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Johnson & Johnson Vision at the Forefront of Myopia Research at the International Myopia Conference 2022

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December 15, 2022

By Monica Jong, PhD, BOptom, Noel Brennan, MScOptom, PhD, FAAO, Xu Cheng, MD, PhD, MBA, FAAO, and Alex Nixon, OD, MS, FAAO

Johnson & Johnson Vision is committed to leading by science to change the trajectory of myopia, helping give children clearer vision today, for better eye health tomorrow.

The Johnson & Johnson Vision team recently presented their latest innovative research at the International Myopia Conference (IMC) in Rotterdam, The Netherlands, which took place September 4-7, 2022. This meeting last took place in 2019 and has a tradition of bringing together leading scientists and experts in the field. The IMC is the largest and most prestigious international myopia meeting, showcasing the latest research in epidemiology, mechanisms, experimental, and clinical trial studies. This year more than 700 delegates attended one of the biggest IMCs to date.

Johnson & Johnson Vision presented 12 posters and podium presentations. A major highlight of the IMC was the presentation of never-before-seen technology and clinical results behind a breakthrough soft contact lens for myopia management by Dr. Monica Jong, Dr. Xu Cheng, Dr. Noel Brennan, and Lisa McAlister to a standing-room-only crowd. The engaging session brought together attendees from all around the world and discussed impactful ways to address the growing myopia epidemic.  

Johnson & Johnson Vision is committed to leading by science to change the trajectory of myopia, helping give children clearer vision today, for better eye health tomorrow.

Below we have summarized several of the most exciting IMC research presented by Johnson & Johnson Vision exploring the mechanisms of myopia and the technology behind a breakthrough soft contact lens designed for myopia control, specifically for pediatric eyes. 

Adult Myopia and Its Implications to Myopia Prevalence Around the World1
There are limited studies on adult myopia progression, and greater understanding is important for better clinical management. Four long-term studies were reviewed, and refractive progression rates were calculated for adults aged 20 to 50 years. Using data from Vitale et al.2 on a U.S. adult population between 1971-72 and 1999-2004, calculated progression rates over a period of 28 years were higher for higher degrees of myopic refractive error. Data from Goldblum et al.3 over five to 10 years suggested that myopia progression was similar among varying degrees of myopia in a German population. Calculated prevalence rates were not possible with data from Ducloux et al.4 However, a trend of myopia progression reducing with increasing age could be considered in the French population. Calculated progression rates with five-year data from Takeuchi et al.5 surprisingly found that Japanese adult males progressed faster than adult females, and those with lower degrees of myopia also progressed more quickly. 

These four clinical studies demonstrate that myopia progression occurs in adults, beyond the teenage years through to age 50 by an average of about 1.00D or more. If we use late teenage myopia prevalence rates, we may be underestimating the comorbidity of myopia in our current myopia disease prevalence predictions. 

Investigating Myopia Control Using ChromaBlur6
Can the use of chromatic fringes in an image, known as “ChromaBlur (CB),” help us to better understand how the retina detects the sign of defocus and alters eye growth? It has been demonstrated by Cholewiak et al.7 that CB can drive accommodation and depth perception. To investigate the effects of CB on short-term axial length change (a putative biomarker for long-term refractive development), 20 subjects (aged 20-35 years) were asked to watch a 40-minute movie with CB. Axial length and accommodation were measured at 10-minute intervals. This investigation found that accommodation was stimulated by CB. However, it was very small, and axial length did not significantly change within the 40 minutes of ChromaBlur exposure as compared to exposure to 40 minutes of optically induced blur.

Optical Soft Contact Lens Designs for Myopia Control8
Traditionally, soft myopia control contact lenses have been limited by treatment power versus vision quality. Enhancing the efficacy of soft contact lenses for myopia control requires disrupting this relationship. An optimized myopia control lens was designed using sophisticated optical modelling as well as an empirical purpose-built optical table consisting of biometric (axial length) measurement, spatial light modulator to deliver optical stimuli, pupil tracking, VA, contrast sensitivity and halo measurements. This lens design comprised a conic section of a torus as the optics of the myopia control treatment zone, overcoming the need to bring the light in the treatment zone to a point focus. The use of non-coaxial plus power in the treatment zone substantially reduced the ghosting and shadowing artifacts while retaining the myopia control properties. A six-month masked, randomized, controlled clinical trial confirms this finding. As a result, this soft contact lens, which was designed to break the interdependency between efficacy for slowing the progression of myopia and providing similar visual quality to a classic dual focus design,9 was granted Breakthrough Device designation by the U.S. FDA to provide for more effective treatment or diagnosis of life-threatening or irreversibly debilitating diseases or conditions.*

Pediatric Fit and Performance of Various Soft Contact Lens Prototypes and the Preferred Design10
To optimize fit and handling of a myopia control soft contact lens for pediatrics, ocular biometric characteristics of 300 Chinese children were assessed. This research found reduced Horizontal Eyelid Fissure (HEF) and Palpebral Aperture (PA) compared to adults,11 leading to prototype soft contact lens designs with diameters ranging from 13.6 to 14.0 mm, base curves ranging from 7.9 and 8.5 mm with a shape factor of 0.26. These various contact lens parameters were then assessed for performance preference. An aspheric design, 13.8 mm diameter and 7.9 mm BC provided optimal centration, movement, and minimal corneal limbal exposure compared to other designs tested. In a trial of a soft contact lens with RingBoost optical design (n=199, age 7 to 12 years), there were no instances of unacceptable lens fittings. At the initial fitting, 94.7% reported centered fit, and 88.2% had optimal movement. At the one-month review, 93% agreed the lens was easy to insert, and 95% agreed it was easy to remove. This soft contact lens, specifically designed for pediatric use, demonstrated excellent fit and handling. 

Impact of Soft Contact Lens Design on Ease of Handling and Comfort in Myopic Children12
Soft contact lens designs were assessed in a pediatric population for handling and comfort using the qualitatively valid Pediatric Comfort and Handling Questionnaire (PCHQ). A total of 75 myopic children aged 7 to 17 years were recruited across multiple sites and randomized to wear three sets of contact lenses bilaterally, including senofilcon A RingBoost Technology (RB), senofilcon A with prototype optics (PO), and the marketed omafilcon A dual focus design (DF). Both senofilcon A designs feature the same smaller diameter and steeper base curve, differing only in optical design. The order of lens wear was randomized, and each design was worn for two weeks, with the questionnaire completed via a digital device after fitting and at the two-week follow-up. The greatest difference in the proportion of “good” responses for the various contact lenses was in the insertion, comfort, and comfort-related compensating behavior constructs. At follow-up, the senofilcon A RB and PO designs had similar proportion of “good” responses; however, RB and PO exceeded the omafilcon A DF design by 15% across five of the six insertion-related items and several comfort and compensating behavior items. In a pediatric population, the senofilcon A lenses with a smaller diameter and steeper base curve provided a higher proportion of good responses for insertion and comfort than the omafilcon a dual focus lens. A larger study would provide a more definitive conclusion. 

 

Dr. Monica Jong, PhD, BOptom, Global Director of Professional Education — Myopia, Johnson and Johnson Vision; Honorary Fellow, School of Optometry and Vision Science, UNSW, Sydney, Australia. Dr. Monica Jong is the Global Director of Professional Education, Myopia, at Johnson & Johnson Vision, where she leads practitioner education initiatives around the world to support evidence-based myopia management. She was the former Executive Director of the International Myopia Institute, an organization she helped found and lead. In this role she led the development of white papers and key initiatives to bring consensus to the field of myopia management by bringing together leading researchers, clinicians, educators, policy-makers, and public health experts. Dr. Jong has published numerous peer-reviewed articles, co-created the first global online education program in myopia at the Brien Holden Vision Institute, and co-authored the WHO report on the Impact of Myopia and High Myopia. She was the former secretary of the Refractive Error Working group of the International Agency for Prevention of Blindness (IAPB) and contributed to position papers and advocacy initiatives in uncorrected refractive error. She has supervised a number of graduate students and speaks regularly at scientific and practitioner meetings in myopia and refractive error.
Noel A. Brennan, MScOptom, PhD, FAAO, Clinical Research Fellow, Johnson & Johnson Vision. Dr. Noel A. Brennan is an internationally recognized researcher and educator. He has led an extensive global scientific program studying myopia epidemiology, metrics of treatment efficacy, and groundbreaking optical designs of contact lenses. This work has resulted in excess of 100 patents, original manuscripts, and conference presentations over the last decade.
Xu Cheng, MD, PhD, MBA, FAAO, Clinical Research Fellow, Clinical Science, Johnson & Johnson Vision. Dr. Xu Cheng is an ophthalmologist and vision scientist with 27 years of experience in Clinical and Vision Science research. She is the clinical lead for multiple contact lens R&D projects with emphases in myopia control, visual optics, and development of clinical testing methodologies. She has designed and executed more than 100 clinical investigations ranging from early feasibility studies for proof of concept to confirmatory pivotal clinical trials, including more than 30 myopia-control-related clinical studies involving 2,000+ pediatric subjects. Dr. Cheng is globally recognized for her expertise in clinical and vision research with 100+ peer-reviewed publications, conference presentations, and patents.
Alex Nixon, OD, MS, FAAO, Principal Research Optometrist, Johnson & Johnson Vision. Dr. Alex Nixon is a skilled clinician, educator, and researcher. He was formerly a clinical instructor at The Ohio State University College of Optometry and a member of the Bifocal Lenses In Nearsighted Kids (BLINK) Study Group. As Principal Research Optometrist at Johnson and Johnson Vision, he leads clinical research and the development of patient-reported outcome measures. He continues to teach, when possible, and he was a co-author for Managing Myopia: A Clinical Response to the Growing Epidemic, a document intended to provide guidance for eye care practitioners in the management of myopia in clinical practice.

 

References

*For more information on the FDA’s Breakthrough Devices Program, visit: https://www.fda.gov/medical-devices/how-study-and-market-your-device/breakthrough-devices-program#s1 

  1. Brennan N, Cheng X, Bullimore M. Adult Myopia Progression. IMC-Abstract-2022-Abstract-book. Accessed 13/10/2022 https://www.internationalmyopiaconference.org/wp-content/uploads/2022/09/IMC-2022-Abstract-book.pdf. Page 113
  2. Vitale S, Sperduto RD, Ferris FL. Increased prevalence of myopia in the United States between 1971-1972 and 1999-2004. Archives of ophthalmology. 2009;127(12):1632-9.
  3. Goldblum D, Brugger A, Haselhoff A, Schmickler S. Longitudinal change of refraction over at least 5 years in 15,000 patients. Graefe’s Archive for Clinical and Experimental Ophthalmology. 2013;251(5):1431-6.
  4. Ducloux A, Marillet S, Ingrand P, Bullimore MA, Bourne RR, Leveziel N. Progression of myopia in teenagers and adults: a nationwide longitudinal study of a prevalent cohort. British Journal of Ophthalmology. 2021.
  5. Takeuchi M, Meguro A, Yoshida M, Yamane T, Yatsu K, Okada E, et al. Longitudinal analysis of 5-year refractive changes in a large Japanese population. Scientific reports. 2022;12(1):1-8.
  6. Cheng X, Collins M, Banks M, Brennan N. Investigating myopia control using ChromaBlur. IMC-Abstract-2022-Abstract-book. Accessed 13/10/2022 https://www.internationalmyopiaconference.org/wp-content/uploads/2022/09/IMC-2022-Abstract-book.pdf. Page 18
  7. Cholewiak SA, Love GD, Srinivasan PP, Ng R, Banks MS. Chromablur: Rendering chromatic eye aberration improves accommodation and realism. ACM Transactions on Graphics (TOG). 2017;36(6):1-12.
  8. Brennan N, Collins M, Cheng X. Efficacy versus vision: breaking the nexus. IMC-Abstract-2022-Abstract-book. Accessed 13/10/2022 https://www.internationalmyopiaconference.org/wp-content/uploads/2022/09/IMC-2022-Abstract-book.pdf
  9. JJV Data on File 2021. Development of Optical Design of ACUVUE Abiliti 1-Day Soft Therapeutic Lenses for Myopia Management.
  10. Cheng X, Brennan N. Soft contact lens parameter optimization for pediatric use in myopia control IMC-Abstract-2022-Abstract-book. Accessed 13/10/2022 https://www.internationalmyopiaconference.org/wp-content/uploads/2022/09/IMC-2022-Abstract-book.pdf. Page 68
  11. Hickson-Curran S, Brennan NA, Igarashi Y, Young G. Comparative Evaluation of Asian and White Ocular Topography. Optometry and Vision Science. 2014;91(12):1396-405.
  12. Nixon A.  Impact of soft contact lens design on ease of handling and comfort in myopic children. IMC-Abstract-2022-Abstract-book. Accessed 13/10/2022 https://www.internationalmyopiaconference.org/wp-content/uploads/2022/09/IMC-2022-Abstract-book.pdf. Page 152

 

 

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