By Martin Conway
In a recent edition of Contact Lens and Anterior Eye¹, Professor James Wolffson et al, published the results of an internet-based questionnaire circulated internationally. The results from 971 respondents make interesting reading.
Unsurprisingly respondents in Asia showed greatest concern for what is now generally accepted to be a global epidemic with 9/10 showing concern and 8/10 of those actively implementing some form of myopia control strategy. The rest of the world showed slightly less concern with Australasia and Europe scoring 7/10, South America 5/10 and North America at 4/10 being least proactive.
Orthokeratology was seen as being the most effective method of controlling myopia available today, followed by time spent outdoors and then pharmacological interventions.
Yet despite the general agreement that not only is both the prevalence and severity of myopia growing at an alarming rate, with all the long-term pathologies that that will bring, but 67.5% of practitioners reported offering single vision spectacles or contact lenses as their first choice of correction for young or progressing myopes. These figures varied significantly around the world (±38.7%). Reasons for not prescribing what most agree is the most effective treatment for the condition include cost, inadequate information, unpredictable outcomes, safety concerns and additional chair time required.
The FDA recently invited researchers and practitioners to a meeting to discuss developing FDA protocols for myopia control. Whilst this is an important first step and the first approvals for a myopia control product will be some way off, it nevertheless demonstrates that this will eventually occur. Such authorisation, even if it really only applies to the United States, will eventually give added confidence in such products around the globe. It will be the justification of label claims that will take time to establish that control has been demonstrated and a treatment that may take place possibly over many years, does not suffer from a rebound effect once treatment has ceased.
In the meantime, industry and proactive practitioners clearly have a role to play in getting the information out to concerned parents. Many of the reasons quoted in the report for not prescribing orthokeratology can be addressed with educational programmes and in-practice literature, but in the end, it will be down to how committed the individual in the consulting room is to provide his or her young patients with the most effective treatment for their condition.
Tangible Hydra-Peg and comfort in Ortho-K
Regular followers of our newsletter will have read of the progress of the revolutionary process known as Tangible Hydra-Peg. This is a permanent hydrophilic coating applied to lenses post-manufacture, designed to improve wettability and enhance both wearer comfort and deposit resistance.
Clinical studies have been undertaken at various locations around the globe, the full details of which will be presented at the forthcoming GSLS meeting in Las Vegas.
As an aside to its use in dry eye situations, I decided to investigate its possible benefits in new Ortho-K wearers.
With the best will in the world, the first few experiences for new wearers can be a little daunting, so I wondered whether a lens with the benefit of the Tangible Hydra-Peg coating would make the initial adaption period a little more comfortable for the new wearer. I have a few captive wearers at Contamac, so I ran a small study where I obtained duplicate lenses in Optimum Extra, but treated one lens with the new coating and left the other one untreated. Every one of the participants reported that the coated lenses felt more comfortable and insisted that their other lens goes through the treatment.
A colleague in another practice reported that a middle aged patient who had been using Ortho-K successfully for a number of years had begun to complain of dryness. I suggested applying the treatment to her lenses and she too has reported a remarkable improvement.
These anecdotal experiences hardly form a clinical trial, but as the Tangible Hydra-Peg technology becomes available and the Optimum Extra and Optimum Extreme materials have now been FDA approved in Ortho-K usage, colleagues might bear this in mind should they wish to enhance comfort for their Ortho-K patients.
Trials with this new technology have also demonstrated an increased deposit resistance in treated lenses. This too could be an important benefit to incorporate in Ortho-K designs, where complex reverse curves on the inside of the lens can harbour metabolic waste products that can trigger an inflammatory response.
Watch this space for further information as this new technology rolls out.