You’ve heard a lot about myopia control, but it wasn’t until a few months ago that we received the first FDA indication of a contact lens for it. Big changes are in the works for presbyopia management, too. It’s shaping up to be a good year to be in the business of correcting refractive errors all across the lifespan.
On-label Myopia Control
In November 2019, the FDA approved CooperVision’s MiSight 1 day contact lens to slow myopia progression for children between the ages of eight and 12.
The daily disposable soft lens is designed with center correction and peripheral defocus to reduce stimuli of myopia progression. In a three-year randomized controlled clinical trial of 135 children, the subjects were divided between MiSight and a conventional soft lens. For the full three-year period, progression of myopia in those wearing MiSight lenses was less than with conventional soft lenses. More importantly, subjects who used MiSight had lesser increases in axial length.1
Adding Myopia Control
If 2020 is the year you tackle myopia control in your office, you’ll need to purchase an ultrasound device to measure axial length. Sometimes refractive error can change significantly, but if the axial length remains the same, you must stay the course with your current myopia treatment.
If both axial length and the refraction are changing significantly, or the child’s activities increase their risk of progression, consider adding low-dose atropine, which also works by creating peripheral retinal defocus. This once-a-day drop can significantly decrease myopia progression in children within a year.2
DGH Technology recently introduced an easy-to-use A-scan ultrasound with high-resolution—for less than $3,000. This technology provides A-scan tracking and myopia control reports. In addition to tracking myopia, ultrasound has relatively good reimbursement for other medical conditions, such as:
Researchers note that various concentrations reduce progression in a dose-dependent manner. All three concentrations—0.05%, 0.025% and 0.01%—are well tolerated and show no adverse events. The 0.05% concentration is the most effective in controlling progression of axial length and slowing progression of the myopic spherical equivalent.2 Currently, 0.05% atropine drops require a compounding pharmacy such as Ocular Sciences or Imprimis.
Presbyopia in 2020
This will be a significant year for presbyopia correction with the potential approval of the VisAbility scleral insert (Refocus). Unlike clear corneal inlays, which are not without compromise, this micro-implant is placed in the sclera to create the space necessary to allow the lens zonules to return to their taught position. Current data of 20 presbyopes suggests they all can read J3 or newspaper print with the implant.
Over the next year, we’ll also see ongoing research on drops to treat presbyopia, including various miotics that increase depth of focus and others that help return the crystalline lens to a more flexible state. Research into crystalline lens restoration shows that, as we age, the sulfhydryl bonds oxidize and progress to more rigid disulfide bonds. Thus, dihydrolipoic acid chemically reduces disulfide bonds and may work to reverse the rigidity of the human lens.
Optometry has many new opportunities in 2020 to better correct refractive errors. Adding any one of them to your daily routine can have significant effects on your patients and practice.
Note: Dr. Karpecki consults for companies with products and services relevant to this topic.
1. Chamberlain P, Peixoto-de-Matos S, Logan N, et al. A 3-year randomized clinical trial of MiSight lenses for myopia control. Optom Vis Sci. 2019;96(8):556-67.
2. 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):113-24.