CooperVision’s MiSight 1 day changed the game when it became widely available to Australian practitioners in 2016 for myopia management. Since then, the contact lens has gained even greater acceptance thanks to robust clinical data, a daily disposable replacement schedule, adaptability and expanded power range.
There are two distinct moments in Ms Melody She’s life which led to her being an optometrist and proponent of soft contact lenses for myopia control.
Myopic in her childhood – progressing from -0.50D to -4.00D within three short years – she will never forget the personal transformation she experienced when fitted with contact lenses for the first time as a young teenager, overcoming confidence issues she had with spectacle wear.
While her contact lenses didn’t treat the root cause of her myopia at the time, it motivated her to pursue an optometry career where she experienced another life altering moment. That was in 2015 at the landmark BHVI-World Health Organization meeting in Sydney where agreement was reached on a series of statements, definitions and priorities for myopia. There, she also learned of CooperVision’s MiSight 1 day contact lens with a myopia control indication that would become widely available to Australian eyecare professionals a year later, in 2016.
For She – an optometrist at 1001 Optical Top Ryde, Sydney – it represented a full-circle moment. Not only was there a soft contact lens to correct the shortsighted vision and improve the confidence of myopes in her care, but now there was a clinically proven option that could slow progression.
“At the time, we were using multifocal and bifocal spectacles and some off-label multifocal distance centre contact lenses, but when I heard about this option, I couldn’t wait to get my hands on it, and today I continue to prescribe it regularly in my practice,” she says.
“We had all these methods to slow myopia, but we didn’t really know how to decide who would benefit from each treatment, and so I set about upskilling myself to learn about each modality. Today, when caring for patients, it’s all about them choosing an option that’s backed by clinical data, works best for them in terms of budget, and what the child will enjoy wearing to ensure consistent wear.”
MiSight 1 day firmly fits this brief for many of She’s patients. But one of the biggest factors for optometrists is the robust clinical data behind the contact lens. MiSight 1 day is at the centre of the world’s longest continuous running soft contact lens clinical trial for myopia control that is now out to seven years.
This was pivotal to CooperVision securing highly sought-after FDA approval in the US in 2019, with the lens gaining even greater acceptance among the eyecare community. This was bolstered again when CooperVision expanded the power range, making it available to patients with higher prescriptions.
Practitioners are confident in prescribing MiSight 1 day thanks to a key piece of three-year data showing the lens slowed myopia progression by 59% as measured by mean cycloplegic spherical equivalent and 52% with respect to mean axial elongation of the eye.
After six years, 23% of eyes prescribed MiSight 1 day at the study’s initiation displayed a total refractive change of less than -0.25D (spherical equivalent), which could be considered clinically stable. The same study also suggested that while intervention at an early age is optimal, commencing treatment at an older age could similarly slow the rate of myopia progression.
And the latest seven-year findings showed no evidence of myopia control rebound in children 12 months after treatment ended.
In She’s own practice, many of her patients have responded well to MiSight 1 day, something she has quantified through monitoring their refraction and axial elongation with an optical biometer.
“For some patients, their myopia has completely stopped progressing, or remained stable for a long time. Just recently, I saw a child who progressed significantly from -0.50D to -2.00D within a year. That was in 2021, and now in 2023 after being prescribed MiSight 1 day and 0.025% atropine, one eye has remained exactly the same and the other has increased by -0.25D – I thought that was a pretty amazing result.”
Ideal patient candidates
Melbourne optometrist Ms Jessica Chi offers nearly the full gamut of myopia control options and – as Victorian president of the Cornea & Contact Lens Society of Australia since 2014 and a former national president of the society – is well-versed in the nuances of each approach. In fact, the location she now owns, Eyetech Optometrists in Carlton, was the first in Victoria to offer orthokeratology (orthok) in 1991 (before her time).
Speaking from a purely myopia control point of view, she says contact lens options offer benefits over other modalities because they remain unaffected by gaze angles, meaning the lens treatment zone is correctly positioned throughout the entire wear period.
“In my experience, compliance, an important factor, tends to be better with soft lenses and orthok because it’s not as easy for children to take them in and out,” she adds.
Myopia control is also a personal topic for Chi who grew up as a young myope with limited, if any, treatment options. When discussing interventions with parents today, she considers the uniqueness of each case.
“Every patient is different. Firstly, it’s about understanding the patient and the parents and their motivations. I’m a big believer and advocate of contact lenses for kids, but only if they are ready for it. There have been many studies showing that contact lenses dramatically improve quality-of-life for kids, their confidence, their sporting ability, and also their academic ability and self-perception. I can vouch for this because I was shy and introverted as a child, but once I received contact lenses it gave me a lot more confidence.”
If contact lenses are preferred, Chi also considers the patient’s ocular surface, any corneal irregularities and checks for high astigmatism, which may limit their access to a soft contact lens option. If the patient is a low myope seeking contact lenses, then MiSight 1 day or other soft contact lenses might be suggested for optimal peripheral blur because in orthok the optometrist can only blur the periphery as much as they correct the centre.
“A benefit of MiSight is that it’s relatively easy-to-prescribe for the optometrist, and comfortable right away for the patient,” she says.
Studies have shown children are generally more compliant than anticipated, Chi says, because they are accustomed to following instructions, attending follow-up appointments and are supervised by their parents. Reinforcing this, Professor Mark Bullimore’s 2017 review on the safety of soft contact lenses in children found the incidence of corneal infiltrative events in children is no higher than in adults and, in eight- to 11-year olds, it may be markedly lower.
“We do find parents who are cautious of sending their kids to school with something in their eyes and would prefer the controlled home environment of orthok use, but the studies have shown the safest form of contact lens wear is daily disposable lenses,” Chi explains. “And although the risk of infection with orthok is very low, eye infections can still be devastating. I explain this to parents and we talk together with the child about the best option. There’s no right or wrong, but you’re never really prescribing just for the child, it’s the whole family.”
She, from 1001 Optical, agrees – adding that it’s important children are not only motivated to free themselves of spectacle wear, but are committed to learning how to handle contact lenses – and remaining compliant with this.
“When they start putting something on the eye, they need to maintain good habits. It also requires more follow up and education around eye health and outlining the importance of coming to see us immediately if there’s a potential issue. I always remind them there’s a level of responsibility, and most of the children understand that – they just want to get away from wearing glasses,” she says.
Back in Chi’s practice, MiSight 1 day patients are typically reviewed every six months, but more frequently if progressing more than expected. Contact lens interventions in the right patient have proven to be successful, with many showing no progression. In those who show fast progression, they tend to spend a lot of time indoors and read on devices in the dark. Some will wear their soft contact lenses throughout the day and take them out when reading at home after school. For maximal treatment effect, this is something she advises them against.
While the treatment effect of myopia interventions is arguably the biggest consideration, questions around cost are often a close second – especially in families with more than one myope. Chi says it varies across the board, but if a contact lens option is preferred, she discusses the initial upfront investment of orthok (with ongoing costs for lens solutions etc), alongside the continuous nature of a soft contact lens option.
Further, Chi and She are unanimous in their appreciation of CooperVision expanding the parameters of MiSight 1 Day, which was previously only available up to -6.00D, leaving them to rely on alternative soft contact lens designs above this prescription.
But the new expanded range covers -0.25D to -10.00D (0.50D steps after -6.00D) – which means that MiSight 1 day now covers 99.97% of prescriptions for Asian children, and 99.97% for Caucasian children – who have myopia and less than 1.00D of astigmatism.
A game-changer in the US
US optometrist Dr Ashley Tucker used to lose a lot of patients who required myopia management. Either they weren’t prepared for orthok, or it would be hard for parents to grasp the off-label use of a distance centre soft multifocal lens that was originally designed for presbyopia.
But since MiSight 1 day became available in the US Spring of 2020, it has helped fill a major gap in her practice, now becoming the primary mode of management at her practice, Bellaire Family Eye Care in Houston Texas.
“It changed everything here in the US, especially for my practice,” Tucker tells Insight. “It took off because it’s an FDA-approved option; parents love there is something that has research and plenty of science behind it. Orthok had that similar buzz because it was so different and unique, but a soft contact lens option opened the door for a lot of patients who were afraid to wear hard contact lenses, or whose parents were worried about that remodelling of their child’s cornea.
“MiSight 1 day has made contact lens wear and myopia management so much more accessible.”
There are many pieces of data that Tucker appreciates about MiSight 1 day: “But I love the stat that there’s no rebound effect,” she says.
“All the time, I talk about the six-year mark where about 25% of patients didn’t progress at all – that’s pretty remarkable. It may not seem like a lot but that is a huge amount of kids that didn’t progress at all in the lens and I love telling parents that stat. It’s been a game-changer for some parents, who need that information and don’t want to just take your word for it.”
Tucker has three-plus years of clinical information of how MiSight is performing in her own patients. The sample is growing, but out of the 15 or so children involved from the beginning, very few have progressed at all.
“The majority of my patients are in that 25% that didn’t progress. I tell parents often that most of my kids do better than what the studies are saying, but you don’t want to over promise and under deliver. I haven’t had any child that’s progressed more than -0.50D in a year,” she explains.
“The fact that most kids adapt to it well is also something that I talk about. Parents don’t think their kids can wear contact lenses and that it’s going to bother them, but the truth is, most kids adapt just fine. It’s really the parents holding them back – if only they allow the child to be released into my care to show them how to use and care for the lens.”
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