June 15, 2023
By Aamena Kazmi, OD, ABO Diplomate
An 8-year-old Caucasian male “WK” presented to our clinic for his first comprehensive examination, complaining of blurry distance vision. Both parents reported myopic refractive errors greater than -4.00D. WK’s medical and ocular health history were unremarkable. He spends two hours per day playing baseball, is an avid reader, and uses a tablet for one to two hours per day.
Presenting distance visual acuity without correction
Manifest and cycloplegic refraction:
OD: -1.25 – 0.50 x 036 , 20/20
OS: -1.00 DS, 20/20
External and internal health unremarkable.
Mild myopia, with expected progression. Risk factors: high familial myopia, age of onset, significant near work/tablet use
I educated WK and his parents that the standard of care for addressing myopic refractive errors has shifted, explaining that myopia refers to an abnormally elongated eye with symptoms of blurry distance vision (nearsightedness). Research has established that simply prescribing single-vision distance glasses to address blurry vision does not actively prevent progression, and the patient may require higher prescriptions in subsequent years. I explained that contact lenses or pharmacologic methods could slow WK’s progression, decreasing the chances of high myopia.
WK’s low refractive error made him a candidate for three myopia management options: soft dual-focus one-day contact lenses, orthokeratology, and atropine drops. Despite an extensive review of WK’s risk factors and discussion on ocular comorbidities with high myopia, his parents elected to forego myopia control and use single-vision glasses exclusively. I counseled them on visual hygiene: reducing tablet use, taking breaks during near work, increasing working distances, spending time outdoors, and getting adequate sleep time. A glasses prescription was released. The family was instructed to return in four to six months for a progress check to determine progression trends.
However, WK did not return until the following year for a comprehensive eye examination with complaints of blurry distance vision in his current glasses. He reported full-time wear of glasses and no changes to ocular, medical, or social health.
Presenting distance visual acuity with correction
Manifest cycloplegic refraction:
OD: -3.00 – 0.50 x 025 , 20/20-
OS: -2.50 – 0.50 x 172 , 20/20
External and internal ocular health unremarkable.
Rapidly progressing myopia.
I educated WK’s parents on his fast progression. I plotted his refractive change on a graph that extrapolated his potential refractive error by 17 years of age. WK’s parents were most comfortable pursuing an FDA-approved option. They were convinced by the three-year and seven-year trial data on MiSight 1 day contact lenses, which established an average of 60% slowing of progression with no rebound effects. A contact lens fitting with insertion-and-removal (I&R) training were completed, and WK was instructed to return for a one-week progress evaluation.
WK returned for his one-week progress evaluation and reported that he wore the lenses every day at least 10 hours per day since the dispense.
Presenting distance visual acuity (with MiSight 1 day lenses):
OD: -3.00 DS, 20/20-
OS: -2.50 DS, 20/20-
WK reported excellent comfort and vision in the lenses and daily improvements with I&R.
Slit lamp examination:
OD, OS: Optimal lens fit with good centration, coverage, and movement of the lenses. External ocular health within normal limits.
I instructed WK to continue contact lens wear for a minimum of 10 hours per day, six days per week. Lastly, a three- and six-month progress evaluation was scheduled.
Three-Month, Six-Month MiSight Progress Evaluation:
WK reported satisfaction with vision and comfort in the contact lenses with >10 hours of wear per day, seven days per week. Visual acuity with lens correction was 20/20- 1 in each eye with no over-refraction. There was no change in refraction at either visit. WK was instructed to continue with full-time wear of the lenses and to return in six months.
At WK’s first annual visit since starting MiSight 1 day lenses, he presented to the office wearing the lenses and had no complaints of blurry distance vision with correction. No changes to WK’s ocular, medical, or social health were reported.
Year Three — one year after starting MiSight lenses
Presenting distance visual acuity (with MiSight lenses):
Manifest cycloplegic refraction:
OD: -3.00 – 0.50 x 030 , 20/20
OS: -2.50 – 0.50 x 175 , 20/20
WK’s refraction was stable, and no changes were made to MiSight1 day parameters. A new biometer in our clinic enabled us to measure WK’s axial length for the first time.
Axial Length (AL):
OD: 25.19 mm
OS: 24.96 mm
WK’s AL is longer than an average 8-year-old’s. This emphasized the importance of myopia control efforts and motivated WK’s parents to continue using MiSight lenses. With no progression, combination therapy with atropine was not warranted. WK was instructed to continue with full-time contact lens wear and to return for quarterly evaluations.
Our initial success of shifting from rapid to no progression with the initiation of myopia control soft lenses is positive. I expect WK’s progression to remain slowed or stopped with continued efforts.
|Dr. Aamena Kazmi graduated from the University of Houston College of Optometry in 2015, and she is currently an associate at Bellaire Family Eye Care, a private practice in the Houston, TX, area. She primarily manages patients in need of dry eye management, specialty contact lenses, and myopia control. In addition, Dr. Kazmi is a consultant for CooperVision.|