An ecosystem for myopia management
Manufacturers across contact lenses, spectacle lenses and optical equipment are providing solutions to address the issue of myopia management and help practitioners offer more options to patients
The way that practitioners approach myopia in children is changing rapidly as the profession accelerates towards myopia management as a standard of care, working to actively delay or suppress its progression.
Manufacturers in areas across eye care have supported this drive. From supporting research, to creating new guides and recommendations on responding to myopia, as well as releasing new products and services.
Suppliers across the industry reported seeing an increase in discussions around and interest in myopia management. Speaking to OT, Mark Draper, director of marketing and national accounts for CooperVision UK & Ireland, confirmed awareness of myopia management as a standard of care, “has been growing steadily over the last few years.”
“Myopia management is a rapidly evolving field of research,” Draper said, pointing to the increasing numbers of peer-reviewed publications and scientific conference presentations, to which CooperVision has contributed with the results of its MiSight 1 day three-year clinical study in 2019, and several key papers including the ReCSS study by Chalmers et al, 2021, with additional research to come in due course.
The launch of CooperVision’s MiSight 1 day contact lens and Brilliant Futures Myopia Management Programme has helped to enable the uptake of myopia management, Draper suggested. The programme launched last year with the aim of introducing “a new standard of care for children with myopia” and incorporates the MiSight 1 day daily disposable contact lenses with ActivControl Technology, along with tools, support and education for practitioners and patients.
The scheme includes a professional accreditation programme, delivered through CooperVision’s online Learning Academy, which aims to equip practitioners to understand and develop a myopia management practice before gaining access to Brilliant Futures. Draper confirmed that 2324 practitioners have now been accredited through the programme.
Communicating the issue of myopia is of course a key part of the puzzle of myopia management, and an area the company has been working in, with Krupa Patel, CooperVision head of professional services UK & Ireland, telling OT that the company “will be supporting practitioners by launching a consumer campaign this summer raising awareness of myopia management with parents.”
As public awareness grows, practices will need to be taking this into consideration. Patel shared: “The need to consider parental awareness will continue to grow and this will be an expected offering for their children.”
For practices entering the field of myopia management, Patel highlighted that no additional investment in equipment or chair time is needed to fit MiSight 1 day, just the time required to complete the accreditation, with educational webinars available on the company’s Learning Academy.
Speaking to OT earlier this year, CooperVision president, Daniel McBride, emphasised the need for a “rich field” of complementary treatments for myopia management, and the company has made a number of partnerships, with the aim of accelerating or supporting developments in this field.
This includes CooperVision’s intention to enter a joint venture with Essilor in acquiring the myopia management spectacle lens company, SightGlass Vision Technology, to strengthen go-to-market capabilities. This was followed by CooperVision’s acquisition of No7 Contact Lenses, as a separate but complimentary business within its CooperVIsion Specialty EyeCare group, and expected to expand access to contact lens designs and support the development of myopia management solutions.
Taking a holistic approach
Speaking to OT, Menicon professional services manager, Josie Barlow, agreed: “The field of myopia management is evolving at an incredibly fast pace now. I don’t see that trend stopping any time soon.”
The company launched its Menicon Bloom Myopia Control Management System in the Netherlands in 2019 and in the time since, it has been preparing to launch in all markets.
“We’ve been making tweaks and advancing the system to ensure that it can offer everything that practitioners and patients need,” Barlow shared. The system is set to launch later in 2021.
The Menicon Bloom portfolio includes an ortho-k lens for overnight wear and a daily disposable, soft myopia control lens. Both contact lenses are CE approved for myopia control, and Menicon was the first to offer an Ortho-K lens that was CE-marked specifically for myopia control.
Describing Menicon Bloom as a “holistic approach,” Barlow explained that it encompasses the contact lenses for myopia control, strategies and tools for the practitioner to monitor and analyse patient’s progress, as well as communication tools.
“Myopia management is a long-term commitment from both parties,” Barlow emphasised – with children potentially beginning myopia control treatments from the age of six or seven and continuing into early adulthood. She added: “We want to make sure that we have given both the practitioners and the patients the tools, skills and support they need to make sure that it is well monitored and the treatment path can be completed successfully.”
As part of the myopia management system, Menicon plans to provide support for enabling conversations in practice around myopia, including point of sale material and patient literature, and will also be hosting training sessions with practitioners and the wider practice team.
Barlow explained: “Everybody has to be on the same page. From the very first person that greets the patient or parent,” adding that training will not only cover how to use the system and fit the contact lenses, but support the practice “to be able to talk confidently about Menicon Bloom and myopia control generally.”
The company is also producing an app which will facilitate communication with the eye care professional (ECP), meaning “issues with anything from comfort, compliance and application can be addressed much faster and more frequently.” The app will support continuous monitoring of the patient’s progress, which can be analysed when back in the practice, and will evolve as the child ages.
Barlow told OT: “We believe that the protocols and the communication that we have put in place will mean that there should be a much higher success rate of compliance, a more successful treatment path for patients and an increased ability to address any issues that may arise or occur.”
Outside of the planned launches this year, Menicon has been working across the sector, announcing a collaboration with Johnson & Johnson Vision earlier this year through which the companies aim to expand the availability of therapeutic contact lenses.
A complementary offering
The past year marked the arrival of Hoya’s Miyosmart lens in Europe, providing practitioners another myopia management treatment to offer patients. The lens utilises a patented Defocus Incorporated Multiple Segments technology to create a myopia defocus effect.
Describing the introduction of the lens to the market, Andy Sanders, professional services director at Hoya Lens UK, said: “Miyosmart is the first myopia control spectacle lens launched in the UK which has been validated by a two-year randomised controlled trial with an efficacy of on average 60% and the third-year follow-up study showing efficacy was sustained.”
Considering how the lens contributes to the range of options needed to address myopia management, Sanders explained: “As the lens is fitted just like a progressive lens design, it is easily incorporated into the practice portfolio, even if other myopia management solutions are not offered.
“In practices that already offer myopia interventions, such as ortho-k or specific contact lenses, Miyosmart offers a broader range of patient suitability,” Sanders continued, adding that the lens can also provide a complementary spectacle treatment for patients when contact lenses are removed.
Hoya has also developed an accreditation process by which ECPs can pass to gain access to the lens. Discussing the engagement of practitioners, Sanders told OT: “Given the accreditation process may, by some, be seen as a barrier to access the Miyosmart lens, we were pleasantly surprised by the enthusiasm of the optical profession to embrace the educational webinars in order to access this innovative technology. So much so that the initial accreditation system became overloaded and was updated one month after launch.”
Across the UK and Ireland, nearly 2000 ECPs are now accredited, a figure that is growing daily, Sanders said, adding: “The majority of whom are regularly prescribing Miyosmart lenses for myopic children after careful consultation.”
To support practices in offering the Miyosmart lens and communicating the option with patients, the company has a range of marketing material available, including patient leaflets, as well as a suite of information contained within its accreditation packs.
Hoya has also developed an in-practice training programme to support the introduction of Miyosmart to parents and children, Sanders explained, adding that this will also be made available as an additional online training module.
Providing the gold standard
Device manufacturer, Topcon, is seeing a “definite shift” in the optometry sector to “more specialised services, including myopia control and dry eye management,” Danielle Lee, clinical affairs specialist for Topcon, explained.
In 2020, the manufacturer launched its Myah myopia and dry eye device in Europe. The device provides the instrumentation needed to take axial length measurements, corneal topography and dynamic pupillometry to support myopia management.
Speaking to OT, Lee shared that though the ‘gold standard’ for myopia management, until recently, devices used for measuring axial length have been out of the price range of a lot of practices because they were aimed more towards surgery, with the Myah device “looking at it more in terms of optical management at an earlier stage.”
The dual-function purpose of the device is also a key factor in helping to reduce the challenges that might prevent a practice from exploring the technology, as it also hosts a suite of dry eye tools.
Considering how the device can play a role in the ecosystem of tools that practitioners can draw on to make myopia control a standard of care in practice, Lee told OT: “Reports such as the Johnson & Johnson Vision Managing Myopia Clinical Guide, released at the end of last year suggest examining children at least once between the ages of three and five to establish baseline.
“By utilising a device like the Myah, which captures axial length measurements and allows you to plot progression of growth as well as variation in the rate of growth, optometrists have the ability to intervene earlier and perhaps make a greater impact on the visual outcome for the patient,” she added.
Topcon is seeking to support practitioners by providing education and resources, including publishing videos to its EyeTube platform which include insights from optometrists Sarah and Edward Farrant, and from Topcon’s director of global education and training.
As well as supporting practitioners through the measurements, the device can support conversations with patients, Lee said: “By screening younger patients who are at risk of becoming myopic, or high myopes, you can engage them throughout their development, offering reports and visual representations of the effect which treatment is hoping to achieve.”
“While there is an initial outlay for a device such as this, the accurate monitoring, and reporting functionalities available in the device, support patient engagement as they have a visual representation of the impact of using their treatments,” she said.
The company has recently introduced an upgrade enabling optometrists to review patient data in relation to growth curves, incorporating the “extensive axial length dataset” collected by Erasmus University. The software also enables clinicians to review patient examinations on a PC, providing greater flexibility.
Communicating the risks
Interest in devices for myopia management is growing, Jason Higginbotham, managing director of industry supplier Birmingham Optical, agreed: “There is certainly an increase in interest in the Myopia Master as well as with other devices we sell, like the Nidek AL Scan.”
The Oculus Myopia Master supports the main measures for myopia management refraction, axial length and keratometry in an all-in-one device. This is along with “a comprehensive range of questions built in that all complement to a range of algorithms which both predict future myopia and also help to monitor treatments,” Higginbotham shared, “hopefully showing a slowing of progression compared to initial predictions based on no treatment.”
The device also makes suggestions for treatments, Higginbotham explained, “Or the clinician can enter therapies and advice into the patient’s record which can even be emailed to them to ensure compliance and regular follow-up.”
To further aid optometrists in using the device, Birmingham Optical is compiling a support pack, as it has previously done for the Nidek OCT, which will include online training and education material, user videos and guides, patient questionnaires, access to online triage software, key stats and figures and marketing support.
“We also intend to work more closely with key suppliers of therapeutic lenses, contact lenses, soft and ortho-k and other potential therapies,” he shared.
Increasing patient awareness is an important issue in myopia management, and Higginbotham commented: “Within the practice, it’s important to be able to communicate the risks of myopia progressing and what that progression might mean longer term for the patient.”
This is something the Myopia Master device aims to support in, with algorithms built to “clearly and effectively show what level of myopia a patient is likely to reach over time.”
Using this information, and key facts and figures on myopia included in the support pack, Higginbotham suggests: “It will then be easy to better explain to the parents what the long-term risks of having high or pathologic myopia are – for example, someone with a -8.00DS prescription is 127 times more likely to suffer with myopic macular degeneration than someone with less than -1.00DS of myopia.”