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April 3, 2024
Photo Credit: VTI
In this interview, Ashley Tuan, OD, PhD, Chief Medical Officer of Visioneering Technologies Inc. (VTI) sat down with Brett O’Connor, OD, to talk about the company’s NaturalVue Multifocal contact lenses for myopia management. Throughout the discussion, Dr. O’Connor shares his experience fitting NaturalVue over the last eight years and how the company’s new PROTECT (PROgressive Myopia Treatment Evaluation for NaturalVue Multifocal Contact Lens Trial) trial will shine a light on the safety and efficacy of this lens.
Listen to or read the full interview here:
John Sailer: Hello, and welcome to Review of Myopia Management’s interview series. I am John Sailor, Editor-in-Chief of Review of Myopia Management, and we are here today with Dr. Ashley Tuan, Chief Medical Officer of Visioneering Technologies Inc., better known as VTI, and Dr. Brett O’Connor, an optometrist practicing with MyEyeDr. in Jacksonville, Florida, who has experience using VTI’s NaturalVue Multifocal contacts for myopia management. Dr. Tuan and Dr. O’Connor will discuss recent data released about the NaturalVue Multifocal. Review of Myopia Management would like to thank Dr. Tuan and Dr. O’Connor for conducting this interview today, and we’d also like to thank VTI for sponsoring this interview.
Dr. Ashley Tuan: Hey, Dr. O’Connor. You were one of the contributors of the six-year retrospective on NaturalVue Multifocal lenses outcome for myopia management. Would you tell me a little bit about your experience with NaturalVue Multifocal?
Dr. Brett O’Connor: Yes, Ashley. Thanks for having me. I was one of the early fitters of NaturalVue Multifocal, and it was back in 2016. I very quickly realized that NaturalVue Multifocal was very unique compared to other lenses I had available. From the start, NaturalVue Multifocal was really a slam dunk success, I would say. So, patients had excellent vision. Kids were going from having historical 1.00D or more of annual progression to seeing very little, if any, change. So, along with some of the other earlier fitters of NaturalVue Multifocal, I compiled real-world data over time from our young myopes wearing NaturalVue Multifocal and published the data in Clinical Ophthalmology. So ultimately, we now have six years of retrospective data. We observed very strong results, and those were reflective of not only what I saw in my practice but in varied practices across the U.S.
Dr. Tuan: I see. With this success rate you have experienced, what were your thoughts when you heard that VTI was conducting a randomized controlled trial (RCT)?
Dr. O’Connor: Yeah, I was definitely excited. Personally, from having five years of personal experience with the lens, I was already myself convinced how well the lens works. The beauty of real-world data, like the six-year retrospective study data, is that it shows ECPs what to expect in their practices. However, the gold standard of myopia interventions is a randomized controlled trial. So, when I heard that NaturalVue was going to be in a randomized controlled trial, I thought, ‘this is great,’ because it’s not only going to give an opportunity for more doctors to use the lens, but hopefully it will line up well with this retrospective data and just really lead to an even stronger evidence base with the lens. I knew it would be a chance for ECPs that maybe weren’t using the lens yet to understand that not only does it work, but it works very well, and ultimately, at the end of the day, I was hopeful that the RCT would maybe shine a little bit more spotlight on NaturalVue being a lens from not one of the big four manufacturers, because in reality, there’s no other lens like NaturalVue Multifocal on the market.
Dr. Tuan: Right. Certainly. So, recently, we have shared our one-year interim analysis with the public from the PROTECT RCT study. We have found that in patients wearing NaturalVue Multifocal in the last 12 months, their average myopia progression rate was 0.17D. That’s equivalent to 71% of myopia reduction when compared to the single-vision control group. In terms of axial length elongation, the NaturalVue Multifocal group only elongated by 0.11 mm, or with a treatment effect that’s 0.17 mm, or 61%. That translates to half of the kids wearing NaturalVue Multifocal experiencing no myopia progression, and two-thirds of them had no clinically meaningful progression, which means 0.25D or less. What are your thoughts on the RCT results?
Dr. O’Connor: Yeah, I think you really hit it there. I think it goes without saying that those results are really sort of a showstopper when you’ve got half of the kids experiencing essentially no progression, and two-thirds of the kids that have got clinically sub-meaningful myopia progression, a quarter diopter, that’s very impressive. I think first, what’s most exciting to me as an early fitter, is not only are those results strong, but they closely parallel the retrospective data we mentioned earlier — that six-year study that we published with some other fitters, and also an independent study from Treehouse Eyes, who uses NaturalVue Multifocal as one of their treatment options. If we look at the retrospective data we have in these different studies and different populations, and we line it up with this randomized controlled trial data, we’re seeing a really strong trend where not only are we seeing excellent vision, excellent myopia management, but it’s very consistent across studies. So, that’s very gratifying for me as someone who’s been fitting this lens and sort of trying to shout from the rooftops how well it works over many years. So it’s very, very exciting.
Dr. Tuan: That’s great. I guess you are seeing that the NaturalVue Multifocal can work in different clinical settings and different populations even. Is that what you think?
Dr. O’Connor: Absolutely, yeah. When you take not only practices from across the U.S. as we did with the six-year retrospective data, but also when it comes to the RCT, the PROTECT study sites across the world, and you’re seeing this strong data, I think you can come away with a conclusion that this lens works not only in certain populations or for certain ages or certain demographics, but it’s working across the world.
Dr. Tuan: What should ECPs take away from this interim data in your opinion?
Dr. O’Connor: I think the simplest takeaway is NaturalVue Multifocal is safe and it’s effective for myopia management. We already had this reflected in the real-world data, but now it’s strongly supported with RCT data as well. So I think at this point, there can’t really be any debate as to whether NaturalVue Multifocal is a valid option for myopia management. I think my second takeaway would be that if you’re not actively managing myopia, you’re really getting to a point where you’re starting to miss the boat. We know that preventing even 1.00D of future myopia progression significantly reduces the child’s odds of future comorbidities. And I can tell you from years of experience prescribing NaturalVue Multifocal that it really couldn’t be simpler. So, if you’ve got a lens that’s working, the fitting process is easy, and it’s successful, why would you not be using this lens? And in that vein, I’d say if your understanding, or your practice of myopia management only includes one lens or one intervention, I think you’ve got some catching up to do to best serve your patients. We’ve got a lot of options that are out there now.
Then, one takeaway that I’m kind of starting to mull over myself as a clinician is we’ve got these different options available for myopia management now. Some have shown strong efficacy, and some, maybe more recently, for example, 0.01% atropine, maybe not showing such strong efficacy. I wonder if maybe it’s time to start digging in beyond the idea of everything is equal, everything’s the same, and maybe start diving into things like lens design. When we talk about the lens design of the NaturalVue Multifocal, it’s extremely unique with the near-focus optics that starts with basically a plus building from the very center of the lens. If you compare that to another lens design, for example, that may have a spherical center, I think as a clinician, I’m starting to mull over, not just is it an effective solution, but how does it work? Why does it work? What’s this design? So, I think that’s one of the things that I’m starting to take away as well.
Dr. Tuan: I see. So, as you point out, you have many options when it comes to myopia management. Do you have a go-to solution and why?
Dr. O’Connor: Yeah, really from the start of my myopia management practice, I fit NaturalVue Multifocal as my go-to solution. It really comes down to the fact that it’s simple. Patients love it and it works well. So, do I offer other interventions? Definitely. But when you can check off those boxes and patients are happy, I find myself always going back to what works and what patients like. So, I think one thing that’s helpful in practice, and it’s been this way since I started fitting NaturalVue in 2016, is that it comes in quarter-diopter increments all the way up to 12.25D. So, for better or worse, you’ll sometimes get referrals of kids at -8.00D, -9.00D, and part of you says, ‘Man, I wish I could have seen this kid at a younger age.’ But the reality is, they’re looking for myopia management. They’re looking to do what they can. And when you have a lens that is FDA approved for the correction of emmetropia with no age restriction, and up to 2.00D of astigmatism, that means you can fit a lot of patients when you’ve got a lens that goes up to -12.25D. So, it really lets me fit a whole lot of patients.
The last thing is I really have enjoyed fitting NaturalVue Multifocal as well, because I’ve enjoyed working with the company. VTI, from the first time I reached out and got a fitting set, has been a great partner to me, and I think they’re a great partner for ECPs. They’ve got a unique business model that I don’t know if all ECPs are aware of, and it’s certainly unique from the other contact lens companies that I work with in my practice, but also their team has been a great partner. They’re a small company. My success, I found, is their success, and their success, for me as a clinician, is my success as well. It’s really been great working with an up and coming, smaller company, and they’ve taken good care of my patients.
Dr. Tuan: Thank you for appreciating our business policy.
Dr. O’Connor: Yes, thank you for the time.
John Sailer: Thank you, Dr. O’Connor, and thank you, Dr. Tuan for your insight into VTI’s NaturalVue Multifocal. Thank you, Visioneering Technologies Inc. for sponsoring this interview, and thank you for listening.
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