We have some exciting new technology to add to our toolbox when it comes to myopia management! While these spectacle lens options have been used in other parts of the world for a while, the US is finally getting to add some glasses options to our myopia management portfolio (previously only consisting of orthokeratology, soft multifocal contact lenses, and low-dose atropine)!
The majority of these lens designs have the goal of reducing peripheral hyperopic defocus (I’ve broken down this concept in a previous post), which is a key factor in eye elongation and thus myopia progression in kids. Let’s look into some of the key players in this arena.
- Essilor® Stellest® lenses is now the first and only FDA market authorized spectacle lens in the United States to slow down myopia progression.
- Stellest® lenses have a clear center that is 9mm in diameter, surrounded by over 1,000 tiny “lenslets,” arranged in a series of 11 concentric rings, that induce peripheral myopic defocus. This peripheral myopic defocus is what is thought to interrupt the visual signaling that contributes to axial elongation in myopia progression.
- The FDA based their decision on a two-year randomized clinical trial comparing the Stellest® lens to single vision, conventional correction of myopia. The FDA says the study showed a 71% reduction in spherical equivalent progression and a 53% reduction in eye elongation (axial length) at 24 months. No serious adverse events were reported, though some subjects reported blur and halos. There are no labeled contraindications.
- MiYOSMART® lenses are based on revolutionary Defocus Incorporated Multiple Segments (D.I.M.S.) Technology.
- These lenses are comprised of a clear center that is 9.4mm in diameter, with 396 mid-peripheral lenslets with positive power (+3.50D) to create peripheral myopic defocus, which is thought to inhibit eye length growth for the purpose of myopia management.
- There are quite a bit of studies on these lenses. The DIMS lens was found to slow myopia (spherical equivalent) by 52% and eye elongation (axial length) by 62% compared to single vision (aka “regular”) lenses over a 2-year period (1). After six years, they found that the children who wore DIMS lenses during that time had − 0.92D of myopia progression (− 0.15D/year) and 0.60 mm of axial elongation (0.10 mm/year) (2).
- ZEISS MyoCare and MyoCare S lenses feature patented microstructures, called Cylindrical Annular Refractive Elements (C.A.R.E.)® to slow the elongation of the eyeball, thus providing myopia management.
- The MyoCare lens has a clear central zone that is 7mm in diameter and a mean additional surface power of +4.6D (ideal for younger children), compared to a 9mm clear central zone and a lower mean additional surface power of +3.8D of the MyoCare S lens (ideal for older children).
- Similar to a multifocal contact lens, the C.A.R.E.® technology alternates zones of defocus and correction in a ring-like pattern on the front surface of the lens, which creates the peripheral myopic defocus that acts as a “stop signal” to slow down the elongation of the eye in myopia.
- Over a one year study period, axial length growth with MyoCare and MyoCare S was found to be lower than in myopes and closer to emmetropes (kids with no nearsightedness) with an overall EPR (emmetropic progression ratio) of 70% for MyoCare and 68% for MyoCare S. Calculated using another method: 17% of eyes had axial length growth similar to emmetropic eyes, while 53% of eyes showed axial length growth equivalent to emmetropes with MyoCare, whereas 21% and 44% of eyes showed axial length growth similar to or equivalent to emmetropic eyes using MyoCare S, respectively. (3).
- Rodenstock MyCon™ and MyCon™ 2 lenses feature HAPD™ Technology, which refracts light so that it strikes the periphery in front of the retina rather than behind it (the peripheral myopic defocus we’ve been mentioning). Different than the previously discussed lens designs, the areas that control myopia progression here are arranged laterally. A focal area is used along with a gentle transition to asymmetrical progression control areas in the horizontal lens periphery.
- An independent clinical study examining myopia progression in Caucasian children aged 7 to 14 years over a period of five years has shown that myopia control lenses built on the principles of Rodenstock MyCon™ are effective in reducing the progression of myopia by up to 40%. Furthermore, axial elongation was reduced by up to 56% after two years and 35% after four to five years (4).
- Unlike the other lens designs discussed, Sightglass uses contrast theory to achieve its effect of slowing myopia progression. Low contrast settings, like the natural outdoor environment, weakly stimulate the visual system (specifically, the retinal bipolar cell response). Thus, Diffusion Optics Technology™ integrates thousands of light scattering microdots to mimic more natural contrast at all distances.
- Per the CYPRESS study, children who used their DOT lenses full-time showed 59% (0.52 D) and 38% (0.21 mm) less myopic progression than full-time wearers in the control group (5). Forty-one percent of the kids wearing the DOT lenses showed no clinically meaningful progression in refractive error (ie: less than a 0.25D increase in myopia from baseline as measured by cycloplegic autorefraction) after two years, compared to 17% in the control group(6).
- The Sightglass lens has a 5mm central aperature surrounded by the treatment zone of scattering/diffusing microdots.
- For my ECPs: if you want to nerd out, there’s a great White Paper on the Sightglass website.
| CliffsNotes: The US will soon have spectacle lens options for myopia management. Most essentially work by providing a clear central zone for myopia correction, while having multiple areas of plus power surrounding that central zone to induce peripheral myopic defocus. That defocus is thought to slow eye elongation and myopia progression. SightGlass Vision’s DOT lens works a little differently, by reducing the contrast on the retina. |