Dual therapy against myopia progression: MIYOSMART + Low Dose Atropine

by Patrick Ng
Optometrist
Msc Clinical Optometry
28th April 2023

This article is targeted at readers who already have read about myopia control options such as atropine, DIMS lenses (Miyosmart) or myopia control lenses. If you have yet to read about those, it may be better to read about those lenses in the same blog first, before reading this article.

In the last 2 years, it has been our observation that Miyosmart lenses ( DIMS technology) when used in combination with low dose atropine has better results than atropine or Miyosmart standalone. However, we did not take the effort to do a statistical review of records. But the improvement in slowing down myopia progression is noticeable. The ophthalmologists are also noticing that too.

A European myopia control study consisting of 146 kids was concluded in Feb 2023. The study aimed to compare the efficacy of low dose atropine vs DIMS lens vs dual therapy (low dose atropine+ DIMS lens) vs control ( no therapy). The study concluded that dual therapy is the most effective at slowing myopia progression. Both Atropine and DIMS has also slowed myopia progression significantly compared to no treatment. This study confirmed what the industry have noticed with monotherapy vs no therapy and in cases of rapidly progressing myopia, with dual therapy against single therapy.

https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0281816

With the findings from this study, we will be more confident to recommend children who have the potential to be highly myopic to start with dual therapy from the onset. Prior to this study, we have erred on the side of caution and start them on monotherapy ( either atropine or DIMS).

It does not mean that every child will need to go through dual therapy. Children with a later onset of myopia or a slower myopia progression will do well enough with a mono therapy. The challenges of dual therapy is that with atropine, even on a lower dose, may result in photophobia due to a slight dilation of the pupils. We had to make do with caps/hats or even clips on sunglasses. But these methods require the child to remember putting them on whilst outdoors.

Miyosmart has now launched Miyosmart SUN. The same DIMS technology, now with photochromatic technology. This means that under the sun, these lenses will change to a darker shade to reduce glare. This makes dual therapy a lot easier for parents and a lot more comfortable for the children. During this launch, HOYA has also announced that regardless the type of lens, Miyosmart or Miyosmart Sun, there will be no price difference! This is quite surprising, as traditionally, photochromatic lenses cost at least 100-200 dollars more than their non photochromatic version. The reason given by the management was that they realized that their lenses was helping a lot of children globally with myopia control, hence for kids for needed dual therapy, they do not want cost to be the deterrent. Sweet!

Speak to your pediatric ophthalmologists or optometrists about your child suitability for dual therapy myopia control. Alternatively, speak to us over WhatsApp @ +6587256911 or email precisionoptics2013@gmail.com

Slow Down Myopia Progression- Abiliti 1 Day by Acuvue

by Patrick Ng,
Optometrist
Msc Clinc Optom (USA)

Covid19 brought about a rapid change in the work and educational landscape. It accelerated digital learning. Although physical lessons have resumed, e-learning has become a part of the education journey. Due to the change from looking at white boards (usually viewed @ more than 3metres, to looking at computer screens ( 80cm or closer), the accommodative load on the eyes has increased by almost 4 times.

Compared to pre Covid19, the primary eye care industry has been witnessing a more rapid progression in myopia. Kids are starting to become myopic at an earlier age and the rate of myopia progression is faster. High myopia is associated with increased risk of eye problems such as retina detachment, glaucoma and maculopathies at an older age. These problems can result in irreversible vision loss. Hence, there is a need to slow down myopia progression in our kids. Spending time outdoor seems to have a protective effect against myopia for those pre-myopes. However, once myopia sets in, outdoor time seems to have little effect in slowing down myopia.

Currently, there are 3 proven methods to slow down myopia.
1) Atropine (prescribed by eye Dr)
2) Myopia control spectacle lenses (Hoya Miyosmart aka DIMS and Essilor Stellest)
3) Contact lenses (Overnight reshaping Ortho k hard lenses and day wear daily disposables, Misight and Abiliti 1 day)

I have written about Atropine, Miyosmart and MiSight before. I will discuss more about Abiliti 1 Day in this article. It is a myth that children are too young to wear contact lenses. We have fitted children from 6 years old onwards as long as their eyes have been assessed to be healthy and the child is able to demonstrate the ability to handle the contact lenses by themselves. Since the myopia control soft contact lenses are daily disposables, the child gets a new clean lens every day, so hygiene is not going to be an issue here.

Previous myopia control contact lens uses a dual focus technology to create a myopic defocus effect on the fovea. This resulted in a slower elongation of the axial length of the eyeball, thus a slower increase in myopia. ( Axial length increases, myopia increases). It is theorized that a larger myopic defocus effect on the fovea has a better effect on myopia control. However, with the dual focus lens, a larger myopic defocus will also significantly decrease the sharpness of images. Hence most of the myopic defocus is around the +2.00D range.

Abiliti 1 day is a daily disposable contact lens developed by Acuvue. It utilizes a RingBoost technology (+7D defocus) for myopia control. It is made with a silicon hydrogel material and smaller diameter for high oxygen permeability, increased wearing comfort as well as easier handling and insertion for young children. The revolutionary RingBoost technology is designed to break the interdependence between vision quality and treatment effect. When light hits the lens, it splits. A portion of this light focuses on the retina to correct vision, allowing your child to see clearly while the rest of light focuses in front of the retina to slow down myopia. Abiliti 1-Day lenses can provide strong myopia treatment while maintaining visual quality. In fact, in as little as 6 months, Abiliti 1-Day reduced axial elongation by 0.105mm on average. Generally speaking, 0.18mm corresponds to approximately 0.5D of myopia.

From our experiences, the lens is easier to insert compared to traditional soft lens. Once the child has adapted to the lenses (as fast as the first few hours and up to 5 days), the visual acuity is much like the usual contact lenses. For children with high astigmatism, a pair of top up glasses will be required. We are excited about this new technology. As much as it is new and in its early days, the first few fits have been excellent. We look forward to share more data once we have reviewed our existing clients who are on this program. It is an option for those who have not responded well/keen on the other options of myopia control. For parents looking for combination therapy with low dose atropine, Abiliti 1 Day lens is an excellent option as it comes with UV protection.

We will update this page whenever there are more new data and findings as well as our own experiences with the lens. Feel free to reach out to us @ 87256911 if you have more questions.

MIYOSMART – Probably the most effective optical myopia control product

1st published 2019, updated April 2022

MIYOSMART is an optical product invented and designed by Hong Kong Polytechnic University, manufactured by HOYA. It works based on DIMS technology ( Defocus integrated multiple segments). This will create a slight blur at the peripheral view of the lenses (hyperopic defocus, we call it). Hyperopic defocus and has been proven in many clinical research to prevent axial elongation which results in progressing myopia.

Well established products such as Myovision by Zeiss (spectacle lens) , MiSight by Coopervision (contact lenses) works on the same theory. MIYOSMART hyperopic defocus is different from the products mentioned above. It utilizes a honeycomb defocus treatment zone around a 9.1mm clear zone.

Clear viewing zone in the center. Honeycomb like defocus zone at the peripheral

When viewing through the lens, the user will feel a slight blur at the edges of your vision. This blur is slight more noticeable than Myovision. However, in a clinical trial, almost of the children adapted to it within 2 weeks. In the same double masked clinical trial, the results are very good. It slowed down myopia progression by 59% and in 21% of the cases, myopia did not increase in the 2 years clinical trial.* Third year results are currently being collected and analysed and will be out soon.

It has been 3 years since we have started prescribing these lenses and as a simple non invasive method, it has done very well. For the treatment to be most effective, the frame selection is very important. The frame has to be well adjusted and fitted to the face. The glasses serves dual function (treatment as well as corrective) and has to be worn full time. We will also recommend a 6 monthly review so that we can stack on low dose atropine to improve the efficacy if required. Miyosmart and atropine are not mutually exclusive and can be used together in a combination therapy if the child does not have extreme photophobia or sluggish accommodation ( rare in low dose atropine, more common in high dose atropine)

We also frequently have request to have blue filter added onto Miyosmart. However, it is currently not available. (to ensure that the lenses used in the research is identical to what is being prescribed). To date, there is no strong evidence that blue light can increase or decrease the rate of myopia.

In summary, Miyosmart is effective in slowing down myopia progression. It can also be used in tandem with low dose atropine for better efficacy if required. Speak to your optometrist.

Link below for full scientific article

https://bjo.bmj.com/content/early/2019/05/29/bjophthalmol-2018-313739

*

MiSight – myopia control contact lenses

 

MiSight is a new daily disposable contact lens that has been proven to slow down the progression of myopia in children by 59% in a 4 year study done in a few countries. As a non-pharmaceutical option to control myopia, it is a very appealing tool for optometrist.

Currently, to control myopia progression, we have special spectacle lenses (progressives, bifocals, prismatic bifocals, myopic defocus), atropine as well as Ortho-K. The myopia control spectacle lenses will work for certain children who exhibit certain binocular vision anomalies such as convergence excess and accommodative lag. The effectiveness is also contingent on the glasses being well aligned and the child using it correctly.

Atropine treatment seems to work quite well for children especially in higher concentration but parents may be concerned with potential long-term side effects (not established as yet). It also may increase glare as the pupils will be dilated. There is also an associated rebound myopia upon sudden cessation of the drops.

Ortho-k works very well to control myopia but there is always a small but real risk of a bacterial infection. During the treatment period, the lenses must be worn regularly to maintain good vision and myopia control. In the event the child has to stop wearing these lenses, the myopia will creep back resulting in reduced vision during this period. The child has to wear glasses in the interim until lens wear is resumed. The prescription will fluctuate during this period.

MiSight presents another option for us to control myopia progression. It creates a retinal myopic defocus to prevent the eyeball from elongating by using alternating rings of corrective and treatment zone on the contact lens. In a multi-center, double masked 3 year study, kids wearing MiSight lenses shown a 59% reduction in the progression of myopia versus those on regular daily disposable lenses. At the end of the 3 year study, the control group was switched over to the MiSight lenses. At the end of the 4th year, they too exhibited a slow down in the progression of myopia.

This contact lens is only available in a daily disposable to reduce the risk of allergies and infection. MiSight disposable lens uses PC Technology. Phosphorylcholine (PC) molecules attract and bind water to the surface, creating a shield that keeps the lenses clean and functioning properly. The PC molecules also help the lenses remain hydrated, which in turn, help them feel moist and comfortable all day long.

Due to the unique rings of corrective and treatment zone, it will take a few days to get used to it. I have personally tried it on myself to test the vision and comfort, under room lighting images are clear with no physical nor visual discomfort. However, when I enter a dim room, I do notice a slight halo around light sources. The lens stayed comfortable in my eye till I finish work and reach back home.

For children with astigmatism, they will have to make a pair of glasses to correct the residual astigmatism as these lenses do not correct astigmatism. The children can then choose to do wear these glasses in class so that while the treatment is taking place, it does not disrupt their vision in school. As it is a treatment administered through contact lenses, the child has to wear the lenses for 6 days per week to have a good effect on the myopia progression.

This is indeed a very promising lens. It is a safe, comfortable and effective way to slow myopia progression in children. It can also be used in tandem with 0.01% atropine if the 0.01% atropine is not working well enough.  The only drawback that foresee is the cost. A month supply costs $150. We look forward to offering this as another option alongside with the existing ones in the fight against myopia. Call or visit us now to understand more.

 

Patrick Ng Yao Min

Optometrist

Msc Clinical Optometry