Shift from myopia treatment to management
BOSTON – Controlling the progression of myopia means managing the condition instead of only treating it, according to doctors participating in a CooperVision-sponsored panel discussion here at the American Academy of Optometry annual meeting.
CooperVision shared 7-year data on its MiSight 1 day contact lens for myopia management, indicating no myopia control rebound, after which the panel of practitioners shared how they are incorporating the lens into their practice.
Ashley Wallace-Tucker, OD, FAAO, FSLS, said she tells parents, “We no longer have to treat myopia; we can manage it. If you have a myopic parent, pull on their heartstrings and say we want better for our children. Most parents want to do something different for their child than what was available for them. Many parents are shocked this is even an option.
“If it doesn’t resonate right away,” she continued, “I send home a packet of information. It’s planting those seeds. Sometimes it takes a year to show the parent what happened because they didn’t start the program.”
Sarah Singh, OD, PhD, FAAO, said the University of California, Berkeley, has a clinic dedicated to myopia control, so most patients are referred.
“We spend a full 45-minute visit doing a consultation to collect all baseline measurements and talk to patients and parents about why they’re myopic and the importance of myopia control and what we’ve learned from the robust clinical trials conducted around the world,” she said. “Having the patient involved in that discussion invests them in the treatment.”
Nathan Bonilla-Warford, OD, FAAO, FCOVD, FIAOMC, said during the exam he tells the parent he is genuinely concerned about the change in the child’s prescription.
“I say that their child has myopia, and we have to treat it short term and long term,” he said.
If the family is interested, he will bring them back for a consultation and axial length measurements.
“Not every parent does it immediately, but they leave feeling empowered,” he added.
Moderator Debbie Jones, BSc, FCOptom, FAAO, clinical professor with the School of Optometry & Vision Science at the University of Waterloo and the Centre for Ocular Research & Education, noted that the short term is how the patient is seeing now, and the long term is what happens when they are older and their myopia is progressing.
Once the family decides to commit to the myopia management program, Bonilla-Warford said, the staff works with the patient on proper lens handling.
“Either me or a staff member puts them in first, then we do the evaluation,” he said. “The first thing the child is doing is taking them out. They have to show us they can take them out, put them back in and take them out. They have to demonstrate that they’re comfortable with this.”
Wallace-Tucker said she has had no parents or patients say handling or comfort is an issue.
“I tell patients it’s designed with children in mind,” she said.
Bonilla-Warford said he is amazed at how quickly the children pick up the skills, and that parents need to be “pleasantly discouraged” from dominating the situation.
“I’ll make an exception if the child needs help and they have a parent who can help them,” Wallace-Tucker said. “But it’s more important to me that [the child] can take it out.”
Jones suggested starting them on a weekend or school break so the children are not getting accustomed to the lens handling during a busy time in the household.
In the MiSight trials, children wore the lenses 10 hours a day, 6 days a week, Jones said. She asked the panelists if this schedule was replicated in practice.
Singh said her patients typically wore the lenses longer than 10 hours.
“We say the kids can wear them as long as they’re comfortable,” she said. “And because their vision is so good with the lenses, there’s little motivation to remove them.”
“I tell them they can take a day off,” Wallace-Tucker said, “but most of our patients want to wear them 7 days a week all day long. I just tell them no napping, no sleeping, no swimming, and I’m OK with all waking hours.”
Bonilla-Warford said he saw no alarming findings in the slit lamp with this lens, “so there is no cause for concern.”
To ensure compliance, Wallace-Tucker said she asks the family to bring in all of their unopened lenses at every visit. However, she said it has not been an issue.
Because the MiSight lens is used in a program model, “people are expecting to come in regularly and be quizzed about what they’re doing and how they’re doing it,” Bonilla-Warford said. “It’s about setting expectations up front in a matter-of-fact manner.”
He noted that all of his patients have remained stable, with the exception of one who had one eye that progressed 0.25 D.
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