The Myopia Control Era is Upon Us

… and an explosion of new treatments and tech is trumpeting its arrival

axial elongation — far from it. In the past, it was all about prevention — and failing that, managing myopia with refractive correction. But thanks to a wave of innovation over the last few years and more on the way, the paradigm has shifted, and we are now on the cusp of the era of myopia control.

The contact conundrum

by Matt Herman

Daily lenses that can slow myopia progression have long been a holy grail of optical tech for their ease of use and relatively low risk of infection. These days, there is now an array of soft varieties with excellent track records for slowing axial elongation.

CooperVision’s MiSight lenses are the latest lens design in myopia control with their alternating rings of refractive correction and myopiatreating defocus zones. The latest data from a six-year study1 on MiSight has been overwhelmingly positive, with axial length growth slowing by 71%.

Other soft contact lens designs exist as well, like the extended depth-offocus (EDoF) Mylo by mark’ennovy and the NaturalVue by VTI Vision. These all join CooperVision’s longstanding monthly Biofinity, with a distance-center focused design made famous by the BLINK study.2

All of these lenses have their advantages, but challenges abound as well. Contact lenses for young children pose many problems. “There's going to be a learning curve, and you need to have the right patient base,” Florida optometrist Dr. Kristie Nguyen shared. “There’s a lot of screening,” she continued.

The long-feared advance of myopia is upon us, and optometrists around the world are finding themselves on the frontlines. And while parents’ warnings against sitting close to the television still ring in the heads of millennials and Gen Xers, myopia has still managed to park itself in the mainstream of modern culture.

It’s not that prevention has failed.

During pandemic lockdowns and social distancing, eye strain from devices held at near distances increased and time outdoors drastically decreased, throwing gasoline on an alreadyburning fire. These lifestyle changes are now firmly entrenched human behaviors — making myopia a firmly entrenched disease.

The good news is that the last bell hasn’t been rung in the fight against

Education is a factor, too, especially for parents. “You have to educate the parent that to not become myopic in the future, [they have to] get [their children] into contact lenses now,” she explained.

And, of course, with children, compliance and maturity come into play. “When I fit a normal child in contacts, I have to make sure that they can do it themselves,” continued Dr. Nguyen. “They can't just rely on their parents — so even when I'm adamant about myopia control, if the child is not mature enough, I can't put them into contact lenses.”

Besides these practical factors, cost is another concern, especially in the United States. Prices for the MiSight stateside hover around $1,000, which is comparable to the Mylo where available. Fortunately, Biofinity is significantly cheaper at around $200 per year — though still a significant expense for many.

Old tech, new tricks

Despite the many advantages to myopia control contact lenses, there are clearly drawbacks. Many of these are answered by one of the most intriguing — and anticipated — new additions to the myopia control armamentarium: spectacle lenses.

“They are a game changer,” said Dr. Glenda Aleman-Moheeputh, founder and CEO of iSmart Vision Care and OK Love Myopia Control Experts. “A spectacle option for myopia management will enable more ECPs to help their patients [and is] a great option to get young patients started.”

Many of the big players have their own unique designs. Hoya is one of the pioneers in the myopia control lens game with their award-winning MiYOSMART lenses. The design of these lenses, termed Defocus Incorporated Multiple Segments (DIMS), showed 52% reduced myopia progression and a 62% lowering of axial elongation3 compared to regular spectacles in a two-year study.

Essilor has added Stellest lenses with its Highly Aspheric Lenslet Target (HALT) tech to its already stellar MyopiLux offering, with the company claiming a 67% higher rate of slowing myopia progression.

Though more research on these offerings is ongoing, their ability to solve many of the problems of contacts, such as compliance in children, is clear. “The most recent studies that have come out are promising and show great results on the efficacy of this modality,” Dr. Aleman-Moheeputh asserted. “We now have an excellent spectacle solution at hand for patients who struggle with putting eye drops in their eyes or are uncomfortable with wearing contacts,” she summed up.

Ortho-K and the combo play

Low-dosage atropine eye drops are in use in many places (though,

Contributing Doctors

Dr. Kristie Nguyen is a boardcertified optometrist. She currently serves as a contract doctor for Perez and Associates and Phan-Tastic Eye Care in Altamonte Springs, Florida, USA. After graduating in the top 10 of her high school class with honors, she went on to obtain her Bachelor of Science degree from the University of Houston, Texas. While at U of H, she volunteered at a local hospital and worked as an optometric assistant. Dr. Nguyen obtained a Doctorate of Optometry (O.D.) in 2005 from Nova Southeastern University College of Optometry in Fort Lauderdale, Florida. She conducted her medical internships at the Chickasaw Nation Health Clinic in Ardmore, Oklahoma and the Lake Mary Eye Care in Lake Mary, Florida. Dr. Nguyen is a member of the American Optometric Association, the Florida Optometric Association, Young ODs of America, OD Divas, Optometry Divas and the Central Florida Optometric Society. In addition, she has been an executive board member for Optometry Divas for the past two years. She is also a brand ambassador for an independent eyewear brand called Kazoku Lunettes and director of business development for an online optical company called Optazoom. She is also an independent consultant for Rodan+Fields, which is a global clinically tested skincare brand. Dr. Nguyen is married and has two beautiful daughters. She enjoys going to the beach, hanging out at Disney, and reading.

kristie817@gmail.com notably, not yet in the USA), and their promise has shone brightly in research like the LAMP study.4 New research is now beginning to investigate the addition of atropine to existing monotherapies. “In my own practice, I usually start patients on a monotherapy such as ortho-K, but not all patients will respond well to the lenses. This is when I decide to start a second therapy, such as atropine drops,” Dr. Aleman-Moheeputh noted. “Many practitioners struggle with knowing when to start a second therapy and are apprehensive about using them. However, combination therapies are something that we need to familiarize ourselves with,” she urged.

Dr. Glenda Aleman-Moheeputh , OD, received her Bachelor of Science degree in Vision Science and Doctor of Optometry from Nova Southeastern University (NSU). She has held the role of clinical liaison for Walmart Health Optometry in Florida from 2019-present. She currently serves as a Johnson and Johnson myopia management professional affairs consultant (PAC). She is an active advisor in the advisor committee AAOMC and is an advisor for Nevakar myopia specialists. She is the founder and CEO of iSmart Vision Care, located in Miami, Florida. In her practice, she specializes in providing multiple solutions for myopia management. And in her mission to fight the myopia epidemic, Dr. Aleman-Moheeputh has recently launched her new venture, OK Love Myopia Control Experts. Beyond myopia management and educating patients, OK Love also offers consulting designed to educate fellow optometrists on various methods of implementing myopia control practices. She has lectured extensively nationally and internationally to contribute to educating others in the field of orthokeratology and myopia management in hopes of mitigating the myopia epidemic.

Drglenda.m@gmail.com