Myopia Q&A: Nicola Logan, Paul Chamberlain and Krupa Patel

Optometrists from across Europe heard about the latest findings from the MiSight 1 day study at an event in Birmingham (11 May, Hilton Birmingham Metropole).

Eye care professionals heard how the myopia management contact lens halves myopia progression, while the latest results suggest the absence of a ‘rebound effect’ – with study participants returning to age-normal eye growth after they stop wearing MiSight 1 day contact lenses.

Nine in ten study participants experienced a myopia control effect wearing the contact lenses. A proportionate effect was seen in the data, with the fastest progressing eyes receiving the largest myopia management benefit from MiSight 1 day.

As the longest clinical study of contact lenses in children, a very low complication rate within the MiSight 1 day study supports the view that children can safely be fitted with daily disposable contact lenses.

OT spoke with CooperVision research programmes director, Paul Chamberlain, principal study investigator, Professor Nicola Logan, and CooperVision myopia management senior manager, Krupa Patel, about what the research means for the way optometrists practise.

Paul Chamberlain

How does the latest MiSight 1 day study bring the research on myopia management forward?

PC: Despite the fact that myopia research has been around for a long time, research investigating the clinical impact on children is relatively immature. What this research brings is an insight into the long-term view. Is the treatment sustained? You couldn’t really commit to myopia management if you had to say ‘Well the data doesn’t really tell us if it works for longer than a year.’

The fact that we have evidence now that this treatment effect continues to accrue over multiple years is critical. We also have evidence that it is effective in children who have started treatment later.

What would you say are the key unanswered questions within the field of myopia management and why is it important to address these questions?

PC: There are lots of questions I would like answers to. There are so many nuances to the data – a researcher wants to know everything, always. The obvious question is what was different about the 10% who didn’t respond to the myopia management intervention? We want every child to benefit.

Younger children can accept contact lenses and excel in them

One question that comes up is whether we should be treating children who are likely to become myopic. The average prescription we had in our study at baseline was -2.00D. That’s two dioptres of opportunity we have left on the table. Early intervention is a good area to research. It is not an easy study, because if you are trying to treat pre-myopes, they don’t need to wear those lenses to function in daily life. Would you get the compliance you need to get a solid result?

Are there any misconceptions that optometrists working in practice might have about myopia management and how would you address these?

PC: They may think that fitting children with contact lenses is hard – the data doesn’t support that. It is a relatively routine fit and no more challenging than fitting a regular contact lens wearer.

Another misconception is that contact lenses aren’t suitable for young kids. I think when you look at the safety profile and the quality of life outcomes, it completely puts that to bed. Younger children can accept contact lenses and excel in them.

ECPs might have the idea that the treatment effect is frontloaded to the first year, and it doesn’t continue to accrue. Our evidence suggests that MiSight 1 day will continue to work on children over a concerted period of time.

As one of the longest studies of contact lens wear in children, what insight have we gained into the safety of contact lens wear generally in children?

PC: The safety profile is high. What you can see is the low incidence of undesirable slit lamp findings, which any contact lens aftercare visit will look at and there were no serious contact lens-related adverse events during the entire study duration over multiple years of wear. That is probably a testament to the daily disposable modality and the ability of children to handle contact lenses on a day-to-day basis. I think that is one of the most encouraging things – children were able to be successfully prescribed contact lenses for full time wear and with a really low incidence of complications..

Are you confident that a one-year follow up period is sufficient to show that there is not a rebound effect?

PC: We were confident from looking at other studies that one year would be long enough to see if there was a different pattern of eye growth and this is also recommended by the International Myopia Institute. The results make logical sense to me. You have taken the treatment away and they have returned to levels of eye growth that you would expect from an untreated myopic eye of that age on average in that population. That one year period has been mirrored by various regulatory bodies who have asked us to perform post-approval studies.

Nicola Logan

What would you say to ECPs who say there isn’t enough evidence to support proactive uptake of myopia management?

NL: I think we are at the stage now where there has been a huge increase in the amount of evidence that we have. The evidence runs across different populations, different types of interventions, all pointing to very similar final outcomes in that yes, we can slow down the rate of axial length elongation and the rate of myopia progression. We are also now starting to see longer-term data emerge.

At a minimum, I think ECPs should be speaking to children with myopia and their parents and saying there are interventions available. As a starting point, they can talk about behaviour and lifestyle changes that are likely to impact on myopia development and progression. It is a really natural conversation for a parent whose child has myopia – ‘has it got worse? Is there anything we can do about it?’ And then for the conversation to move forward to discuss the current interventions available.

Myopia management can be seen as a specialty area, but to me, it is the bread and butter of optometry practice. A majority of patients are going to have myopia. Managing myopia more proactively is within the clinical competence and scope of practice for all ECPs. It is having the confidence to make a start, see that you can do it and integrate it into your clinical practice.

What topics would you discuss with a parent and their child considering myopia management?

NL: I would discuss a range of topics and it would depend on the background of the parents too, depending on whether the parents themselves have myopia and understand it, or if they don’t. If I am starting from basics, I will explain what myopia is and the impact it has on their child’s vision as well as the likelihood that it will progress from one visit to the next. I will balance that by presenting the different options that we have for trying to slow down the rate of progression.

What many parents are concerned about is the change in prescription from one visit to the next. I do also mention the potential longer term risks of eye disease, but for many parents that is so far in the future, that I will focus on what is relevant for now. I talk about the different interventions – they will give the child good vision but have the added advantage of trying to slow down the rate of progression. I talk with parents about how myopia management is a long-term strategy – definitely while children are still growing and maybe through their university years. It is not a quick fix. It is also important to ensure that the parents know that we cannot predict the final outcomes for an individual child.

How do you predict myopia management will evolve and progress in the future?

NL: I’m hoping that myopia management will become the standard of care for how we manage all progressing myopes in clinical practice. So that the first option would be myopia management, rather than standard single vision correction.

Especially with the World Council of Optometry’s resolution bringing myopia management in as a standard of care and the Canadian Association of Optometrists also adopting that, I am hoping that approach may come to the UK too.

Alongside myopia management becoming a standard of care, what we need to see is greater accessibility and availability of the different myopia management interventions so that all ECPs have access to a range of options. It is not necessarily an area where one thing is suitable for everybody.

Looking further down the line, longer term goals are asking whether we can better predict, for an individual child, what type of treatment may be more suitable for them. We may be able to take a tailored approach and enhance the effect.

What do we know about the factors that influence whether someone will experience a management effect using MiSight 1 day lenses?

NL: We know that the majority of children who have myopia will progress. They will progress through their early childhood and teenage years then it tapers off as they get older. Family history and their lifestyle can influence their rate of progression.

We know that 90% of children fitted with MiSight 1 day will respond to the intervention. However we are not yet at the stage of being able to understand why those 10% of children do not respond. Hopefully as the research develops we will get a better understanding of that. At the moment, the data shows that the majority of children will experience a treatment effect. In practice, I will say to the parents and child ‘This is what we know, this is what we expect but we cannot guarantee a certain outcome.’

Krupa Patel

Can you tell OT why you organised this event? What are CooperVision’s aims for myopia management?

KP: CooperVision brought key opinion leaders and experts together to share the seven-year findings from the MiSight 1 day clinical study. This unique study design over multiple years has allowed us to answer some of the biggest questions in myopia management including when to start, when to stop, who will benefit, and what happens when treatment stops. The research offers new evidence to support ECPs with their clinical decision-making.

It was important for CooperVision to share and learn, together with key experts in the field, as we pursue our commitment to supporting ECPs adopt myopia management as the standard of care in their practices. CooperVision recently published the six-year findings in Optometry & Vision Science and plans to publish the latest seven-year treatment cessation data in due course.