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.

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

The See and the Sun

“You can help your children too. Make sure they take frequent breaks from homework. Don’t let them spend too much time playing computer games or watching TV . During this school break, why not take them out to enjoy our beautiful parks, beaches and gardens?”- PM LEE on his FB

When a person is exposed to sunlight, our body secretes a chemical known as dopamine. Dopamine is theorized to inhibit the abnormal growth of the eyeball, thus reducing the progression of myopia. Studies have shown that children who spend an average of 2 hours under the sun daily, has a lower rate of myopia progression.

In this post, we will feature a few outdoor activities that you can bring your children to

1) Botanic Garden

It’s a lovely place, especially so on weekday mornings and evenings for the children to roam in the wide, lush greenery. Mummy could pack a picnic basket and daddy can lug a small cooler box to enjoy a picnic. You can bask under the soft glow of the evening sun, letting the cool breeze carrying away the day to day stress. For those who do not mind paying, Food for Thought have a rent a picnic basket that you can check out.

http://www.foodforthought.com.sg/restaurant.php?branch=sbg

2) Pulau Ubin

A trip back to ulu-ness.. (well almost) before the landscape changes again. Taking a bumboat ride can be quite an experience for the city kids. Only a short distance away, seasickness should be of no/minor issue to parents. Once on the Ubin, parents would feel that we have been transported back to the days they were teens. ( you have been there when you were young, haven’t you? ) The modus operandi of getting around in Ubin is the humble bicycle. Yep, THE humble bicycle.. no expensive road bikes whizzing around at 40km/hr. There are different types of bicycles available to suit the family needs

http://www.wildsingapore.com/ubin/index.html

3) Rock Climbing/Abseiling

For parents with older kids who may want a more challenging activity, consider this. There are many places that offer rock climbing. Safra is one place most dads would be fairly familiar with. They also offer other activities such as abseiling and canopy walk.

http://www.safra.sg/Enjoy/SAFRA-Adventure-Sports-Centre.aspx#.VG8NlvmUchF

4) Fly under the Sun

Warning! This is one expensive family trip…. but it sure seems like fun. We haven’t tried it yet, but would love to someday. Apparently, one would “fly” with the aid of water propulsion! There are of course more sedate water activities you can do, but it all seems a bore relative to this. Let us know if you do try this out! Make sure you secure your glasses though!!

http://www.seabreeze.com.sg/about.html

5) East Coast Park

One of the usual haunts for families. You can fish, you can bike and you can build sandcastles. Of course, after sweating it all out, dinner at the Lagoon would be a great way to end the exhausting day.

http://www.singaporekidsplaces.com/2008/03/east-coast-sand-castles.html

6) Parkour

Now… this is very different from the activities listed before. A good workout for the heart (of Mums) and the body.

http://superflymonkeydragons.com/

There are many other activities such as Universal Studio, Luge at Sentosa, swimming needs no introduction/reminder.  Enjoy the holidays! And when the school term approaches, remember to pay us a visit to have your kids eyes checked!

Binocular Vision

Binocular vision is one of the hallmarks of the human race that has bestowed on it the supremacy in the hierarchy of the animal kingdom. It is an asset with normal alignment of the two eyes, but becomes a liability when the alignment is lost.

Binocular Single Vision may be defined as the state of simultaneous vision, which is achieved by the coordinated use of both eyes, so that separate and slightly dissimilar images arising in each eye are appreciated as a single image by the process of fusion. Thus binocular vision implies fusion, the blending of sight from the two eyes to form a single percept.

Binocular Vision requires

1) Clear Vision in both eyes

2) Motor Fusion (both eyes aligned to look at an object)

3) Sensory Fusion ( Brain fuses two slightly different vision into one)

Common Binocular Vision anomalies often missed in Children

1) Convergence Insufficiency

CI is the inability to obtain or maintain sufficient convergence for comfortable binocular vision for close work. Occasionally, they may develop into an intermittent outward squint when fatigued. Subject will usually complain of frontal headaches or poor concentration at close work.

2) Convergence Excess

It is the condition where the eyes over converge while reading. The main symptoms are frontal tension headache, often accompanied with transient blurred vision for far distance after a period of close up work. In children, it often goes wrongly diagnosed at an increase in myopia. Children with convergence excess in combination with high accommodative-convergence ratio is also likely to be at risk for progressive myopia without the right lenses or visual therapy

3) Accommodative infacility

The inability of the ciliary muscles within both eyes to change focus from far to near and/or vice versa. This condition usually is co-existent with convergence excess. The symptoms may also be very similar,where the child may complain of transient blurred vision at distance after a period of close reading

4) Divergence excess

This condition usually manifest in children where the eye muscles tend to over divergence while looking far. The signs are usually that the child’s eyes may intermittently turn outward while day dreaming or when fatigued.

How can parents detect such anomalies?

Depending on the severity of the condition, some of it can go often undetected with minimal symptoms. The child may also commonly complain of sleepiness, fatigue or headache after prolonged close up work or transient blurred vision. An optometrist who is trained in Binocular vision is able to perform an assessment to detect such anomalies. He/She is then able to recommend certain visual therapy or special lenses to help assist you child in his vision.

So do not dismiss your child’s complains of headaches or tiredness as plain laziness. Perhaps there is something more to it that can be done. As parents, it is our prerogative to ensure that their health and well being is being taken care of. So do the right thing, bring your child to visit an optometrist today.

*Patrick & Linda @ Precision Optics rountinely perform binocular vision assessment on kids and adults to ensure that you get the best out of both your eyes. Consultation (Usual $35) is waived for children between the age of 5 to 12.