CooperVision’s MiSight 1 day is a key product helping slow the progression of myopia in children. As optometry increasingly embraces myopia management as the standard of care, the emphasis is shifting to ensuring the largest possible proportion undertake treatment with the most suitable product for the individual.
Optometrist and contact lens practitioner Ms Jessica Chi, the owner of Eyetech Optometrists in Melbourne, has been offering MiSight 1 day for a number of years. Within her myopia toolkit, she regards the soft contact lens as one of the small number of treatments with a strong, long-term evidence base.
The lens was subjected to a large, seven-year, multi-centre study involving a mix of ethnicities and looking not only at safety and efficacy, but also the reaction of children and parents to soft lens wear.
This is essential in a condition like myopia, given the importance of achieving the best possible result over a decade or more of treatment.
Few, if any, of the current crop of myopia control interventions are backed by a study of this length. As such, it’s the first and only FDA-approved product proven to slow myopia progression in children aged eight to 12 at the initiation of treatment. On average, age-appropriate children wearing MiSight 1 day progressed less than -1.00 D over six years.
As an optical treatment, Chi appreciates how MiSight 1 day provides the dual benefit of myopia control and vision correction. Being a soft contact lens it is also ideal for the active lives of kids.
And because soft lenses are unlikely to be removed or worn incorrectly during the day (like spectacles can be), the necessary full-time “dose” of myopic defocus is more certain of being delivered. In the case of MiSight 1 day, this is a minimum of 10 hours per day, six days per week, CooperVision reports.
For Chi, who’s also the Victorian president of the Cornea and Contact Lens Society of Australia (CCLSA), familiarity has built a fondness for the product.
“Knowing that it’s a proven, and importantly, safe treatment over a long period gives me the necessary confidence to recommend it to parents of children who would benefit,” she says.
With the expansion of the power range from to -10.00 D in 2022, one question is whether the special optical design still delivers sufficient myopic defocus to the unusually prolate retinas often seen in high myopia?
A recent study published in Ophthalmic and Physiological Optics, demonstrated the lens’ ability to deliver consistent retinal defocus in such eyes.
The work, led by associate scientist Dr Dawn Meyer of Indiana University School of Optometry, found the MiSight 1 day design demonstrated significant optical defocus across varying view distances and retinal regions.
That gives Chi even more confidence to use the lens in her practice and recommend it to parents and often very young patients.
“Many parents put all trust in the practitioner, and as the practitioner, it is our responsibility to be up to date with the latest clinical evidence,” she says. “However, some parents want a bit more, and feel more confident reading into the science.
“It’s up to us to instil that confidence in parents, and I wouldn’t say that I was confident in it if I didn’t have the evidence.”
That science is supported by Chi’s patients.
“Feedback is almost unanimously good,” she says. “It’s simple and easy to use, they can see well, and then there’s confidence that we can control their myopia.
“The only complaint is, in the beginning, it can be a little bit tricky to get on and off, but that’s no different to any other contact lens. Occasionally, some patients experience some dryness, however it’s that’s usually alleviated by lubricant eye drops.”
She says that, using the MiSight 1 day soft contact lens, there has been no progression in the “vast majority” of her patients, and “the ones who have had progression, they’ve progressed at a much slower rate”.
Often, for those who have shown progression, the right questions can reveal why.
“I’ve had one child who was well controlled, and then at one review demonstrated progression. I discovered that was because he was waking up early and reading before his parents put the contacts in for him. It is important with all myopia control techniques to continue to ask the right questions. It is easy to blame the product being ineffective, however, much of the time it can be due to non-compliance.”
Contact lenses may not be for everyone, she says.
CooperVision has come up with a product suitable for close to 100% of children, and patients as young as five have been shown to confidently apply and remove MiSight 1 day on their own.
“But there are some kids and families very resistant to contact lenses and no matter how hard you try, there’s some people that just have an extreme fear of anything near their eyes,” she adds.
“However, I never view this as a no, simply as a ‘not yet’.”
Chi believes optometrists can overcome this by portraying confidence in the product.
“If you demonstrate confidence in the treatment, then you won’t give the parents the confidence to want to use it. Parents are often very nervous about prescribing contacts for their children at a young age.
“But I find that the kids are actually the easiest and the most compliant, because they’re used to following instruction, and they usually have not yet developed a rebellious nature.”
Mr Joe Tanner, the head of professional affairs at CooperVision, acknowledges that conversations with parents about myopia, the potential impact on their child, and the recommendation for contact lenses for young children can sometimes be challenging.
“Explaining the need to slow myopia’s progression is not at first a good-news discussion,” he says. “But once the need to act is communicated, the discussion should become a positive one whereby the parent and child feel they are taking control of the condition with the expert support of their optometrist.
“One of the common questions that practitioners get from parents, and I certainly remember being asked this a lot when I was in practice, is, will it get worse?
“And of course, now our answer is, it probably will get worse. But there are things we can do about it, very effective things.”
In the case of MiSight 1 day the positive discussion is informed by many years of research. It’s also supported by plenty of feedback to CooperVision, from practitioners like Chi.
“You’ve got a thoroughly proven treatment with a lot of long-term evidence behind it,” says Tanner.
“Now it’s just about getting myopia management to as many children who need it, and there’s still a lot of children who would benefit from wearing soft lenses to achieve this.
He encourages eyecare professionals to take up that challenge.
“With MiSight 1 day, we are only asking that the child undertake a trial so they and their parent gain a proper understanding of the practical benefits of contact lens wear. That ‘try before you buy’ aspect is another real advantage of this form of treatment.”
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