Myopia: “There is going to be a veritable explosion of diagnosis”

In a recent industry profile with OT, CooperVision president, Daniel McBride, identified myopia management as a key focus and trend for the profession, calling it “the most exciting area of what is going on in optometry right now.”
 
The case for myopia management has been further strengthened this year with a resolution passed by the World Council of Optometry (WCO) advising optometrists to incorporate a standard of care for myopia management into practice.

The resolution followed a partnership announced between the WCO and CooperVision, with the aim of encouraging the adoption of a standard of care.

This marked one in a spate of myopia-focused moves made by the contact lens manufacturer in the past year, including the release of its six-year MiSight 1 day results, and the the intent to form a joint venture with EssilorLuxottica to accelerate commercialisation of technologies from SightGlass Vision, which focuses on developing spectacle lenses to reduce the progression of myopia.

McBride gave OT his observations on the evolution of acceptance around myopia management, the key questions involved in incorporating this within practice, and why he thinks it is particularly important for practitioners to be preparing now.

Myopia management: Daniel McBride shares his insight…

Getting over the hurdles of acceptance

Myopia management is by far the most exciting area of what is going on in optometry right now. It is a sea-change in terms of what we do for people’s vision.

We have seen the myopia management category continue to grow strong from a small base. It really is the case where, if you don’t treat the child in the year, you can’t pull that progression back, so there is an urgency to act. What really triggered it was getting over the hurdle of – ‘is the clinical science good enough to support something like the WCO saying that this should be standard of care?’ And the science really is there.

That has been the last couple of years in myopia management, and has been so exciting to see. Now we’re seeing competitors and other players within the eye care world saying myopia management is something that should be done.

There was an incredible journey to get the science accepted, and now that is over the hump, the focus is consumer and parent awareness. It is about convincing practices that this isn’t a niche where you have a fast-growing eye and want to do something for a parent that is concerned. It really should be a conversation with every child right at the start.

This isn’t a niche where you have a fast-growing eye and want to do something for a parent that is concerned. It really should be a conversation with every child right at the start

A suite of treatments

For eye care practitioners (ECP), we think myopia management brings that medical piece of their practice to the fore.

We’re really excited about the MiSight 1 day contact lenses; we think it is a phenomenal product, but we also understand that practitioners should have a suite of products that they can use to make sure they are getting a treatment effect on every child. This includes ortho-k, soft contact lenses, or spectacle lenses – like SightGlass Vision, which we are partnering with Essilor in. We think it adds a richness to the field.

The earlier you can impact myopia, the more of an effect you can get. That is why we are excited about SightGlass Vision’s spectacles because if you can catch a child who is seeing myopic growth at age five, the amount of dioptres you can save until they might be willing to put on contact lenses, which could be at eight or nine, is tremendous.

Incorporating myopia management into practice

It is an interesting time and practitioners have a lot of work in front of them. ECPs have to figure out – how am I going to incorporate this into my practice?

It used to be a fairly simple process. A patient came in needing a vision correction, and they had to leave with something, so you put them in glasses, soft contact lenses, or ortho-k. Now, there needs to be a conversation with the parent about the child needing a treatment that can actually improve their vision for life. That is a little more complex of a conversation and it is something that people are less familiar with in the West. In China, parents are already engaged with it. There is a very high usage of myopia management interventions there and we have to see how that can be globalised.

For the practitioners, the reward for this is a much deeper relationship with that family. We’re talking about a treatment that should be going for eight to 10 years. Because myopia management is not a product, it is a treatment, it’s also not something patients can just go online to find or get through another non-prescribing vendor.

Preparing for an increase of diagnoses

We believe we’re going to see an explosion of diagnosed myopia coming out of the pandemic.

We see this for two reasons; the first is that we have a whole population of children spending a lot more time indoors and a lot more time on screens. The idea that it is bad for eye development in children to be indoors for long periods of time is known, and we’ve seen that globally. The question of screen time is a little more unknown and there is not a lot of clinical data around that point. But screen time and being indoors are related and mean children have a lot of near-field work that doesn’t give the diversity of view to the eye. It really is a big change in terms of how children learn and how they have spent a full year that is pretty developmental for many of them. So there is a belief that this is going to have a negative effect.

Possibly bigger than that, in my opinion, is the amount of undiagnosed myopia that occurred during the pandemic. At least in the US, the biggest place where myopia is identified is in the schools when a child can’t see the chalk board. During the pandemic, all of those children have been in near-field work where that myopia isn’t being diagnosed.

Regardless of whether being indoors or screen time has increased the amount of myopia, the fact is that there is a whole bunch of myopia that has not been diagnosed in children. I think there is going to be a veritable explosion of diagnosis, particularly in the upcoming school season in the US and across the globe.

It really is a big change in terms of how children learn and how they have spent a full year that is pretty developmental for many of them

As a result of that, eye care practitioners have to be ready. They should start figuring out – ‘what am I going to do to treat children? Am I prepared to do that? Have I started those dialogues with the parents, teachers, school nurses or paediatricians?’

Practices are going to have myopic children coming through. You don’t want to let it arrive and then not have an understanding of: ‘What is the most appropriate myopia management intervention for this individual, and how do I best encourage parents and children to say yes.’

I think that is going to be an interesting phenomenon coming out of this experience. It will also mean a boost in business for practices who have been suffering through the pandemic.

We are all privileged to be in a massively interesting and growing area. We are looking at a world population that could be 50% myopic by the year 2050 – there is an enormous amount of opportunity in the space and the idea that we are now looking at myopia as a treatable condition is fantastically interesting.