues/2010/december-2010/ product-spectrum [Accessed 15/12/20]. 57. Mack, C., 2008. Contact Lenses 2007. Contact Lens Spectrum [e-journal]. https://www.clspectrum.com/issues/2008/january-2008/contact-lenses-2007 [Accessed 8/12/20]. 80. Merchea, M., Steffen, R., et al., 2014. Clinical performance of Bausch + Lomb ULTRA® contact lenses with MoistureSeal® technology silicone hydrogel. Please read the Instructions for Use (IFU) for risks associated with Bausch + Lomb ULTRA® contact lenses. ULTRA and Biotrue are trademarks of Bausch & Lomb Incorporated or its affiliates. All other product/brand names and/or logos are trademarks of their respective owners. © 2021 Bausch & Lomb Incorporated or its affiliates. ULC.0040.IE.21