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Clinical

Myopia- Management

1rem

Authors

is assistant professor and chief of cornea and contact lens services at Southern California College of Optometry

The quality of options for patients has improved in recent years.

Stability is an important quality in toric lenses

Erin Rueff, OD, PhD, FAAO, shares highlights from her 2022 American Academy of Optometry presentations in the contact lens space.

AAOpt 2022: Helping astigmatic and presbyopic patients find comfort in their contact lenses

Dry eye or ocular surface disease is not the only reason patients drop out of contact lens wear

4 vision-related causes of contact lens discomfort

A new clinical study evaluating long-term myopia control effect and user experience in patients wearing Defocus Incorporated Multiple Segments (DIMS)-outfitted MiYOSMART spectacle lenses found that a significant amount of said patients continued to wear the lenses for as long as 8 years. Findings from the 8-year follow-up clinical study were presented by HOYA Vision Care at the 60th International Myopia Conference 2024 in Sanya, China, according to a news release.

“With myopia on the rise, it is important for eye care professionals to choose treatments to slow the progression in children based on best evidence available,” said Carly Lam, PhD, principal investigator of the study, in the release. “Previous research has shown that the DIMS spectacle lenses appear to be a safe and effective method for managing myopia among the study population. We’re looking forward to seeing the impact of longer-term use on myopia management in this pediatric population.”

According to HOYA, the randomized, controlled trial is the longest of its kind conducted and presented on the MiYOSMART lenses. Of study participants, 60% who wore the DIMS spectacles for 6 years continued to wear the lenses for as long as 8 years.

 All participants were satisfied with the benefits from the DIMS lenses, according to the release.

DIMS technology has a ring-shaped treatment area to slow myopia progression. By alternating the focus area—or the clear zone of the lens—and defocus area—the honeycomb-shaped segment of the lens—clear vision and management of myopia is obtained.

The lens has also been found to remain consistent on the myopia management front in a different study over 6 years.

“Childhood myopia is a widespread concern, and we are committed to continue fighting this problem, by using innovative solutions like MiYOSMART spectacle lenses. We look forward to the data from this important study as we continue to work to slow the progression of myopia in children and preserve their vision and eye health for the future,” said Natalia Vlasak, MD, MBA, global head of Medical and Scientific Affairs at HOYA Vision Care, in the release.

The MiYOSMART spectacle lenses have not been approved for use in the management of myopia and is currently not on the market in the US. However, HOYA has sold more than 8 million MiYOSMART spectacle lenses in more than 35 countries and regions.

HOYA Vision Care announces the results of the longest follow-up study conducted and presented on myopia management spectacle lenses worldwide. News release. HOYA Vision Care. September 27, 2024. Accessed September 30, 2024.

MiYOSMART. HOYA Vision Care. Accessed September 30, 2024. https://www.hoyavision.com/for-spectacle-wearers/miyosmart/ 

By alternating the focus area—or the clear zone of the lens—and defocus area—the honeycomb-shaped segment of the lens—the spectacle lenses achieve clear vision and manage myopia progression.

Study reports the majority of MiYOSMART spectacle lens users continue use for as long as 8 years

EyeCon 2024: Kelly Nichols, OD, and A. Paul Chous, OD, discuss multidisciplinary care and AI in diabetes management

Co-chairs Kelly K. Nichols, OD, MPH, PhD, FAAO, and A. Paul Chous, OD, MA, FAAO, highlighted Day 1 of EyeCon 2024, which emphasized collaboration between optometry and ophthalmology. The day's discussions included topics such as identifying red flags in patient care, thyroid eye disease, and advancements in refractive technologies. They noted the importance of integrating insights from both fields to enhance overall patient management, emphasizing that the shared knowledge benefits all practitioners involved in patient care.

A key takeaway from the sessions was the emphasis on recognizing herpes simplex as a potential cause of unilateral red eye in hospitalized patients, a point raised by ophthalmology cochair Peter J. McDonnell, MD. This advice is particularly valuable for optometrists, reinforcing the need for vigilance in diagnosing ocular conditions.

Looking ahead to the following day, they expressed excitement about sessions on dry eye as well as multidisciplinary approaches to managing diabetes. 

Kelly K. Nichols, OD, MPH, PhD, FAAO, and A. Paul Chous, OD, MA, FAAO, co-chairs of EyeCon 2024, discussed the first day of the conference, which featured talks on thyroid eye disease, refractive technologies, and red flags in patient care. 

Mark Dunbar, OD, FAAO, emphasizes the critical role optometrists play in the collaborative care of diabetic eye disease.

EyeCon 2024: Taking a multidisciplinary approach to diabetic eye care

At the EyeCon meeting in Fort Lauderdale, Mark Dunbar, OD, FAAO, of the Bascom Palmer Eye Institute will be presenting on the importance of a multidisciplinary approach to managing diabetes. Joined by diabetes care expert and EyeCon co-chair A. Paul Chous, OD, MA, FAAO, Dunbar will emphasize the critical role optometrists play in this collaborative effort. 

As frontline providers, optometrists are often the first to recognize signs of diabetic retinopathy in their patients. But Dunbar stresses that their responsibilities extend far beyond just identifying eye health issues. "As optometrists, we do a great job of educating our patients on blood sugar levels, diet, and exercise—things that are typically part of primary care," he explains. 

The key, according to Dunbar, is maintaining open lines of communication with the other healthcare providers involved in a patient's diabetes management, including endocrinologists, primary care physicians, nurse practitioners, and physician assistants. "We're in the middle, and our job is to relay information back and forth—what we're seeing in the eyes, and what the primary care team is telling the patient about controlling their diabetes," said Dunbar. 

Dunbar notes that building these collaborative relationships, especially for young optometrists starting their practices, can be challenging. Patients may have difficulty accessing specialists or be limited by their insurance coverage. But he believes it's a critical step, as primary care providers are actively seeking optometrists they can trust as resources for their diabetic patients. In his EyeCon presentation, Dunbar plans to share practical tips for optometrists, such as the key questions to ask new diabetic patients to assess their level of disease management and engagement. He'll also discuss strategies for helping patients navigate the complexities of the healthcare system, drawing on the expertise of his co-presenter Chous. By fostering a true multidisciplinary approach, Dunbar is confident optometrists can play an invaluable role in improving outcomes for the millions of Americans living with diabetes. Attendees of the EyeCon meeting will come away with a roadmap for strengthening these vital partnerships.

Conference

Ultimately, the goal is to help optometrists better understand which cases require urgent or emergent attention versus those that are more benign and can be managed over time.

EyeCon 2024: Inside neuro-ophthalmic dilemmas

Leonard Messner, OD, professor of optometry at the Illinois College of Optometry, presented at EyeCon 2024. The presentation, titled "Neuro-ophthalmic dilemmas: To refer or not to refer," was co-presented with Kelly Malloy, OD, and aimed to provide an overview of the types of neuro-ophthalmic cases optometrists may encounter in their practices. 

Messner explains that the goal was to help optometrists better understand which cases require urgent or emergent attention versus those that are more benign and can be managed over time. On the benign side, he discusses cases of "pseudo-papilledema," where the optic nerve appears elevated but is simply an anatomical variation that requires no further investigation. In contrast, true cases of papilledema, indicative of elevated intracranial pressure, necessitate neuroimaging, lumbar puncture, and appropriate management. 

A key strategy Messner emphasizes for seamless co-management of these patients is establishing strong working relationships with providers in the area, such as neurologists and neuro-ophthalmologists. Effective communication is crucial to ensure all members of the care team are on the same page, avoiding redundancy and breakdowns in care. He suggests optometrists take the time to delineate responsibilities with these specialists, perhaps over a meal, to build comfort and trust. 

When it comes to strengthening relationships with ophthalmologists, Messner reiterates the importance of clear communication to determine each provider's role. He advises optometrists to respect patients' time by avoiding unnecessary referrals and ensuring efficient, coordinated care that prioritizes good outcomes. By fostering these collaborative relationships, optometrists can better navigate the complex landscape of neuro-ophthalmic conditions and provide the best possible care for their patients.

EyeCon 2024: To refer or not to refer? Inside neuro-ophthalmic dilemmas

Nicotine, when administered either as an intravitreal injection or a topical eye drop, significantly inhibited the development of experimental myopia,

 according to a team of Australian investigators led by Kate Thomson from the Centre for Research in Therapeutic Solutions, Faculty of Science and Technology, University of Canberra, Canberra, Australia.

This research builds on their previous experience in which they found that stimulating nicotinic receptors can inhibit experimental myopia. They made this observation during an investigation of the mechanism by which atropine inhibits ocular growth. Their study currently under discussion expands on that preliminary finding and investigates the safety and efficacy of nicotinic stimulation in the inhibition of ocular growth.

The researchers investigated the ability of nicotine to prevent form-deprivation myopia (FDM) both when chicks were either injected intravitreally once with nicotine (9 chicks per group) or nicotine was applied topically (6 chicks per group) in 3 doses. The researchers also investigated the ability of nicotine to inhibit lens-induced myopia (LIM) in 12 chicks.

The ocular safety of the treatments was evaluated after 4 weeks of topical nicotine treatment with nicotine (n = 10), by evaluating the pupillary reflex, intraocular pressure, corneal curvature/thickness, lens thickness, retinal health (retinal thickness/cell apoptosis), and retinal function (electroretinogram recordings). In addition, they examined the effects of nicotine on non-ocular autonomic functions in both chicks (n = 5) and mice (n= 5).

 < 0.05) to a similar degree to that seen for FDM. Although ocular health was mostly unaffected by nicotine, it significantly inhibited the development of FDM in chicks both when administered as an intravitreal injection or in topical eye drops (

< 0.05 for both comparisons), albeit not in a dose-dependent manner; the highest topical dose induced an unexpected temporary reduction in cardiorespiratory output (

The investigators concluded, “Nicotine, administered as an intravitreal injection or topical eye drop, significantly inhibited the development of experimental myopia. Although the anti-myopic effects observed presently are interesting, the well-reported side effects and addictive properties of nicotine would preclude its clinical use.”

Thomson K, Karouta C, Ashby R. Administration of nicotine can inhibit myopic growth in animal models. 

Nicotine inhibits myopic growth in animal models

The Vision Council frequently releases research surrounding trends in various facets of the eye care industry, and Vice President of Research and Insights Alysse Henkel shares some highlights of recent reports.

VEW 2024: Insights from The Vision Council

At Vision Expo West 2024 in Las Vegas, Nevada, Alysse Henkel of The Vision Council shared some key takeaways from recent research published by the association. Topics included consumer behavior around eyewear labeled 

, low vision referrals and caregiver research, and practice growth trends for 2024 compared to 2023. Henkel also previewed studies regarding online behavior: Their surveys concluded that patients are more reliant on online reviews to select their eye care provider than they were 2 years ago, that they are more open to receiving an eye exam from a remote provider, and that online eyewear sales have remained steady.

I'm Alysse Henkel. I'm the Vice President of Research and Insights at The Vision Council, which is a trade or association for the optical industry. So on the market research team at The Vision Council, we develop reports and insights that are of use to our members. And our members come from sort of all over the industry. So we have everything across the supply chain, from folks who manufacture lenses and frames all the way to the eye care practitioners who, you know, do exams or sell eyewear in their offices, and sort of all of the other related eyewear accessories, or over-the-counter products as well, too.

So those are all members of The Vision Council, and the way that we develop our research is that we annually survey our members to find out what topics are sort of bubbling to the top for them and what's of interest for us to research the next year. So we always set our research agenda sort of in the fall, planning for the next year based on what we hear from our members. So sometimes they want us to sort of update research we've done in the past so we can trend it over time, and sometimes we're researching new topics that come up each year. But we do have sort of regular reports, including we do annual market estimates, like how big the industry is, how much are people spending? And then we also do a quarterly Consumer Insights study, because we run a monthly survey, and we roll those numbers up quarterly to tell people, sort of how consumers are behaving related to eyewear and eye care. And then we also have a Provider Insights that we run twice a year where we ask eye care practitioners about what's going on in their practice.

So that we recently ran a survey of US adults this summer and asked them, sort of their feelings about eyewear and just generally, what 

-labeled products mean to them. So we found out that about half of US adults are saying that they're looking for made in the USA products when they go shopping, and overall, so this is not specific to eyewear, but overall, we saw about 47% of folks saying that they would pay a premium of 6% or more for a product labeled made in the USA.

And then when we get specific to eyewear, we're kind of testing whether or not the way that the definition is developed now by the Federal Trade Commission, which is a pretty strict definition for made in the USA products, it means that all, or virtually all, materials that go into the product have to be sourced in the US. So we did some testing about whether or not they felt like, for example, like a factory that designs, manufactures, sort of does all the craftsmanship of a frame in the US, but some of the materials are imported. We asked folks if they considered that product made in the US, and we had about three quarters of American adults say that they would consider that as a made in the USA product. And then overall, we saw, again, a little more than half of consumers saying that they would, for some products, some eyewear products, pay more for a 

 label. So in particular, prescription sunglasses and safety eyewear, I think sort of we're at the top of the list of people more likely to pay a little bit more for a label that says 

So for the low vision report that we did earlier this year, we had sort of two elements about how we asked people, low vision patients, about what's going on with their diagnosis and sort of their experience as a patient with low vision. We did qualitative focus groups with two groups of low vision patients. So one with people who were low vision patients themselves, and then the other group was with caregivers of people, mostly children, with low vision. And then we also did a survey as follow up. So the focus groups were small, but the survey was large. We had a lot bigger audience for the survey, again, asking both caregivers and patients with low vision about their experience.

What we found was that about two thirds of people who had been diagnosed with a low vision condition said that they got a referral to a specialist. But we're seeing that those who had a more recent diagnosis so within the last 10 years, they're much more likely to have a referral to a specialist, at about 74% compared to people who were diagnosed over 10 years ago, they were less likely to get a referral to a specialist at about 44%. So we're seeing some progress in getting people the care that they need and sort of the specialist attention that a low vision patient warrants, but that's something that we're seeing. And overall, I think important to note for these patients is that they primarily rely on their eye care provider for information about their condition. So we have about 74% of folks saying that they rely primarily on their doctor for information. But the younger patients and like sort of younger caregivers, so patients with children who are sort of small, who have low vision issues, they're much more likely to go online to look for information about their condition.

In our Provider Insights study, which we release twice a year, we survey mostly independent practices to find out sort of what's going on in their practice with their performance. And what we found recently this year as compared to last year, that providers are telling us overall [that] they're having a little bit more of an average year. So last year, we saw, on average in 2023 about 50% of providers saying that their practice revenue was above average or excellent, and that this year, so far, we're only seeing about 30% of folks falling into that same category. So that's a 20 percentage point drop. But really the change we're seeing is that more people are saying that that, overall, the practice this year, the performance is about average. So we're not seeing declines in practices, but not seeing the same kind of growth that people were telling us they were seeing last year. So that's sort of one of the highlights as well is that inflation is still top of mind for a lot of providers, saying that it's affecting their wholesale prices, and they're having to pass that on to some of their consumers. So that's sort of another something that we're keeping our eye on, but fewer practices are saying they're having as many problems as they were last year or the year before, retaining or hiring staff.

So we have an upcoming report that we can give a little preview of. We'll probably publish that sometime early this fall. But what it is is it's a survey of US adults and finding out sort of how they behave or what kind of choices or priorities they make when they're choosing their eye care provider or when they're buying eyewear. And so what's nice about this report is that it's trended from a similar report we did 2 years ago. So we're able to sort of talk about how things have changed over the last 2 years.

And so one thing that we're really interested to see is that when folks are looking at choosing their eye care provider, that we're seeing about a 6%, so six percentage point increase, in people saying that online reviews, so like Zocdoc or Google reviews, are more important now than they were years ago. So we're seeing a little bit more of a reliance on online reviews in terms of choosing your provider.

One of the other kind of notable things that we saw in the survey is asking people about why they have an eye exam, and what we're hearing overall, this was the number one item, both 2 years ago and now, is that people say they want healthy vision, but we're seeing an increase in the number of people who are saying that. So we went from 34% in 2022, to 41% in 2024, so healthy vision is more top of mind for patients as they're coming in for an exam.

One thing we don't have trended, because we asked about this for the first time this year, was about whether or not patients had experienced a telehealth exam. So primarily, we asked if people had gone to an eye care practice and then had a provider join their exam remotely and sort of go through their exam remotely with an assistant in the room. And so we saw surprisingly, 11% of people said they had experienced an exam like that with their eye care provider. So that was a higher number than I would have expected, because primarily, we've been asking people, from the telehealth perspective, if they were at home and then video conferencing with their eye care provider, and we've seen that number be really low for a long time, ranging between 1% and 3%--it was 3% in this most recent survey. But that 11% sort of seeing that remote exam, was interesting to us, especially because we've also been hearing sort of anecdotally from some of our members about how difficult, in some cases, it is to hire optometrists for their practice, especially in more rural or remote areas, and this is one solution that they're looking to and so it looks like patients are experiencing that. We also asked people who haven't had that kind of exam if they would be willing to engage with a remote provider, and about half of participants said they would be willing to have an exam like that.

So one of the things that I think has been surprising of late in our data is that we have run a consumer survey very consistently back to 2022 to sort of track changes over time. And one of the things that we've seen over the last couple of years is that the online purchase rate for eyewear has been really steady. So it's been almost exactly 16% each month, with the exception--because we saw sort of an increase during Covid[-19 pandemic], and then it's ramped down a little bit since 2022. But what we've seen this year is like a 2 or 3 percentage point decrease, so almost like 1 percentage point per quarter so far this year, where fewer people are buying their eyewear online. So I think that's sort of an interesting trend. I think that people often assume the trend is going in the other direction. So, you know, overall, it's still about 1 in 6 eyewear purchases for prescription eyewear are happening online, but really the market is very much still in person. And actually the in-person market is growing a little bit.

Yeah, so I think overall, I just want people to sort of understand the wealth of information that we have at The Vision Council. So not only do we have sort of a research download center on our website, just packed full of reports that are free to our members, but we also have a Foundation website, so thevisioncouncilfoundation.org, where we also publish highlights from some of our research that's available to anyone. So I think that's those are, you know, some takeaways that people can sort of go in and see for themselves about the kind of data that's available. And we're also always looking for people to join our research panel and answer our survey questions at eye care practices about what's going on.

Erin Rueff, OD, PHD, FAAO

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