Myopia’s prevalence has spawned all-new innovation and unexpected collaborations. One of those is a three-way company alliance promising Australian optometrists a new one-two approach to myopia management.
With myopia set to reach epidemic proportions, there’s arguably never been a stronger incentive for industry and the eyecare profession to unite against one of the largest looming modern-day public health problems.
It’s remarkable to consider that by 2050, every second person is projected to have myopia. While this is a daunting proposition, it’s spurring the rapid innovation of purpose-built diagnostics and treatments to slow progression rates in children.
At present, few manufacturers, if any, are offering an end-to-end diagnostic and treatment solution for myopia. Often eyecare professionals are required to either offer interventions without key diagnostic and monitoring tools like an optical biometer, or need to find room in their budgets to invest in such equipment with little assistance or incentive.
The manufacturers behind two of the latest myopia innovations in Australia want to address this issue through a new alliance offering optometrists “a one-two approach” to myopia management.
In October, Haag-Streit – producer of the Lenstar Myopia optical biometer with myopia-specific software – and Hoya Vision Care – manufacturer of the MiYOSMART defocus spectacle lens – signed a global preferred partnership agreement.
At the local level, Haag-Streit’s Australasian distributor Device Technologies and Hoya Vision Care Australia & New Zealand are managing the program to pave a smoother path for optometrists towards optical biometer ownership.
Mr Ulli Hentschel, national training and development manager for Hoya Australia, says through a dedicated partnership program, Hoya and Haag-Streit are supporting eyecare professionals in acquiring the device – now called Lenstar Myopia by Hoya – to strengthen their myopia management capabilities and expand this part of their clinical practice. The collaboration will also see the companies work together on practice business building and education initiatives.
Since the local introduction of MiYOSMART in October 2020 – described as one of the most effective spectacle lens interventions – more optometrists have been motivated to offer myopia management, Hentschel says.
Optometrists are reportedly seeing the value in prescribing the lens for young children that have either not had any myopia treatment yet or less effective spectacle lenses. Others have found the lens a good option for kids not ready for contact lenses, or those that don’t want to continue with a contact lens approach.
“We’ve seen many practices that might have been reluctant to set themselves up for contact lens interventions like orthokeratology (orthoK) start to offer myopia management for the first time through MiYOSMART,” Hentschel explains.
“While still offering similar efficacy as the other best available interventions like orthoK, soft contact lenses and specific concentrations of atropine, MiYOSMART comes into its own through being safe, and easy-to-prescribe; it’s a pair of glasses a child needs to wear, and something parents are more familiar with.”
Trials have concluded children wearing Hoya’s MiYOSMART lens had 60% less myopia progression compared with single-vision wearers as measured by the axial elongation, and a 59% reduction in spherical equivalent refraction.¹
Newer data shows the lens continued to slow myopia progression after three years, while patients who switched from single-vision had a significant slowdown in their condition. The optimal age for commencing treatment and whether rebounding occurs with discontinued wear is yet to be determined.
With Australian optometrists prescribing MiYOSMART for a little over a year now, Hentschel says they have been inquiring about how to expand their myopia offering. This unmet need has formed the basis of Hoya’s new Haag-Streit/Device Technologies partnership.
“The aim both at a global and local level is to get more optometrists involved in myopia management in a way that would be considered gold standard,” he says.
“Having an optical biometer like the Lenstar Myopia and its accompanying software not only helps to educate a parent on myopia management, but allows the optometrist to track it far more consistently than they might have otherwise. For Hoya globally, we recognised we had this amazing product that can help many children, but there remained the need for a platform to educate parents about the importance of taking action, while also monitoring the child’s myopia over time.”
Biometry – the new reference
To develop the Lenstar Myopia, Haag-Streit has taken its well established Lenstar 900 optical biometer – popular among cataract surgeons – and optimised it for myopia management by incorporating specialised software, EyeSuite Myopia.
Device Technologies introduced the instrument in the first half 2021, with optometrists trialling the system across the country.
“At its core from a hardware perspective, the Lenstar Myopia accurately and quickly measures axial length and keratometry, as well as additional metrics useful in myopia management,” Device Technologies ophthalmic diagnostics product manager Mr Angus Hatfield-Smith says.
“Biometry is a key tool in myopia management, being able to measure and track changes in eye length allows practitioners to fully understand the effectiveness of different treatment pathways in slowing the elongation of the eye.”
To underpin the hardware, Hatfield-Smith says the system uses the latest axial length growth curves from the myopia experts at the Erasmus University Medical Center in the Netherlands, developed with leading myopia authorities Dr Thomas Aller and Mr Pascal Blaser.
“So far the device has been very well received by Australian optometrists, especially the software because, uniquely, the Lenstar Myopia has the ability to show you the potential outcome across multiple different treatment options, as well as treated vs untreated over time,” Hatfield-Smith says.
“These graphs make it very effective for the optometrist to visualise treatment plans using graphical overlays of biometric and refractive data, while clearly communicating to parents about the different interventions potentially suitable for their child.”
In addition, the EyeSuite Myopia software enables clinicians to define environmental factors and their impact based on recent research findings and to visualise their changes over the period of myopia management. These may include myopic parents, the age of onset, reading time or using electronic devices and time spent outdoors.
Hatfield-Smith says many optometrists subscribing to the Hoya/Haag-Streit program will be adding an entirely new instrument to their practice, or upgrading a conventional optical biometer.
“Investing in new technology is a fantastic way to broaden the services available in any practice, enabling growth, but recovering the investment cost is also important. Treatment conversion is key to this, so by combining diagnosis and treatment, this program has made access to each more affordable than ever.”
Setting your practice apart
Optometrist Jenkin Yau, of Sanctuary Lakes Eyecare in Melbourne, has offered myopia control options for the past seven years. He initially started with orthoK, atropine and distance centre multifocal contact lenses, but expanded into other specially designed contact lens options as they came to market.
“But MiYOSMART had been on our wish list for as long as I had heard about the initial lens trials in Hong Kong and China,” he says.
“The apprehension about contact lenses for young children meant a lot of parents were opting for no myopia control, atropine or less effective spectacle lens options. MiYOSMART removes a lot of those barriers and has been a wonderful addition.”
As part of his myopia offering, Yau also has an optical biometer, which he says has enabled a better understanding of periodic axial length growth and how effective the treatments are working to control this.
“On occasions it can be surprising. The refractive error may tell a different story to the axial length. Some demonstrate an extremely flat cornea and very long axial length for moderate myopia, whereas for others a steeper cornea, modest axial length and high myopia may be the result,” he says.
“Clinically, [the optical biometer] has allowed us to more closely ascertain how well the treatments have worked and often guides clinical decision making to be more aggressive in treatment such as adding a secondary treatment. It has also guided discussions with parents about environmental considerations, sleep patterns and sunlight exposure and importance in compliance with treatments.”
Optometrist Dr Trusit Dave, director of EYETECH Optometrists in the UK, has offered myopia management for years, but last year made dedicated investments in marketing and technology.
This included the Lenstar Myopia, which he believes sets his practice apart by giving confidence to diagnose myopia more accurately, while providing an objective basis to assess the probability of myopia over time in children who are not yet myopic. He can also offer a more individualised assessment, rather than a loose assessment based on refraction, family history and lifestyle.
“We know that refraction, particularly in children, is variable. When a child presents with 6/6 vision and is -0.25 or -0.50, are they really myopic? We can improve our accuracy by putting the child through a cycloplegic refraction or we could perform biometry – or both. Biometry and other metrics such as the AL/CR ratio have been shown to have good sensitivity and specificity in detecting myopia.”
Trusit chose the Lenstar because it was globally accepted as a leading device for axial length for cataract surgery. It also has the Tideman axial length growth charts (over 12,000 eyes from Netherlands and England) and the ability to import latest growth curves for specific populations.
“What sets this device apart is the automatic positioning system, it improves repeatability and also speeds up the capture process,” he says.
“Finally, the Lenstar offers excellent reports and a logical way to communicate findings with children and their parents. Anyone who is involved in myopia management will confirm this aspect is probably the most time-consuming part of any consultation.”
More reading
Hoya Vision Care and International Myopia Institute announce partnership
Hoya and Haag-Streit’s new alliance brings one-two approach to myopia
Myopia management for dispensers by Grant Hannaford – Part 1
References
- Lam CSY, Tang WC, Tse DY, Lee RPK, Chun RKM, Hasegawa K, Qi H, Hatanaka T, To Ch. Defocus Incorporated Multiple Segments (DIMS) spectacle lenses slow myopia progression: a 2-year randomised clinical trial. British Journal of Opthalmology. Published Online First: 29 May 2019. doi: 10.1136/bjophthalmol-2018-313739
