ECPs Must Adopt Myopia Management: Editorial

Eye care professionals (ECPs) long ago mobilized on the front lines to combat potentially sight threatening conditions such as glaucoma, diabetic retinopathy, and age-related macular degeneration. Now, three prominent researchers are urging ECPs to champion myopia management and treat children with myopia while there’s still time to preserve their vision and ocular health.¹

 The editorial, “Practitioners Must Embrace Myopia Management,” calls myopia one of the most pressing ocular health issues of the 21^st Century.¹ The opinion piece was published in Contact Lens Update and authored by myopia experts Dr. Mark Bullimore, OD, PhD, MCOptom Paul Chamberlain, BSc (Hons), CooperVision Director of Research Programs, and Dr. Noel A. Brennan, research fellow at Johnson & Johnson Vision.

“Myopia management must be standard of care, a position echoed by the World Council of Optometry and prominent voices worldwide,” MCOptom Paul Chamberlain wrote in the paper. “Yet the power to make that happen—to change lives—lies with eye care professionals. Researchers have much to learn and build in this fast-paced area of research, but there is little preventing those on the frontlines from treating children today.”¹

Powerful Science Accentuates the Need to Treat

Over the past few decades, myopia prevalence has accelerated across the globe, and currently poses an unprecedented threat to global eye health due to disproportionate increases in high myopia, associated pathology, and vision impairment, Dr. Brennan suggested.¹ By 2050, researchers estimate myopia rates will nearly double.¹  Further, projected 2050 caseloads in the West, Latin America, South Asia, and the Middle East may exceed myopia rates in both East and Southeast Asia, which goes against the grain of the popular theory that myopia is a problem limited to the latter two regions of the world, Dr. Brennan added.¹ Current research has also revealed that myopia progression is almost always faster in younger eyes², and no level of myopia is safe, since a sizable portion of individuals with low and moderate prescriptions develop myopia macular degeneration.¹

The Potential Debilitating Results of Unchecked Myopia

Previous investigations firmly established myopia as a risk factor for open-angle glaucoma and retinal detachments.¹ However, modern clinical trials have discovered a person’s myopia level also plays a significant role in whether they will develop future ocular diseases and eye conditions.¹ In one study, Dr. Bullimore and his colleagues found each diopter of myopia increased risk by 20-30%.^1,3

Of note, an individual’s myopia level is directly linked to their risk probability of developing macular maculopathy, since each diopter increases risk by at least 60%, Dr. Bullimore stated in the opinion piece.^1,3,4 This finding is of grave concern, since myopic maculopathy is untreatable and a common cause of visual impairment, he added. Looking into the future, myopia will be responsible for approximately one-third of all irreversible visual impairment by 2050, he continued.^1,5 “While eradicating myopia might be considered science fiction, reducing myopia by just one diopter across the population would produce a very meaningful reduction in the prevalence of visual impairment,” Dr. Bullimore wrote.

ECPs Hold the Power to Change the Trajectory

Practitioners now have a variety of proven, trusted treatment options to slow myopia progression, which can reduce the risk of high myopia and the threat of future maculopathy, Dr. Chamberlain said.¹ In recent years, novel, breakthrough technologies have entered the market or are poised to do so, including spectacle and contact lenses for myopia control. In 2019, the FDA approved MiSight^® 1 day contact lenses, the first FDA-approved* product proven to slow the progression of myopia in children, aged 8-12 at the initiation of treatment.^6҂ CooperVision’s strong commitment to myopia control includes the longest-running international study of pediatric soft contact lens myopia control clinical trial to date.^†7 Six-year results showed continued myopia control and the seventh year found no rebound post treatment.^1,7,8‡ The study also showcased MiSight^® 1 day’s strong safety profile⁹ and quality of life benefits offered by a myopia control contact lens. ^†1,7,8

Myriad Treatment Benefits

Whichever myopia treatment option a doctor selects, intervention may also offer benefits beyond lowering ocular disease risk. For example, lower myopes have better uncorrected and corrected visual acuity, and since a child with myopia will one day be a refractive surgery candidate, their visual and refractive outcomes will be improved with lower presurgical myopia, Dr. Bullimore suggested.¹ Treatment can also help reduce future medical costs associated with the condition.¹

An Immediate Call to Action

Myopia is a major public health issue, but this challenge can be met head-on if ECPs treat all children with myopia to slow their progression, as early and close to onset as possible.¹ Simply correcting the vision of a young child with myopia is no longer adequate and waiting to treat serves little purpose, Dr. Brennan said in the editorial. Added Dr. Chamberlain, “Awareness means nothing without action. Faced with this irreversible disease, there’s no time to lose.”¹

*Indications for Use: MiSight^® (omafilcon A) daily wear single use Soft Contact Lenses are indicated for the correction of myopic ametropia and for slowing the progression of myopia in children with non-diseased eyes, who at the initiation of treatment are 8-12 years of age and have a refraction of -0.75 to -4.00 diopters (spherical equivalent) with ≤ 0.75 diopters of astigmatism. The lens is to be discarded after each removal.

^† On average, children wearing MiSight® 1 day progressed less than -1.00D over 6 years. Children in the single vision control group progressed about -1.00D over the first 2 years.

^‡ Preliminary international study data shows that, on average, for children that discontinued treatment at age 14-19 following 3 or 6 years of MiSight^® 1 day wear, the eye growth reverted to age-expected average myopic progression rates. Disclaimer: The stability of the myopia reduction effect 1-year post-treatment is being further evaluated in a post-approval study in the U.S. as a condition of FDA approval for MiSight 1 day.

^҂ Compared to a single vision 1 day lens over a 3 year period.

1. Bullimore M, Chamberlain P, Brennan NA. Practitioners Must Embrace Myopia Management. Contact Lens Update. contactlensupdate.com/. Accessed 9/26/2022.

2. Hyman L, Gwiazda J, Hussein M, et al. Relationship of Age, Sex, and Ethnicity with Myopia Progression and Axial Elongation in the Correction of Myopia Evaluation Trial. Arch Ophthalmol 2005;123:977-87.

3. Bullimore MA, Ritchey ER, Shah S, et al. The Risks and Benefits of Myopia Control. Ophthalmology 2021;128(11):1561-79.

4. Bullimore MA, Brennan NA. Myopia Control: Why Each Diopter Matters. Optom Vis Sci 2019;96(6):463-5.

5. Bullimore MA, Brennan NA. The Underestimated Role of Myopia in Irreversible Visual Impairment in the United States. Ophthalmology 2022; under review.

6. Chamberlain P, et al. A 3-year Randomized Clinical Trial of MiSight® Lenses for Myopia Control. Optom Vis Sci. 2019; 96(8)556-567.

7. Chamberlain P, Arumugam B, Jones D et al. Myopia Progression in Children wearing Dual-Focus Contact Lenses: 6-year findings. Optom Vis Sci 2020;97.

8. Chamberlain P, Arumugam B, et al. Myopia progression on cessation of Dual-Focus contact lens wear: MiSight 1 day 7-year findings. Optom Vis Sci 2021;98.

9. Woods, J., Jones, D., Jones, L., Jones, S., Hunt, C., Chamberlain, P., & McNally, J. (2021). Ocular health of children wearing daily disposable contact lenses over a 6-year period. Contact Lens and Anterior Eye.