Myopia management: “It is one of the most exciting things to happen to optometry in my career”
A Hoya webinar brought together optometrists and industry professionals to discuss myopia management in practice
14 July 2021
Myopia management needs to be discussed with every myopic patient and their families – that was a key takeaway from Hoya’s recent webinar: Miyosmart and the myopia visionaries held on 22 June.
The event brought together a range of industry speakers, researchers and optometrists to discuss myopia management in practice, as well as the Miyosmart lens which launched earlier this year.
The event began with a presentation from Tom Griffiths, who was recently appointed managing director of Scotlens, offering a parent’s view of myopia.
Griffiths, an entrepreneur and disrupter, joined Scotlens after seeing the results a myopia management solution had for his son who, at eight years old developed myopia which progressed rapidly in his secondary school years.
“When he was in primary school, he was a happy-go-lucky kid and suddenly his world disappeared,” Griffiths shared. “He lost his confidence, he had to sit in front of the class, his glasses got thicker, and he kept smashing his glasses.”
After beginning a myopia control intervention, his myopia has now stabilised.
Reflecting on the experience, Griffiths shared that while the term ‘short-sighted’ sounded like “a natural thing we hear all the time,” if he and his wife had been told about myopia, “that would have had a whole different reaction from us.”
He added that the family would have liked to have had the opportunity to review potential myopia control solutions, adding: “As a parent, I feel I have a right to know this… We honestly felt let down.”
When he was in primary school, he was a happy-go-lucky kid and suddenly his world disappeared
Scotlens is working with Hoya, CooperVision, Menicon, Bausch + Lomb, and Avizor, to collaborate on a non-commercial, crowdfunded campaign to help eye care professionals ensure that all UK parents of a child first diagnosed with myopic progression, are made aware of key information around the condition.
Professor Bruce Evans, director of research at the Institute of Optometry in London and visiting professor at City, University of London and London Southbank University, then shared his experience of myopia management as a practitioner.
Evans outlined the different approaches to myopia control, when to start a treatment and how myopia should be discussed.
It’s more than just a duty. It’s a joy
When discussing options to deal with myopia progression, Evans first suggested dealing with lifestyle changes, pointing to a paper by Huang et al (2019, British Journal of Ophthalmology) which indicated three interventions that can be helpful at reducing the risk of becoming myopic and reducing the progression.
Noting that the effects of this are quite modest, Evans then presented a number of the optical approaches to slowing myopia progression, including contact lenses, ortho-K and now spectacle lenses.
Describing the Miyosmart as a “revolutionary device” Evans said: “The reason this is such an important development is because contact lenses are suitable for those whom they are suitable whereas spectacle lenses are suitable for just about every myopic child.”
Considering when to begin myopia control, Evans emphasised, “you don’t want to miss the boat,” adding that the sooner an intervention is started, the greater effect it can have at “reducing the end point of their myopia journey.”
We are changing from a profession that corrects, to a profession that treats, and it is wonderful to have that option for intervening in a very positive way
He also suggested that everyone in the practice should be having discussions about myopia control, commenting: “As a very minimum, I feel strongly that we must inform parents about the possibility of treatment options.” Pointing to the General Optical Council standards of assisting patients in making informed decisions, he said: “if you don’t tell them that myopia control is an option, then you are not informing them.”
Emphasising the importance of informing families about the treatment options, Evans said: “It’s more than just a duty. It’s a joy. It is one of the most exciting things to happen to optometry in my career.
Affordability of myopia
“Hopefully someone at the NHS will do the number crunching and work out that, in terms of the saving this could make to the NHS in terms of eye health throughout life, this is really something they should be properly funding,” Evans said.
Professor Carly Lam, of the Hong Kong Polytechnic University, discussed the Defocus Incorporated Multiple Segments (DIMS) technology and described a clinical study to investigate the effectiveness of Miyosmart lenses in a three-year follow-up, in which children who were assigned control (single vision) lenses in the original trial, were switched to Miyosmart lenses.
Conclusions from the follow-up study found that, for children in the study who were wearing DIMS lenses for the three years, the myopia control effect was sustained, with both myopia progression and axial length changes similar to the previous two years.
For the control group who switched to the DIMS lens, a myopia control effect was present in a similar trend to the age-matched DIMS lens wearers.
Hoya then brought together a panel of optometrists to discuss myopia management in practice.
Helen Carroll, of Carroll Opticians in Ireland, shared how the practice works closely with ophthalmology and has a substantial paediatric patient base with a lot of referrals. She explained that “everybody is aware of myopia” in the practice, adding: “We introduce it from the very beginning – when we see the decrease in hypermetropia we are gearing them up for that information.”
Progression in young adults
Reflecting on Griffith’s comments about the conversations that need to happen around myopia management, Dr Stephanie Kearney, research optometrist and lecturer at Glasgow Caledonian University, explained that the myopia clinic at the university is receiving referrals at a later stage of progression, sharing: “We’re seeing children who have a much higher amount of myopia, which is then excluding them from other contact lens options,” adding that the spectacle lenses can provide an alternative.
Optometrist and dispensing optician, Andrew Keirl, of Andrew Keirl Opticians, received access to the lens in winter 2020 to trial the product and shared a case study of a 14-year-old girl with myopia who has seen “essentially no change” in refraction in the five months she had been using Miyosmart, with the mean spherical equivalent actually -0.25 less than at the end of 2020 on her most recent appointment.
Describing how he had introduced the lens to the patient, Keirl explained that he had used a device for marking up varifocal lenses to show the patient and her parents the lens in detail and how it worked, sharing that: “the segments show up beautifully.”
Practitioners also discussed the importance of key measurements, such as axial length, for myopia management. Acknowledging that not all practices have devices to take axial length measurements, Kearney suggested: “We should be very aware of the limitations of using refractive error only, and to communicate that with the parent.”
Dr Manbir Nagra, optometrist, educator and researcher, agreed, adding however: “Not having a biometer should not be a deterrent to prevent you from undertaking myopia management.”
Myopia and UV
Asked about the evidence linking ultraviolet (UV) light therapies with myopia management, Kearney described part of her PhD research in which she measured an indicator of UV exposure – conjunctival ultraviolent autofluoresence (CUVF) and found that myopic young adults had much lower amounts of the UV damage index on their conjunctiva in comparison to non-myopic adults. Although this wasn’t a longitudinal study, when compared to progression, Kearney said: “myopic individuals didn't have as much UV damage to the eyes, which ties up with the strong research suggesting that not spending enough time outdoors is a significant risk factor for onset.”
However, Kearney highlighted that what isn’t known is whether this is UV light, or intensity of the light which promotes the release of neural chemicals in hormones like dopamine and melatonin. Animal studies suggest higher amounts of dopamine and melatonin are possibly involved in the myopia growth mechanism, she explained, but highlighted that more human studies are needed.
Optometrists agreed more research is needed in this area and Dr Sara McCullough from Ulster University highlighted current research to measure the distance in which children’s vision is active during the day and the amount of light exposure they receive.