Important Insights on Myopia Management

As optometrists, our prescribing choices are influenced by numerous factors, including our experience, our patient’s profile, and, of course, sound science. For ODs such as myself, who’ve adopted an evidence-based practice approach, the latter generally holds sway, especially when prescribing a medical device, such as a contact lens, for a child.

Most (77%) parents prefer FDA-approved prescription medications for their child.¹ When it comes to myopia management, FDA approval is a paramount decision-making factor for both parents and optometrists alike.² The International Myopia Institute recommends ODs prescribe an on-label, or FDA-approved, product first if the child has progressive myopia and fits the criteria.³

Although FDA approval may be the gold standard, it’s important to note that not all FDA approvals and clearances are the same, nor are myopia control and myopia management indications for use interchangeable. In this article, I explain why, from a day-to-day practice perspective, all of this is important. I also outline other key lessons I’ve learned since I started prescribing myopia treatments.

TREATMENT DISTINCTIONS AND INDICATIONS

Myopia management is a catchall term that includes scientific treatments and patient lifestyle modifications, such as increased outdoor time and reduced near work.

MiSight 1 day contact lenses (CooperVision) are the first FDA-approved medical option for myopia control, indicated to slow disease progression in children 8 to 12 years of age.^4,5

Orthokeratology (ortho-K) has been a mainstay in myopia management in the United States for decades.⁶ Certain ortho-K treatments have gained approval for the temporary reduction of myopia, as indicated in their specific indications for use by the FDA.³ Paragon CRT lenses (CooperVision) were the first therapeutic overnight ortho-K lens design, approved by the FDA in
2002 for the temporary reduction
of myopia.⁷

Recently, the FDA approved Acuvue Abiliti Overnight Therapeutic Lenses (Johnson & Johnson Vision) for myopia management. The FDA product description indicates “temporary reduction of myopia or refractive error,” whereas MiSight 1 day is indicated for “slowing the progression of myopia” in children.

Diffusion Optics Technology-enabled spectacle lenses (SightGlass Vision) are working their way through the FDA clearance pipeline, and recent studies have reported favorable results, with data from the CYPRESS clinical trial showing the lenses were effective in controlling myopia in children 6 to 10 years of age at the initiation of treatment.⁸

Stellest spectacle lenses (Essilor) were recently granted a breakthrough device designation by the FDA. Evaluation of myopia progression with highly aspheric lenslets versus conventional single-vision spectacles found that the former option was effective in slowing progression, with no rebound effect reported upon discontinuation.⁹

PARENT EDUCATION

Parents have much to think about after their child’s myopia diagnosis, and they will have questions about the best path forward. We are the trusted stewards of their child’s eye care; therefore, arming them with knowledge and dispelling any confusion will help them select the appropriate myopia treatment for their child.¹ The FDA’s sign of approval may be all that a parent needs to help make their decision, but as clinicians, it’s important we are well-versed in the intricacies of what each treatment’s approval or clearance entails to help better
guide them.

EDUCATION AND PERSISTENCE PAY OFF

One of the biggest lessons I’ve learned is how to effectively talk to families about myopia, and in doing so, I’ve come a long way. Three years ago, I never would have imagined that I’d have eight renewals and four new myopia treatments in just 1 month. The rewards of successful treatment make this specialty one worth pursuing.

If you’re just starting out in myopia management, I promise, it does get easier. Just remember: Our job is to educate every patient with myopia and those at risk of developing the condition. Parents and patients deserve to know the importance of myopia management and the risks of letting myopia go unchecked. High myopia increases the risk of vision-threatening eye conditions. Those with high myopia are 17% more likely to need cataract surgery, six times more likely to develop a retina detachment, and at a 50% greater risk of developing glaucoma.¹⁰