What will myopia control look like in 2034?

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In the world of pediatric ophthalmology and optometry, myopia control is the center of many conversations. For practitioners who want to stymie the disease’s progression, and parents who want to help their children take control of their eye health, one particular technology is growing increasingly in demand. Carly Lam, PhD, MSc, the immediate past president of the Asia Pacific Council of Optometry, is also a crucial figure in the development of defocus incorporated multiple segments (DIMS) lenses. Her research led to the development of DIMS spectacle lenses and their soft-contact counterpart. Now a growing body of research supports Lam’s view that DIMS spectacle lenses could relieve some of the worldwide problems presented by childhood and adult myopia.

Lam is from the Centre for Myopia Research, School of Optometry, The Hong Kong Polytechnic University and the Centre for Eye and Vision Research, both in Hong Kong. During a conversation with Ophthalmology Times Europe®, Lam discussed new findings from a recent 8-year study of DIMS spectacle lens use, presented in a poster at the International Myopia Conference (IMC) in Hainan, China. She shared her predictions for the next decade of myopia control, including the barriers that will make or break DIMS lenses in Europe, Asia, and North America. She also urged eye care providers to take myopia more seriously and treat it for what it is: a progressive disease with life-long impact.

Hattie Hayes: First, can you tell me more about how DIMS spectacle lenses are used for patients with myopia, on their own and in conjunction with other therapeutics?

Carly Lam, PhD, MSc: Yes. The DIMS spectacle lenses are specially designed for the management of myopia, and particularly in children and adolescents. So the lens has 2 zones: the center 9-mm zone is for clear vision, to correct the refractive error and [provide] sharp central vision. In the peripheral zone, there are about 400 tiny segments, and they create a defocus effect. And it is this defocus effect that slows down myopia progression by signaling the eye to reduce its elongation. So by presenting simultaneous defocus across the retina, the DIMS lenses help control the progression of myopia while allowing clear central vision for everyday activities. On their own, DIMS lenses are highly effective in slowing down myopia progression in children. There are ample studies [whose data] demonstrate that DIMS lenses can reduce myopia progression by around 50% and reduce axial elongation by around 60%. These lenses are noninvasive, highly effective methods for controlling myopia. DIMS lenses have also been shown to be effective when combined with other myopia control therapies; for example, atropine eye drops. It has been found that atropine eye drops, together with DIMS spectacle lenses, have an additive effect, and their myopia control is better than the single usage of each. So this additive effect is even more beneficial to young children.

HH: Now, today, you and I are talking about some long-term research findings recently presented at the IMC. I know this research fits into a broader landscape of recent research on myopia therapies and technology. Can you highlight the findings from this long-term study, and maybe put an emphasis on how important it is to have early intervention when we’re talking about pediatric patients with myopia?

CL: Yes, I’m very pleased that we have presented the 8-year follow-up results at the recent IMC. As of now, it is the longest follow-up study on myopia control using spectacle lenses. There are several key messages from this long-term study. The first and the most important one is that we found sustained myopia control over 8 years. The study [data] highlighted a consistent reduction in myopia progression in children who continue wearing the DIMS spectacle lenses, and when they are compared with the control and historical groups who were wearing the single-vision lenses, these lenses showed remarkably less myopia progression and axial elongation.

Secondly, we also found high patient satisfaction among the participants and an increased awareness in managing their own myopia. Those who did not continue use of the DIMS lenses cited that it was due to the high cost of the lenses, and they no longer received free lenses from the study. The third message is about the importance of early intervention in myopia management. Participants who began wearing DIMS lenses at a younger age had significantly better control of the myopia compared [with] those who delayed the intervention.

But in fact, at any age, a child who [began] wearing DIMS lenses…would get the benefit immediately. So early intervention is critical, because myopia tends to progress very rapidly at a young age, while they are still in their developmental years…. Intervening early [on] with the DIMS lenses…will maintain good long-term control over the myopia progression, and therefore likely reduce the risk of high myopia and the associated ocular complications that happen later in life.

Also notable is that, in our study, some of our participants were adults, 21 years old. But we still see that if they stop wearing the DIMS lenses, they will experience a little bit more myopia progression than those who continue with the DIMS lenses. So it seems that reaching adulthood may not be a prime factor of stopping the myopia management. Rather, we have to wait and see, and monitor patients for a longer period. I will suggest at least to [age] 25, because there have been [study data] showing late-onset myopia progression in adults.

HH: I’m curious to know if you see these lenses having the biggest potential impact in a specific area—a geographic region, a specific community, among patients who have multiple ocular conditions. What patient group do you think has the most to gain by using DIMS spectacle lens technology?

CL: There have been tons of studies on the risk factors of myopia, and we found that DIMS lenses are likely to minimize [all those factors]. According to the research [findings], I think the biggest potential impact of DIMS lenses is likely to be among young children in the high-risk population, such as children with an early onset of myopia, a family history of myopia, and those living in urbanized, academic-focused environments with a very intensive education and curriculum. This happens a lot in the East Asian communities. DIMS lenses are excellent options for communities with limited access to advanced eye care due to the simplicity in prescribing the lenses, and children very quickly [adapt] to this form of spectacle lens. There are also patients who cannot tolerate other types of myopia control, [for example,] they cannot not wear orthokeratology lenses, or they do not like eye drops. The spectacle lens is a good option for them. I think by targeting these groups, DIMS lenses can play a key role in reducing the global burden of myopia, preventing high myopia, and promoting long-term good eye health.

HH: I’m glad you used that phrase, “global burden.” Myopia is a crucial point of consideration worldwide, but obviously there are very different accessibility and regulatory inhibitions across the globe. In the current myopia progression treatment paradigm throughout Europe, Asia, and the United States, where do these lenses fit in?

CL: As you know, DIMS lenses first launched in Hong Kong, which has a very high prevalence of myopia. That is why I myself entered into myopia research, because it’s a burning question and we all want to resolve it.

I think in each of the places that you mentioned, DIMS spectacle lenses will become an integral part of the myopia control treatment paradigm. In Asia, particularly East Asia, I think all these myopia control strategies are leading the global fight against myopia, especially in those places with a high prevalence rate, such as Hong Kong, China, Japan, and Korea. There is a higher public awareness, and parents are concerned about the children’s eye health, so Asia will be leading the charge in the next few years.

Europe is currently slower to adopt myopia control technologies, but that is expected to change soon. Currently, there are clinical trials and longer-term data being produced in Europe. So it is possible that in Europe, where eye care systems are more integrated with the government health care system, DIMS spectacle lenses may eventually be facilitated by public health guidelines and [European models of] insurance coverage, and probably will become also very popular.

In the US, because of the medical device approval regulation, DIMS lenses must go through the FDA, and this process may take several years. This is the key factor that will determine whether DIMS spectacle lenses will be available in the US market and when. I have heard that some parents from the US bring their children to Canada to gain access to a DIMS spectacle lens prescription.

HH: There are a lot of factors at play here, but what is the biggest obstacle to effective myopia control right now?

CL: I think it is still the general lack of awareness, among parents and the public, about the seriousness of myopia and the long-term risk it poses. Especially if it progresses to high myopia, the eye becomes so large that there are a lot of ocular complications. Many parents still perceive myopia as “just wearing a pair of glasses,” rather than treating it as a progressive disease, and a disease can be managed, slowed down, or prevented. Even among the optometric and ophthalmological communities, I think some practitioners may not always prioritize myopia control as they do other conditions. This is very important because myopia, over the course of a patient’s lifetime, affects their whole well-being and can cause significant visual impairment. Eye care professionals also need to update themselves [on] the latest myopia management knowledge.

Myopia control, at this time, is still expensive and may not be covered by health insurance or by the government. This can also be a significant financial barrier for many families, and especially those in low-income communities. Raising the public awareness, improving access, and making treatment more affordable will encourage myopia control to be more well established and be more effective.

HH: For this final question, you get to use your imagination a little bit. What is the global outlook for DIMS spectacle lenses in the next 5 years or the next 10 years?

CL: My prediction is that, for DIMS spectacle lenses, the next 5 to 10 years are very promising. The current market share of DIMS lens is only around 3% to 5% among the population of children in China alone. So many children still don’t get the benefit of a myopia control treatment. However, I think adoption will be influenced by various trends, including governmental actions for public health concern, improvements to the technology, and regulations that ensure a standard of care for myopia.

I think the technological innovation of DIMS lenses could definitely be further improved. We are already seeing the adoption of the myopic defocus concept in a whole range of different lens designs, in both contact lenses and spectacle lenses. Other advancements could include better materials, enhanced customization options for different levels of myopia severities, and improved durability of the lenses.

I’m sure some of these are beyond our current imagination. But I think, in 10 years’ time, one thing that is sure is we will have more longitudinal data to support whether these lenses can be used for a much longer time. We have proved that it works for 8 years, and how this 8-year period can impact the reduction of myopia and related complications like retinal detachment or glaucoma. I think future data will reinforce the role of myopia control therapies in preserving overall eye health as well as preventing myopia.

Reference:

1. Lam CSY, Leung TW, Zhang H, et al. Eight years of wearing defocus incorporated multiple segments (DIMS) spectacle lenses: user experience and myopia control outcomes. Poster presented at: IMC 2024; September 25-28, 2024; Sanya, Hainan, China. Poster B32.