How your practice can address this condition now and in the future
COVID-19 has forced the world to adapt and change like never before. In a matter of weeks, we’ve seen doctors who have never before offered telemedicine figuring out how to continue caring for their patients. And patients—even elderly, technology-averse ones—are adapting to new ways of connecting with their healthcare providers and educating themselves about their health.
Even as elective care continues to be on hold, doctors need to be looking forward to consider how they will run their practices and meet patients’ needs in our “new normal.” This includes staying informed about growing health concerns and new treatments and technologies being developed to address them.
One of the increasingly prevalent issues impacting vision is myopia, or nearsightedness. Published evidence has shown that more time spent indoors and excessive “near work” activities, such as working on computers and reading, increase the risk of myopia. As you can imagine, the risk will only increase as entire countries are quarantined indoors and forced to conduct business and learning online to control the spread of COVID-19.
Globally, at least 2.2 billion people have a vision impairment or blindness, according to the first World Report On Vision, released by the World Health Organization (WHO) last year. At least 1 billion of those people have a vision impairment that could have been prevented or has yet to be addressed. As an eye care provider, identifying and treating vision-threatening conditions in your patients is your top priority.
Myopia by the numbers
Generally, myopia first occurs in school-age children. According to the American Optometric Association (AOA), the number of children affected is growing at an alarming rate in this age group. The AOA’s 2018 American Eye-Q survey found that one in four parents have a child with myopia. Because the eye continues to grow during childhood, myopia typically progresses until about age 20. Myopia currently affects nearly half of all young adults in the U.S. and Europe.
Often caused by increased time indoors and on screens, myopia affects nearly half of all young adults in the U.S. and Europe, and is projected to affect over 50 percent of the world’s population by 2050.
Spending a significant amount of time indoors at a young age can impact the eye’s development. As this patient education video explains, this can cause the eye to grow too long, which changes the focus of light entering the eye and causes far-away objects to appear blurry:
High myopia is defined as a spherical equivalent of > 5.00D. (The World Health Organization-Brien Holden Vision Joint meeting defined it as 5.00 D or more). Estimates for high myopia are about 2.8 percent of the world’s population, or 170 million people. According to published studies, the prevalence of myopia is highest in China, Japan, the Republic of Korea, and Singapore, approaching 50 percent of the population in these countries.
Preliminary projections based on these prevalence data and the corresponding United Nations’ population figures, and accounting for the effects of age and time, indicate that myopia and high myopia will affect over 50 percent of the world’s population by 2050.
Risks to vision if untreated
While mild myopia can generally be treated with glasses or contact lenses, in extreme cases if the condition is not managed properly over time, it can put patients at risk for a number of vision-threatening conditions. Concerns of high myopia include myopic macular degeneration (MMD), choroidal neovascularization, retinoschisis, paravascular inner retinal cleavage, lamellar holes, tractional detachment, macular holes and retinal detachments as well as glaucoma and cataracts.
A new contact lens shows promise
In November, the U.S. Food and Drug Administration (FDA) approved the first contact lens indicated to slow the progression of myopia. It’s indicated for children between the ages of 8 and 12 years old at the time of treatment initiation. The MiSight contact lens is a daily disposable, soft contact lens designed with center correction but also concentric peripheral rings to focus light in front of the retina.
The safety and efficacy of the MiSight contact lens was studied in a three-year randomized, controlled clinical trial of 135 children. In this study, children were randomized between the MiSight contact lens versus a conventional soft contact lens. The results showed that for the full three-year period, the progression of myopia in those wearing MiSight lenses was less than those wearing conventional soft contact lenses. More importantly, subjects who used the MiSight CL had lesser increases in axial length. Over the course of the trial, there were no serious ocular adverse events reported.
The FDA has approved the first contact lens indicated to slow the progression of myopia in children. In addition, a new, lower cost A-scan is now available.
What else do eye doctors need to control myopia?
The MiSight lens is a good starting point, but you’ll need a few more technologies to effectively identify and control myopia in your patients. These include an ultrasound device to measure axial length. Remember, it’s not specifically refractive error we’re treating but rather prevention of the elongation of the eye.
While the cost of an A-scan, which traditionally ranged from $40,000 to $80,000, was once cause for concern, a new A-scan was introduced recently by DGH Technology, which shows high resolution, is easy to use, and retails for about $2,990. This technology provides A-scan tracking and myopia control reports, which are impressive.
Besides myopia control contact lenses, you’ll need a spectacle option for some children, and you will need access to low dose atropine, which works by creating peripheral retinal defocus. This drop once a day has been shown to significantly decrease myopia progression in children within a year. According to the same study, the various concentrations tested reduced myopia progression in a dose-dependent manner.
All three concentrations were well tolerated and showed no adverse events, but results confirmed that the 0.05% concentration was the most effective in controlling progression of axial length. This is another effective treatment, but requires compounding pharmacies such as Ocular Sciences or Imprimis to provide the 0.05% atropine drops.
Myopia is increasing at an alarming rate. The new MiSight lens is an exciting advancement in controlling myopia, but the first step is educating patients about the condition and its risks. As eye care professionals, we have a great opportunity to make a difference in these patient’s lives while also preventing blindness. Patient education is a critical component of your strategy. Stay tuned for part two of this post next week, where we will discuss how practices can raise awareness among their patients about the childhood threat of myopia now, and set themselves up for future success when post-COVID-19 business resumes.
The views expressed above are of Dr. Karpecki and do not necessarily reflect those of Rendia.