The rising rate of myopia globally has prompted extensive research and development within the optical industry – rightly so with the higher risk of eye disease linked with permanent blindness or vision impairment for high myopes.

Options for myopia control in children’s spectacle lens designs are on the rise, as are contact lens options. And, as Virgilia Readett writes, frame manufacturers are taking the specifics of myopia spectacle lenses into consideration when designing for children.

WRITER Virgilia Readett

The common trend across the eye health industry to combat the growing rate of myopia has been a multi-pronged, holistic approach – pharmaceutical, behavioural, and optical appliances are being used in unison in many cases.

Atropine eye drops are the most common pharmaceutical treatment used for myopia control.1 Rather than correct the refraction, they have been shown to slow the progression of axial elongation. Therefore, they are used in conjunction with optical devices.

Numerous studies have shown increased time spent outdoors for children can be successful in preventing the development of myopia2 and may delay progression.3 Furthermore, evidence suggests that the increased amount of time spent concentrating on near tasks increases the chance of children developing myopia.4

A specific combination of treatments and compliance is vital for success when treating myopia. CR Labs’ Dr Fiona Om emphasised the importance of discussing compliance with patients as it “is a key factor to decrease their risk of further myopia progression”.

SPECIALTY MYOPIA CONTROL SPECTACLE LENSES

Major national and global manufactures, including CR Labs, Opticare, HOYA, ZEISS, and EssilorLuxottica, provide specific dispensing options for myopia control. These designs use various technologies to reduce axial elongation and in some, they relax accommodation lag. By contrast, when myopia is corrected with a single vision lens, the peripheral light rays focus behind the retina, stimulating the eye to elongate – this is known as hyperopic defocus.5

The defocus incorporated multiple segments (DIMS) technology, used in HOYA’s MiyoSmart range, uses a hexagonal ringshaped treatment area of alternating focus and defocus areas. This reduces hyperopic defocus while maintaining clear vision simultaneously.6 The success of the DIMS technology used in the HOYA MiyoSmart range is backed by numerous clinical trials and studies.7

DISPENSING CONSIDERATIONS

For specialised designs to function as intended, specific fitting requirements are needed. Director of Opticare, George Nasser explained that his company’s suite of myopia management lenses (MyoEase, Myonic, and Optilux Relax), require specifics to be followed regarding fitting height, decentration, and frame depth above and below fitting height.

The need to follow specific fitting requirements was echoed by Dr Om. She explained the minimum fitting heights above and below pupil centre, “ensure sufficient levels of defocus”. CR Labs’ myopia portfolio includes MyoMe and MyoStock.

NEED FOR SUN PROTECTION

With a holistic approach to myopia management, the requirement for sun protection is amplified.

Although increasing time outdoors is recommended to aid in myopia control,3,4 increased risk of melanoma, cataract, and pterygium should be considered.3 Atropine eye drops, while also effective for myopia control, have been shown to cause photophobia.1

HOYA’s MiyoSmart Sun range addresses the holistic need for sun protection while maintaining its DIMS technology. The range encompasses the MiyoSmart Sunbird, a grey polarised lens, and the MiyoSmart Chameleon, a grey photochromic lens.8

FRAME REQUIREMENTS

To ensure the fitting and wearing requirements of myopia control lenses are met, effective frame selection is paramount. Frames with depth – such as rounded shapes – that allow the eye to be reasonably central when considering the anatomy of children’s bridges, are an ideal choice.

And this is driving demand. As Lana Arnold, co-founder of augie Eyewear explained, “Dispensers are seeking frames that can work for a myopia control lens and this is reflected in their buying choices. Kids’ eyewear trends have followed adult trends and round shapes have overtaken the traditional square shapes, for boys and girls.

“So, it’s a combination of frame trends and demand for suitable shapes that I see reflected in buying choices.”

She said augie Eyewear’s Remy style was designed and developed to meet this increase in demand, because it “gives dispensers variation for different face shapes”.

“The Remy has extended nose pads and a dropped bridge, which creates the right position for the eyes to be centered. However, as each little face is so unique, the key is to offer a variation in styles, sizes, bridge width, and nose pad depth, which our collection offers.”

Owner and co-founder of ProOptics, Jacque Katsieris, has seen an increase in demand for the Random Kids range. Ms Katsieris explained the range is, “sized from 44–50 with easy to adjust acetate temples and hinges so the pantoscopic tilt is opportune”.

“All frames fit five years to small adult, so they are perfect for the age group needed for myopia management. Our frames are all over 30 mm deep with bridge fitting to children’s faces, so they sit properly with the pupil in the middle of the frame,” she explained.

FRAME AND LENS PARTNERSHIPS

The holistic approach taken by the industry has brought about frame and lens partnerships to provide reduced wait times, reduced costs, and increased ease in the dispensing process.

CR Labs and Safilo have collaborated with their ‘Full Circle’ partnership. Dr Om described the Polaroid Kids range within this partnership: “It offers a variety of low-bridge frames, designed to provide a comfortable fit for children prescribed with myopia management spectacles. The frame uses anti-slip material to provide stable vision through the central clear viewing zones. It comes in different shapes and sizes and allows for adjustability to cater for different face shapes.”

Designed specifically for HOYA lenses, the Oliver Wolfe Junior range provides a time and cost-saving option in a complete package offering for myopia control. HOYA’s Training and Development Manager, Ulli Hentschel explained, “practices can keep their stock on the shelf and just order the complete job from us. This reduces courier costs, speeds up the order process, and helps with inventory management. The pricing is at a point to make it easier for parents to afford as we offer the range at a lower price than what these frames would normally sell for.”

CONTACT LENSES

Contact lenses offer another option in the myopia management portfolio.

Studies have shown success with orthokeratology (OK) in manipulating peripheral defocus to reduce myopia progression.9 With overnight wear, OK lenses “flatten the central cornea, leading to mid-peripheral steepening and providing peripheral myopic defocus, while eliminating daytime myopia”.2

Various studies have also shown success with the use of centre-distance contact lenses.2 Multiple lenses are available from leading contact lens manufacturers in these designs.

CooperVision offers the MiSight 1 day – a daily disposable soft contact lens designed specifically for children with progressing myopia. CooperVision’s Julia Kwok explained the lenses are, “dual-purpose, designed to slow down the progression of myopia in children, while also correcting their vision” and are backed by seven years’ of clinical evidence.

ROLE OF THE DISPENSER

“But why?” is one of the most common questions asked by children who find themselves under treatment for myopia control. The complexity of myopia as an ocular condition and treatment strategies for myopia management can drive parents to ask the same question, even after numerous discussions with their optometrist.

This is another area where optical dispensers can make a significant impact.

HOYA’s Mr Hentschel explained, “Dispensing staff can be vitally important in the knowledge transfer to the parents and children. They can help the optometrist by reinforcing what was said in the consulting room. Discussing the importance of outdoor time and less screen time with the child will often help the parent when they try to switch off the iPad at home later on.”

Taking the opportunity to explain that compliance with treatment is vital for myopia management success is also important, as Mr Nasser from Opticare explained.

“Optical dispensers can play a vital role by impressing on children (and their caregivers) the importance of wearing their myopia control lenses for more than 12 hours per day and attending scheduled follow-up appointments.”

For compliance to be met, and success in myopia management to be achieved, a holistic approach is essential.

Virgilia Readett is a senior trainer with the Australasian College of Optical Dispensing (ACOD). She holds a Certificate IV in Training and Assessment, a Certificate IV in Optical Dispensing and a Bachelor of Arts majoring in Communications.

Ms Readett has been teaching with ACOD since 2019 and is passionate about student support and development. Having begun her optical career with Specsavers in 2012, she found training and staff support were her passion and went on to complete her optical dispensing qualification, and later her training and assessment qualification. Over her 12 years of optical experience, she has worked in several stores in supervisory and in store trainer positions.

References
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2. Jonas, J.B., Ang, M., Cho, P., et al. IMI prevention of myopia and its progression. Invest Ophthalmol Vis Sci. 2021;62(5):6. DOI: 10.1167/iovs.62.5.6.
3. Lingham, G., Mackey D.A., Lucas R., et al., How does spending time outdoors protect against myopia? A review. Br. J. Ophthalmol. 2020;104:593–599.
4. Lawrenson, J.G., Dhakal, R., Walline, J.J. et al., Interventions for myopia control in children: A living systematic review and network meta-analysis. Cochrane Database Syst Rev. 2021 Apr 7;2021(4):CD014758. DOI: 10.1002/14651858.CD014758.
5. Erdinest, N., London. N., Levinger, N., et al., Peripheral defocus and myopia management: A mini-review. Korean J Ophthalmol. 2023 Feb;37(1):70–81. DOI: 10.3341/ kjo.2022.0125.
6. Hoya, Vision product – Miyosmart (webpage) available at: hoyavision.com/au/vision-products/miyosmart/ [accessed June 2024].
7. HOYA, Confidence through evidence (webpage) available at: hoyavision.com/vision-products/miyosmart/evidences/ [accessed June 2024].
8. HOYA, MiyoSmart Sun (webpage) available at hoyavision.com/au/vision-products/miyosmart/miyosmartsun/ [accessed June 2024].
9. Lee, Y.C., Wang, J.H., Chiu, C.J.. Effect of orthokeratology on myopia progression: Twelve-year results of a retrospective cohort study. BMC Ophthalmol. 2017 Dec 8;17(1):243. DOI: 10.1186/s12886-017-0639-4.