On November 15, 2019 the US Food and Drug Administration (FDA) announced an approval for the MiSight contact lens with the indication of slowing nearsighted (myopia) progression in children. This is big news for the vision care industry as this is the first approval of any kind indicated for the slowing of myopia progression.
The reason that eye doctors are motivated to slow the progression of myopia is that every increase in a child’s myopia increases the risk of serious eye diseases later in life. Does this mean that US based doctors can now, for the first time, offer help to slow the progression of myopia? The short answer is no.
Research has been available for a number of years that supports various interventions that are effective for slowing the progression of myopia. Studies looking at the role of an eye drop called atropine on slowing the progression of myopia dates back to a US based medical journal in 1971.
There has been a surge of studies over the past 30 years that is guiding the management of children with myopia. See the following link for a list of studies that guide our decision making in managing progressive myopia. https://www.prvisioncare.com/wp-content/uploads/2019/11/Myopia-references-2019.pdf
The research supports three arms of intervention that are effective at different stages of myopia development. Those are behavioral, optical and pharmaceutical interventions. Behavioral interventions include monitoring screen time, improving visual hygiene and increasing exposure to natural outdoor light. Optical interventions include bifocal glasses and contact lenses, optical defocus glasses and contact lenses, and overnight corneal reshaping therapy. Pharmaceutical interventions include atropine eye drops at a concentration ranging from 0.01% to the commercially available 1.0%. The specific recommendation is based on a number of factors including age of the child, genetic risks, current refraction, eye teaming and focusing abilities. If the goal of myopia management is to reduce the incidence of eye disease, then the key to gauging the effectiveness of any intervention is to measure the axial length of the eye.
The devices and pharmaceutical interventions mentioned are FDA approved but not specifically for slowing the progression of myopia. For example overnight corneal reshaping lenses are approved for the daytime correction of myopia without the need for glasses and contact lenses but not for slowing the progression of myopia even though multiple studies have shown that the lenses slow the progression of myopia up to 50%! Applying an intervention for benefits not specifically indicated by the FDA is known as off label prescribing and is common in medicine.
It is wonderful to finally have an intervention that is specifically indicated by the FDA for slowing the progression of myopia. Our practice is excited to put this new lens to use and have it as part of our tool box in the fight against progressive myopia.
Comprehensive myopia management involves a number of moving parts and our doctors will continue to customize a treatment plan as individual as your child is. We will continue to evaluate each child with a holistic approach with the goal of improving the quality of life for each patient we have the honor of seeing.
