Daily contact lens shown to slow progression in children

The “Contact Lens Focus” column presents an optometrist’s firsthand experiences with a new lens, via answers to questions posed by Optometric Management.

Please describe the contact lens.

MiSight 1 day (CooperVision) is a daily wear contact lens clinically proven to slow myopia progression. The lens has a dual focus optical design that simultaneously provides distance optical correction and myopic defocus to alter axial elongation when worn six days a week for 10 hours a day. The lens is the first and only FDA-approved treatment for myopia.

For whom is the lens indicated?

The lens is approved for children ages 8 to 12, who, at the initiation of treatment, have a refraction of -0.75D to -4.00D (spherical equivalent) with ≤ 0.75D of astigmatism.

How do you recommend the lens?

I have a discussion about myopia management with every parent of a myopic child. I present the lens as a first-line therapy for children who fit the criteria and are ready to try contact lenses. I find this is about 80% of my patients. The other 20% may be uneasy about contact lenses or not willing to start treatment. In those instances, I recommend follow-up in six months to discuss options again.

What education do you provide?

If it is the first time a child is receiving myopic correction, I take time to set future expectations, based on family history of myopia, age of patient onset, current prescription and type of correction. Next, I discuss all myopia management options.

In addition to our in-office discussion, I provide parents with website links to myopia management studies and information, including CooperVision’s Brilliant Futures Myopia Management Program.

What results can an O.D. expect?

Based on randomized multi-year clinical trial, doctors can expect an average of 59% reduction in spherical equivalent refraction compared to age-matched, untreated myopes. Additionally, expectations for initial fit, visual comfort and handling of the lens are similar to conventional single vision daily contact lenses. Based on my experience, patients have had minimal complaints about distance VA. While studies do mention peripheral ghosting or blur, I have not yet had patients complain about these items.

How is the insertion/removal and hygiene lesson adjusted to accommodate young patients?

We involve parents in the learning process, but we encourage the child to be the one handling the lenses. Staff members use age-appropriate language and terminology in the instruction. Also, we have found some young kids need a second day of instruction, but most are able to successfully handle the lenses after that.

What is your follow-up procedure?

After the initial exam and successful evaluation and fit, I send the patient home with trial lenses. The patient returns for a one-week follow-up. At this visit, I reassess VA and fit and answer any questions. Follow-up then moves to every three to six months, at which time I re-evaluate refractive error and make changes to the lens power if needed. My current protocol includes auto-refraction, retinoscopy, subjective refraction and slit lamp biomicroscopy at every visit. A cycloplegic refraction is obtained at annual exams and as needed at follow-up visits.

What benefits does the lens provide to your practice?

Giving my patients the best opportunity for lifelong vision is always my No. 1 goal. Having the lens available to my patients allows me to provide the best care. Also, the lens brings new patients to my office who are looking for a new way to manage their myopia. I am able to educate patients and families throughout the community and grow my practice at the same time. OM

DR. YOUNG works as lead pediatric optometrist at Frisco Eye Associates for Kids in Frisco, Texas, where she specializes in binocular vision, amblyopia and myopia management. Dr. Young is a consultant for CooperVision’s MiSight Certification Program.