A Farsighted Approach to Myopia ManagementWRITER Alan Saks The recent Myopia Management Conference in The Netherlands showed myopia continues to be a hot topic, releasing hundreds of papers dealing with many aspects of myopia research and clinical management. Our homegrown Myopia Profile portal provided regular, succinct summaries of some of the most important papers, and continues to be a leading resource for those engaged in myopia management. Essilor There’s a general view that every eye care practitioner (ECP) needs to be involved in myopia management. At the very least, ECPs should discuss the issues and refer any patients showing signs of myopia progression, while monitoring those at risk. The efficacy of some of the numerous options and interventions are covered by our leading experts in various articles in this annual mivision myopia edition. Here we’ll focus on some of the many spectacle and contact lens options currently on the market. There are also some exciting new options that are likely to arrive in 2023. These include new myopia controlling soft lenses, spectacle lenses and the emerging, repeated low-level red-light (RLRL) therapy. THE MAIN MARKET PLAYERSThere has been much publicity surrounding the release of CooperVision’s seven-year data on its well-established MiSight daily disposable contact lens. Jacqui Regan, CooperVision’s ANZ MiSight 1 day Brand Manager, speaking to the findings from the seven-year clinical trial said, “Twelve-months following treatment cessation, mean axial elongation data indicate no evidence of rebound effect, meaning the myopia control gains are retained”. 1,2*This bolsters the already impressive data revealed from detailed analysis of the MiSight myopia control modality. In general, more and more data comparing various myopia control options – including myopia controlling spectacles and contact lenses – shows a similar level of control can be achieved. Pauline Kang, Director of Learning and Teaching at the School of Optometry and Vision Science at the University of NSW, who has strong research interests in myopia control and the mechanisms underlying the development and progression of myopia in children said, “our understanding of best practice for the management of progressive myopia is continually evolving”. “Latest research indicates similar treatment efficacies with minimal rebound effects across optical and pharmacological myopia control treatments, including orthokeratology, soft contact lenses, spectacles, and atropine. “Modifying orthokeratology lens designs and increasing treatment wear time presents alternative approaches to enhancing outcomes with existing myopia treatment options. “Research into novel spectacle and contact lens designs and light exposure treatments are continuing to emerge, presenting new potential treatment options for clinicians.” LENS OPTIONS AVAILABLE LOCALLYWith these continuing advances in mind, let’s consider some of the numerous lens options currently available in Australia and New Zealand. Spectacle LensesHoya’s MiyoSmart is an innovative, specialised, myopia controlling spectacle lens featuring award-winning D.I.M.S. (Defocus Incorporated Multiple Segments) technology developed by Hoya, together with its research collaborator, the Hong Kong Polytechnic University. Professor Carly Lam and fellow researchers recently provided promising data for up to six years, published in Investigative Ophthalmology & Visual Science.3There are a variety of other myopia control specific spectacle options, some already well established. These include Zeiss’ MyoKids and MyoVision Pro, while Essilor has Myopilux and Eyezen. Essilor’s latest offering, its long awaited Stellest lens, incorporates HALT technology (Highly Aspherical Lenslet Target) and was recently launched in our region. New designs are in development. Some are already available. Some have been released in other regions and may reach our shores in 2023 and beyond. Watch this space. Contact Lenses In addition to the well-established MiSight contact lens mentioned earlier, consider the SEED, 1day Pure EDOF (extended depth of focus) lens. This lens is based on technology developed at Brien Holden Vision Institute in Sydney and optimises vision while discouraging axial elongation. It does this by delivering good global retinal image quality (RIQ) for points on, and anterior to, the retina, while degrading RIQ posterior to the retina. SEED is now available through Capricornia. Other centre distance multifocal soft lenses used by practitioners include the monthly Biofinity multifocal ‘D’ lenses, with variable add power options. Visioneering Technologies Inc. (VTI), NaturalVue Multifocal 1 Day Contact Lens is also showing promising results. It features Neurofocus Optics Technology with an EDOF, centre distance design. These lenses are available through Corneal Lens Corporation New Zealand and Contact Lens Centre Australia.Johnson & Johnson Vision is rolling out its Abiliti myopia program internationally, but details and availability are yet to be announced in our region. Orthokeratology remains a proven and popular myopia management choice among contact lens experts. Innovative Contacts provides its software/ topography-based, custom designed Forge Ortho-K , while Gelflex offers Gelflex Ortho-K , the Euclid Emerald Lens, and distributes CooperVision’s Paragon CRT. Menicon has its Bloom Ortho K, while Capricornia continues to offer the proven, long-established Mountford-Noack BE system OK lenses and CLC/CLCA offers Brighten Optix.Check out the following product section for more details on some of the many available myopia management options and stay up-to-date with this important and rapidly evolving field. References 1. 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:E-abstract 210049. 2. Hammond D, Arumugam B, et al. Myopia Control Treatment Gains are Retained after Termination of Dualfocus Contact Lens Wear with No Evidence of a Rebound Effect. Optom Vis Sci 2021;98:E-abstract 215130 3. Investigative Ophthalmology & Visual Science June 2022, Vol.63, 4247 * Preliminary international study data shows that, on average, for children that discontinued treatment at age 14–19 following three or six years of MiSight 1 day wear, the eye growth reverted to age-expected average myopic progression rates.

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