From spectacles to eye drops and everything in between, the vanguard of myopia control is here — and not a moment too soon. As myopia cases mount around the world, optometrists are about to get a much deeper bag of tricks for halting the progression of the disease.
The long-feared advance of myopia is upon us, and optometrists around the world are finding themselves on the frontlines. And while parents’ warnings to not sit too close to the television are still ringing in the heads of millennials and Gen Xers, myopia has still managed to park itself in the mainstream of modern culture.
Glasses have gone from being the stuff of schoolyard taunting to a universally beloved fashion statement. Corrective procedures like LASIK have shed their expensive and risky reputation to the point where nearly everyone knows someone who has gone under the laser.
This all may seem like a throwing-in-the-towel of sorts to myopia. It’s not that prevention has failed — COVID-19 has understandably been blamed for the flood of new myopia cases, but the pandemic was simply a splash of gas on an already-burning fire. Increased eye strain from devices held at near distances and decreased time outdoors are nothing new and 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 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, we are on the cusp of the era of myopia control.
The contact conundrum
The invention of contact lenses changed eyewear forever, and there’s an array of soft varieties with an excellent track record for slowing axial elongation. Daily lenses that can slow myopia progression have long been a holy grail of optical tech for their ease of use and lower risk of infection.
CooperVision’s MiSight lenses, which are now approved for use around the world, claim to fill that gap. These lenses work by alternating rings of refractive correction and myopia-treating defocus zones on the lens. And the latest data from a six-year study1 has been overwhelmingly positive, with axial length growth slowing by 71% and a non-responsive group of only 10%.
Other soft contact lens designs exist as well, like the extended depth-of-focus (EDoF) Mylo by mark’ennovy and the NaturalVue by VTI Vision. These all join CooperVision’s long-standing monthly Biofinity, with the distance-center focused design made famous by the BLINK study.2
All of these lenses have their advantages, and there’s plenty to be excited about here — but challenges abound, as well. Contact lenses for young children, for example, pose many problems. “There’s going to be a learning curve, and you need to have the right patient base,” shared Florida optometrist Dr. Kristie Nguyen. “There’s a lot of screening,” she continued.
Education is a factor, too — for both parents and children. “You have to basically educate the parent that to not become myopic in the future is to get them into contact lenses now. And I think for a lot of people that is kind of hard to grasp. They don’t see the issue yet,” she explained.
And, of course, with children, compliance and maturity are another prohibitive factor. “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, they have to be at a certain maturity level. So even if I’m adamant about myopia control, but the child is not mature enough, I can’t put them into contact lenses.”
Besides 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 it has gained approval. Fortunately, the Biofinity is significantly cheaper at around $200 per year, though still a significant expense for many.
Old tech, new tricks
Contact lenses are an excellent choice, but 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.
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 elongation compared to regular spectacles in a two-year study.3
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, this new entrant on the scene is also well worth watching.
Low-dosage atropine eye drops are in use in many places (though, notably, not yet in the USA), and the case for their use has been strengthened by data from research like the LAMP study,4 which provides evidence for fine-tuned dosage regimens. However, new research is beginning to investigate the addition of atropine to existing monotherapies.
Orthokeratology is one of the oldest and most effective forms of myopia management for those who can afford its yearly cost. A recent meta-analysis5 of studies investigating low-dose atropine shows a significant slowing of axial elongation compared to monotherapy with orthokeratology.
Of course, this wave of new technologies is just the first crank of the wheel opening the floodgates. Such impressive early results for both soft contact lenses and myopia control spectacle lenses are sure to have drawn the attention of many others in the industry. And as more lenses come out, there is even more fodder for researchers looking for synergies with atropine. All of which is good news for the growing legions of myopia sufferers, especially children, worldwide.
- Chamberlain, P, Bradley A, Baskar A, et al. Long-term Effect of Dual-focus Contact Lenses on Myopia Progression in Children: A 6-year Multicenter Clinical Trial. Optom Vis Sci. 2022;99(3):204-212.
- Walline JJ, Walker MK, Mutti DO, et al. Effect of High Add Power, Medium Add Power, or Single-Vision Contact Lenses on Myopia Progression in Children: The BLINK Randomized Clinical Trial. JAMA. 2020;324(6):571-580.
- Lam CSY, Tang WC, Tse DYY, et al. Defocus incorporated multiple segments (DIMS) spectacle lenses slow myopia progression: a 2-year randomised clinical trial. Br J Ophthalmol. 2020;104(3):363-368.
- Yam, JC, Jiang Y, Tang SM, et al. Low-Concentration Atropine for Myopia Progression (LAMP) Study: A Randomized, Double-Blinded, Placebo-Controlled Trial of 0.05%, 0.025%, and 0.01% Atropine Eye Drops in Myopia Control. Ophthalmology. 2019;126(1):113-124.
Yang, N., Bai, J., & Liu, L. (2022). Low concentration atropine combined with orthokeratology in the treatment of axial elongation in children with myopia: A meta-analysis. Eur J Ophthalmol. 2022;32(1):221-228.