Brien Holden on contact lens myopia management

Liverpool, UK- The British Contact Lens Association (BCLA) opened the first day of its 2015 conference with a day-long focus on myopia management. Professor Brien Holden, BAppSc, PhD, DSc, chief executive officer of the Brien Holden Vision Institute, offers several points to remember when managing myopia with contact lenses.

There is a massive increase in the prevalence of myopia and high myopia, according to Dr. Holden. As the number of myopes increase, the number of people with uncorrected refractive error will increase.

Traditionally, myopia is measured as -0.75 D in one or both meridians. Today, myopia should be considered at –0.50 D, according to Dr. Holden.

“Everyone knows that if a child is -0.50 D, at the end of the year she won’t be -0.50 D,” he says.

Dr. Holden proposes to control myopia by not using standard spectacles and contact lenses which promote myopia, delaying the onset of myopia, and using interventions that will reduce the rate of myopia.

The eyecare community needs to identify and treat the young, faster growing, at-risk myopes. Two questions need to be answered:

• Can we control the progress of a child destined for high myopia?

• Does myopia control reduce pathological consequences?

The World Health Organization (WHO) and the Brien Holden Vision Institute (BHVI) recently held a global scientific meeting on myopia to review scientific evidence and create recommendations to prevent blindness from myopia.

In addition, BHVI is launching The Myopia Institute, which will provide evidence-based information about myopia, educate society about the adverse influence of myopia, and develop strategies for reducing vision impairment caused by myopia.

Related: Q&A: Brien Holden

Key myopia management points

1. We need to change our attitudes

Any myopia in a young child is a major risk factor.

Related: Reviwing pediatric primary care optometry

2. The only soft contact lens available today that does not have a myopia-provoking spherical aberration in the periphery of the optic is lotrafilcon A

Power profiles of contact lenses vary; some have a negative spherical aberration profile that exacerbates myopia.

3. Outdoors is good

Increasing the time outdoors delays the onset of myopia and reduces the rate of progression. Children today are spending more time indoors, especially with digital devices.

Related: Time outdodors and myopia: A case for vitamin D?

Taiwan recently proposed a new law which would ban children under the age of 2 from using electronic devices, levy a fine on parents who allow children to use iPads and/or smartphones, and allow digital device use for children under age 18 for a “reasonable” length of time.

Related: How digital devices are affecting vision

4. Ortho-k works

“Ortho-k lenses are the most successful myopia control treatment that we have,” says Dr. Holden.

Overall, ortho-k lenses provide a 30 percent reduction in axial length increase.

5. Peripheral plus lenses work

Peripheral plus contact lenses bring the peripheral image forward toward the retina; correcting peripheral hyperopia helps to control myopia.

“If you want to do something tomorrow,” Dr. Holden says, “fit every kid aged 7 to 27 with peripheral plus lenses.”

The lenses consistently reduce the rate of progress of myopia by 40 percent each year.

6. Stepped anti-myopia (SAM) and extended depth of focus (EDOF) contact lenses work

Higher-order aberrations are manipulated via mathematical algorithms to optimize retinal image quality across a wide range of distances.

These lenses show a 40-48 percent reduction in axial length.

Related: New technologies to improve global health

7. Dose matters

Wearing myopia control contact lenses on a consistent basis and remaining compliant increases success.

Lenses worn 10 hours a day showed a 47 percent reduction, lenses worn 12 hours a day showed a 58 percent reduction, and lenses worn 14 hours a day showed a 66 percent reduction.

8. Fear, handling, and discomfort are concerns

Confidence in these contact lenses from both public and eyecare professionals is needed.

9. Myopia is both a challenge and an opportunity

Myopia is a challenge to eye health.

Myopia is also an opportunity for:

• Contact lenses

• Eyecare practitioners to prevent high myopia

• Contact lens industry

• Health and welfare of children and adults

• Prevention of global blindness