Paediatric Myopia Control Gains New Contact

A potential practice opportunity opens as products gain regulatory approval. Cheryl Guttman Krader reports.

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A potential practice opportunity opens as products gain regulatory approval. Cheryl Guttman Krader reports. Controlling myopia progression in children has not yet become part and parcel of the care offered by most ophthalmologists, and those who have entered this space are most likely to prescribe compounded low-dose atropine. However, because paediatric myopia is a growing and important public health issue with new and emerging contact lens options available for its management, myopia control represents both a valuable service and a practice opportunity, said Michael X Repka MD, MBA. CONTACT LENS OPTIONS Contact lens-based strategies for myopia control aim to eliminate the peripheral hyperopic defocus believed to stimulate axial elongation. These strategies do so by either optical design or peripheral cornea remoulding, i.e., orthokeratology. Focusing on the United States market, Dr Repka said the FDA approved a single product within each of the two categories for myopia control. They include the dual-focus MiSight® 1 day (CooperVision®) single-use contact lens. Reflecting the characteristics of the patient population enrolled in the clinical trial supporting its regulatory approval, MiSight lenses are indicated for children 8 to 12 years of age with spherical equivalent myopia -0.75 to -4.00 D and <1.00 D astigmatism. It is recommended to be worn at least 10 hours per day, 6 days per week. The FDA-approved orthokeratology product—ACUVUE® Abiliti™ Overnight Therapeutic Lenses (Johnson & Johnson Vision)—is a gas permeable lens worn nightly for two weeks with the use of soft contact lenses during the day. The ACUVUE Abiliti 1-Day Soft Therapeutic Lens for Myopia Management (Johnson & Johnson Vision) is pending FDA approval. It is approved in Canada for slowing myopia progression in children ages 7 to 12 years with a spherical equivalent myopia -0.75 D to -4.50 D and ≤1.00 D astigmatism. The Biofinity® Contact Lens (CooperVision), which is approved only for vision correction, was studied for myopia control in a prospective trial that randomised children ages 7 to 11 years with -0.75 to -5.00 D sphere and <1.00 D astigmatism to a single-vision lens or a multifocal lens with a +1.50 or +2.50 D add power. The results showed the high add power lens significantly reduced the rate of myopia progression and axial eye growth compared to the single vision control. PRACTICAL ISSUES AND UNANSWERED QUESTIONS Clinicians should be aware there can be a mismatch between the relatively modest effect contact lens interventions have for controlling myopia progression and patients’ (and parents’) potentially high expectations for outcomes. In addition, although the rate of infectious disease complications with these modalities is unknown, Dr Repka suggested that because of the importance of proper lens care and hygiene, the contact lens intervention may be more appropriate for older versus younger children. At the same time, however, he added intervening even earlier than the currently approved minimum ages of 7 or 8 years may be desirable considering evidence that the younger the age of myopia onset, the greater its eventual severity. Dr Repka also suggested optimising outcomes may necessitate combination therapy but noted there are no data at this time to support its effectiveness. The study was presented at AAO 2021 in New Orleans, Louisiana, USA. Michael X Repka MD, MBA, is a Professor of Ophthalmology at Johns Hopkins University, Baltimore, Maryland, USA. mrepka@jhmi.edu