Our Q&A format is designed to explore a particular clinical topic, intervention, product or research paper with an expert. Here, we talk to optometrist Elizabeth Lumb about the evolution of myopia management over the past six years, through two 'lenses' - as CooperVision's Director of Global Professional Affairs, Myopia Management, and through the very personal experience of her now 12-year-old niece, Maddy.
How have you seen the field of myopia management change in the past five years?
Liz: Six years ago, I recall speaking at national and global events about myopia management, with a key message that it was 'Time to stop talking and start doing'. Now in 2023, we have such a volume of evidence for the efficacy and safety of interventions and the importance of myopia management.1
How do these observations mirror the experience you've witnessed of your niece, Maddy?
Liz: Back in 2017, Maddy was 6 years old, and with a family history of myopia, I look back now and wish that her pre-myopia had been recognized at the time and managed as such. Risk assessment tools allow us to do this, such as the MyKidsVision.org survey by Myopia Profile; the PreMo tool developed by the University of Ulster; and Ocumetra's new mEYE Guide. At age six, Maddy's visual system most probably waved a red flag of being less than +0.75D, which as we know from research, places her at high risk of becoming myopic by age 13.2 Well, it emerged sooner than that.
When was Maddy diagnosed with myopia?
Liz: At age 8 her teacher noticed that Maddy was struggling to see the board at school and suggested an eye examination. Her refraction at diagnosis was R -1.25/-0.50x104 and L -1.00/-0.50x106. That was in 2019, and as a child in England, Maddy's clinical care was conducted in the frame of the the UK College of Optometrists' Guidance for Myopia Management at that time, which stated that "the evidence is not sufficient to recommend the wide scale roll out of any intervention..." and "if you are not already offering myopia management, you do not have to do so." This was an incredibly disappointing stance given that in 2019, there were three landmark moments in myopia. Firstly, the International Myopia Institute published their first suite of reports,3 clearly stating the clinical imperative for myopia management. Secondly, the MiSight 1 day three year clinical trial study was published,4 showing myopia control efficacy of at least 50%. Thirdly, MiSight 1 day was granted the first (and still only) FDA approval (*see footnote below) as a product to slow myopia progression in children.
Do you think that these mixed messages on myopia have influenced eye care professionals?
Liz: Yes, absolutely. Despite the evolution in the field of myopia management research and product innovations, global surveys of eye care professional (ECP) attitudes show that single vision corrections are still, by far, the most commonly prescribed correction for young progressing myopes. Data from 2015, 2019 and 2022 shows that ECPs have a high level of concern about myopia, and report moderately high levels of activity in myopia management. Over this time, single vision prescribing is trending downwards, but still constitutes over half of dispensed prescriptions.5-7
Thankfully, the UK College of Optometrists Guidelines were updated in 2022 to be more in line with the evidence, removing this as a barrier for colleagues in my country. Even so, much more can be done to ensure that myopia management is initiated at the ages and for the degrees of myopia for which the biggest impacts are possible.8 For the short-term benefits of a more stable refraction, and for the long-term preventative eye health perspective, ECPs really need to get started and stay the course in myopia management.
How does Maddy's story illustrate this point about getting started and staying the course in myopia management?
Liz: When Maddy was diagnosed with myopia at age 8, she was initially dispensed single vision spectacles - and a discussion on myopia management didn't happen. As a concerned Aunt and an optometrist with a special interest in myopia management, I encouraged her to see a local optometrist experienced in the field. This optometrist fit Maddy with MiSight 1 day contact lenses a few months after her initial myopia diagnosis at age 8. Unfortunately, this was in early 2020, with cycling lockdowns and home-based schooling and indefinite pauses on extra-curricular activities across the rest of that year. Maddy's motivation to wear her contact lenses was influenced by these huge changes and adherence to the recommended wearing times was minimal. Within the year she had progressed by -0.75D in her right eye and -1.00D in left eye, now being around -2.00 in both eyes just as she turned 10.
Maddy's experience highlights that even with proactive intervention, the 'medicine' doesn't work if it's not taken. The important lesson is that compliance with full-time wear is crucial for optimal outcomes to slow myopia. Evidence for both spectacle9 and contact lens10 interventions illustrate this.
What signs do you see of change being driven in myopia management?
Liz: Another landmark moment in recent myopia history was the 2021 World Council of Optometry's resolution of the Standard of Care for Myopia Management. This defined that evidence-based care for children with myopia must include efforts in mitigation, measurement and management to not just correct myopia but also provide evidence-based interventions to slow its progression. Since that time almost 40,000 individual optometrists have taken the WCO pledge to make myopia management part of their practice.
The evidence-base for interventions is also growing. Numerous interventions have published two-year and three-year outcomes1 and the MiSight 1 day study is now the world's longest single clinical trial in myopia management, with six-year data published11 and seven-year data reported.12 The evidence-base gives ECPs increasing reassurance of efficacy of these treatments for children with myopia.
Maddy is now 12 and loves wearing her MiSight 1 day contact lenses, seeing the benefits of them for her vision, hobbies and lifestyle as well as to slow her myopia progression.
Clinical Article: When to start myopia management
Clinical Article: Mastering MiSight 1 day
Science Summary: Six-year MiSight 1 day clinical trial data
Science Summary: Six-year safety data for children wearing soft contact lenses
*FDA Indications for use (US only): MiSight® 1 day (omafilcon A) soft (hydrophilic) contact lenses for daily wear 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.
Availability of interventions with regulatory indications to slow progression of myopia varies by country. CooperVision does not endorse off label prescribing of interventions for myopia control.
About Elizabeth Lumb
Elizabeth Lumb is Director of Global Professional Affairs for Myopia Management with CooperVision, working with regional marketing and professional affairs teams delivering professional education and training programs as well as driving publication planning in support of the myopia management interventions available including MiSight® 1 day, orthokeratology and SightGlass Vision. Liz is based in the UK and is an optometrist with a first class honours degree from The University of Manchester and is a fellow of the British Contact Lens Association. She joined CooperVision in 2015 with the integration of Sauflon, where she was Professional Relations Manager.
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- Zadnik K, Sinnott LT, Cotter SA, Jones-Jordan LA, Kleinstein RN, Manny RE, Twelker JD, Mutti DO; Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error (CLEERE) Study Group. Prediction of Juvenile-Onset Myopia. JAMA Ophthalmol. 2015 Jun;133(6):683-9. (link)
- Gifford KL, Richdale K, Kang P, Aller TA, Lam CS, Liu YM, Michaud L, Mulder J, Orr JB, Rose KA, Saunders KJ, Seidel D, Tideman JWL, Sankaridurg P. IMI - Clinical Management Guidelines Report. Invest Ophthalmol Vis Sci. 2019 Feb 28;60(3):M184-M203. (link)
- Chamberlain P, Peixoto-de-Matos SC, Logan NS, Ngo C, Jones D, Young G. A 3-year Randomized Clinical Trial of MiSight Lenses for Myopia Control. Optom Vis Sci. 2019 Aug;96(8):556-567. (link) [Link to Myopia Profile Science Review]
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- Wolffsohn JS, Calossi A, Cho P, Gifford K, Jones L, Jones D, et al. Global trends in myopia management attitudes and strategies in clinical practice - 2019 Update. Cont Lens Anterior Eye. 2020 Feb;43(1):9-17. (link)
- Wolffsohn JS, Whayeb Y, Logan N. Global trends in myopia management attitudes and strategies in clinical practice - 2022 International Myopia Institute Update. International Myopia Conference (IMC) Abstract, September 2022. Accessed on February 15, 2023 from https://www.internationalmyopiaconference.org/wp-content/uploads/2022/09/IMC-2022-Abstract-book.pdf
- Moore M, Flitcroft DI, Loughman J. Prescribing patterns of myopia control contact lenses among optometrists in Ireland. Ophthalmic Physiol Opt. 2023 Jan 18. (link)
- Lam CS, Tang WC, Tse DY, Tang YY, To CH. Defocus Incorporated Soft Contact (DISC) lens slows myopia progression in Hong Kong Chinese schoolchildren: a 2-year randomised clinical trial. Br J Ophthalmol. 2014 Jan;98(1):40-5. (link)
- Bao J, Huang Y, Li X, Yang A, Zhou F, Wu J, Wang C, Li Y, Lim EW, Spiegel DP, Drobe B, Chen H. Spectacle Lenses With Aspherical Lenslets for Myopia Control vs Single-Vision Spectacle Lenses: A Randomized Clinical Trial. JAMA Ophthalmol. 2022 May 1;140(5):472-478. (link) [Link to Myopia Profile Science Summary]
- Chamberlain P, Bradley A, Arumugam B, Hammond D, McNally J, Logan NS, Jones D, Ngo C, Peixoto-de-Matos SC, Hunt C, Young G. Long-term Effect of Dual-focus Contact Lenses on Myopia Progression in Children: A 6-year Multicenter Clinical Trial. Optom Vis Sci. 2022 Mar 1;99(3):204-212. (link) [Link to Myopia Profile Science Summary]
- Chamberlain P et al. Myopia progression on cessation of Dual-Focus contact lens wear: MiSight 1 day 7-year findings. Optom Vis Sci. 2021; 98(E-abstract): 210049.