The value of innovation in controlling myopia

As the global population of children with myopia increases, there are 3 key action areas that eye care stakeholders should focus on: education around preventative action, personalization of treatment, and affordability

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Myopia is a rapidly increasing global health concern and is one of the leading causes of vision impairment today.^1,2 By 2030, the World Health Organization (WHO) predicts that 40% of the global population will be living with this condition.³ Although myopia has historically been considered untreatable, innovations especially in ophthalmic optics now offer a chance to halt its progression in children with the condition. One such innovation is Defocus Incorporated Multiple Segments (DIMS) spectacle lenses, the technology behind HOYA Vision Care’s MiYOSMART.(Note: MiYOSMART spectacle lenses have not been approved for use in the management of myopia in all countries, including the US, and are not currently available for sale in all countries, including the US.)

Conclusions and limitations of a study based in France

Data from an interim analysis of the observational French study OPHTAMYOP⁴ have demonstrated a significant trend of myopia control with DIMS spectacle lenses in children aged 4 to 16 years, who have progressive myopia and spherical equivalent refraction from –0.25 diopters (D) to –8.00 D. Obtaining country-specific efficacy data is essential for unlocking access to this treatment for children globally through approvals and reimbursement support.

The research from this study is in line with a larger bank of clinical data supporting the efficacy of DIMS spectacle lenses; 6-year data of use in Chinese children found that on average, the technology slowed myopia progression by 52% and axial elongation by 62%.⁵ However, these averages include extremes on both ends of the spectrum: The spectacle lenses stop myopia progression completely in some children but are not effective in others.

Large study populations are needed to understand myopia physiopathology

More research is needed to deepen our understanding of myopia physiopathology to better understand why children respond differently to treatment. To do this, we need to study large population sizes. Key DIMS studies in China^5,6 have the largest populations, so future Chinese studies present the best chance of performing this data drill down.

To increase opportunities to grow our study populations, we must increase awareness. At present, not enough parents are aware that myopia control is a possibility. To ensure that as many children as possible have access to this treatment, education on their options is essential.

Myopia’s causes are multifaceted

Looking at the bigger picture, we see different trends in myopia prevalence and treatment efficacy in populations around the globe for geographic, environmental, and genetic reasons.⁷ Myopia progresses faster in Asian children and begins at an earlier age on average than in European children.^8,9 We understand that early-onset myopia tends to progress fast—in these circumstances, myopia can sometimes be more difficult to control.

The highest prevalences of myopia worldwide are seen in urbanized East Asian regions such as Taiwan, Singapore, and Shanghai, China; in Australia and European countries such as the Netherlands and UK, the prevalences are much lower.⁷ When discussing European populations, however, it’s worth noting the environmental and behavioral differences between countries. In Spain or Italy, for example, children tend to spend a lot of time outside. In Nordic countries, there are long periods of darkness and children may spend less time outside.

Living conditions are a key prevalence factor, again with a strong link to behavioral trends. Myopia is less common in rural areas than in urban areas worldwide, and weather and pollution levels can impact its prevalence.^7,10 An epidemiological study conducted by HOYA Vision Care found a strong correlation in Scottish children between residing in flats/apartments and myopia prevalence, particularly increasing following the COVID-19 pandemic with a link to increased screen time.¹¹

Treatment choices are dependent on how easy it is for children to access eye care. For example, there’s a significant difference in accessibility of eye care between a big city such as Paris and a small town in the center of France.

Education, personalization, and affordability are critical

As the global population of children with myopia increases, there are 3 key action areas that eye care stakeholders should focus on: education around preventive action, personalization of treatment, and affordability.¹²

The mitigation of environmental and lifestyle factors is widely recognized as critical for preventing the development and progression of myopia.¹⁰ Parents and policymakers must be educated on implementing vision-friendly behaviors such as limiting screen use and encouraging time outdoors. The importance of this has been underlined by the WHO with the launch of its SPECS 2030 initiative, which intends to raise awareness, develop advocacy, and strengthen refractive error services to help tackle myopia.¹³

Secondly, myopia control protocols should be personalized to fit the specific needs of each child and their parents’ capacities, especially through the utilization of combination management systems, for example, alternating between DIMS spectacles and contact lenses if the child plays a lot of sports, or combining DIMS spectacles with atropine drops if the myopia is progressing very rapidly. In clinical practice, I have seen a positive difference as a result of utilizing combination systems in these patients—especially those who don’t respond as well to DIMS. However, we need more data to support this being rolled out on a larger scale.

The final area of focus is the issue of affordability. In France, DIMS lenses have been recognized as a treatment for myopia progression and soon will be eligible for reimbursement by insurance. However, across much of Europe, there is no such reimbursement for myopia treatments, putting them out of reach for many children. This access barrier underlines the importance of prioritizing myopia management by governments, policymakers, and health care stakeholders. It also emphasizes the importance of the study itself, as these data are required to support reimbursement by highlighting the value of myopia treatment.

The bright future of myopia management

As we look to the future, I hope that we deeply understand myopia’s physiopathology, explore combination systems further, develop protocols to associate different treatment modalities with individual needs, and stop rapid myopia progression in its tracks. Moving forward, I also hope that we improve screening for myopia in children and can swiftly enact management solutions once the condition has been detected.

The evolution of myopia management over the past decade has been fantastic and as a result, children and their parents now have choices available. It is a great pleasure to be a part of this adventure, contributing to a better future for the visional health of children that is so important for their lifelong well-being.

References

1. Chua SYL, Foster PJ. The economic and societal impact of myopia and high myopia. In: Ang M, Wong T, eds. Updates on Myopia. Springer; 2019;53-63. https://link.springer.com/chapter/10.1007/978-981-13-8491-2_3
2. Tomiyama E. Myopia: an epidemic of global proportions. Optometry Times. March 21, 2024. Accessed November 8, 2024. https://www.optometrytimes.com/view/myopia-an-epidemic-of-global-proportions
3. Sankaridurg P, Tahhan N, Kandel H, et al. IMI impact of myopia. Invest Ophthalmol Vis Sci. 2021;62(5):2. doi:10.1167/iovs.62.5.2
4. Bremond-Gignac D, Le Meur G, Bonifas C, Colliot JP, Mortemousque B; study group OPHTAMYOP. OPHTAMYOP study myopia control in French children treated with defocus incorporated multiple segment spectacle lenses: interim analysis. Presented at: European Paediatric Ophthalmological Society Annual Meeting; September 14, 2024; Paris, France.
5. Lam CSY, Tang WC, Zhang HY, et al. Long-term myopia control effect and safety in children wearing DIMS spectacle lenses for 6 years. Sci Rep. 2023;13:5475. doi:10.1038/s41598-023-32700-7
6. Lam CS, Tang WC, Lee PH, et al. Myopia control effect of defocus incorporated multiple segments (DIMS) spectacle lens in Chinese children: results of a 3-year follow-up study. Br J Ophthalmol. 2022;106(8):1110–1114. doi:10.1136/bjophthalmol-2020-317664
7. Matsumura S, Ching-Yu C, Saw SM. Global Epidemiology of Myopia. In: Ang M, Wong T, eds. Updates on Myopia. Springer; 2019;27-51. https://link.springer.com/chapter/10.1007/978-981-13-8491-2_2
8. Jones-Jordan LA, Sinnott LT, Chu RH, et al. Myopia progression as a function of sex, age, and ethnicity. Invest Ophthalmol Vis Sci. 2021;62(10):36. doi:10.1167/iovs.62.10.36
9. Fricke T, Morjaria P, Sankaridurg P. Who is at risk of myopia? Community Eye Health. 2019;32(105):16.https://pmc.ncbi.nlm.nih.gov/articles/PMC6688409/
10. Biswas S, El Kareh A, Qureshi M, et al. The influence of the environment and lifestyle on myopia. J Physiol Anthropol. 2024;43(1):7. doi:10.1186/s40101-024-00354-7
11. Conway M. Increasing myopia and associations with deprivation and rural/urban environments in children aged 3.5-5.5 years in Scotland. Presented at: International Myopia Conference; September 25-28, 2024; Sanya, China.
12. Robert MP, Daruich A, Bremond-Gignac D. Myopia: insights from a population-based survey. Acta Ophthalmol. 2024;102(5):e869–e870. doi:10.1111/aos.16687
13. SPECS 2030. World Health Organization. Accessed November 8, 2024. https://www.who.int/initiatives/specs-2030