February 18, 2025
Vishakha Thakrar, OD, FAAO, FSLS
MARKHAM, Ontario, Canada – At THE Myopia Meeting held here, Sunday, December 8, 2024, Vishakha Thakrar, OD, FAAO, FSLS, presented a clinical review on behalf of Johnson & Johnson Vision. The presentation focused on the case study of a 6-year-old patient who ultimately found success in the ACUVUE Abiliti 1-day lens.
Patient History
The presentation began with Dr. Thakrar providing background information on the patient from the case she was presenting, which was a patient that she had treated in her office. Dr. Thakrar introduced the group to Sara, the patient in the case study, who came to her office in 2017 with no vision complaints.
“Sara is a 6-year-old, Caucasian female,” Dr. Thakrar said. “This was her first eye exam in 2017, and her mother was a low myope, and her father was an emmetrope. Her visual acuity was 20/40 in each eye, her binocular vision was normal, and she refracted at that time to -0.50D and -0.75D. Her ocular and systemic health were normal. In 2017, myopia management was very different than it is now. At that time, I only had the ability to treat with OrthoK lenses and atropine. We didn’t have all of the tools that we have today. When I spoke to the parents of a 6-year-old about OrthoK and atropine, they were hesitant to start treatment. She was only -0.50D, but she was 6 years old. We can assume that the trajectory of a 6-year-old who is already myopic is that she will likely advance.
“So, what happened? The parents opted for no myopia treatment. They went with single vision glasses, and I asked them to come back six months later. They came back one year later. Her prescription was now -1.75D. I spoke to them again about myopia control, and they denied it again. They returned six months later, and Sara was -2.00D and -2.25D. Her parents continued to deny myopia control. Then, a year later, the pandemic hit, and she came back shortly after our doors opened back up. At that point, myopia control glasses had been released on the Canadian market, and her prescription had increased to -4.25D OU and her axial length was 23.87 mm in the right eye and 23.90 mm in the left eye.”
Initiating Myopia Treatment
Dr. Thakrar then shared how she got the parents on board with myopia management, and she shared her thought process on which treatment would be best suited for Sara.
“At this visit, I finally convinced Sara’s parents to start myopia management treatment. So, what did I prescribe? The approval of myopia control glasses was what swayed them. The parents were so nervous about putting something in her eyes that every other treatment had been rejected. I think when a parent sees their child progressing from -2.00D to -4.00D in the course of a year, it’s scary. Her axial length was increasing as well.
“This change occurred at a time when kids had switched to online schooling, and many of us observed an increase in myopia in our practices. Hyperopes unexpectedly became myopes. Low myopes became higher myopes. We now observe that the characteristics and the habits of these kids have changed permanently since online schooling. At this point, with Sara, I was able to correct her with a myopia control lens that her parents approved of.
“So, six months pass. Sara’s in myopia control glasses, and she still progressed to a -4.75D. Her axial length in the right eye previously was 23.87 mm, and it went up to 24.09 mm, so that’s a 0.22 mm change. The left eye went from 23.90 mm to 24.04 mm in six months. What do we feel happened? She’s in myopia control glasses. One thing I want to reiterate over and over is that there are certain devices that work better for certain patients. Many of us fit myopia control glasses. We put patients in them with the best intention of slowing their myopia down. Sometimes it doesn’t give us the effect that we want or expect. The glasses weren’t providing the results that I wanted for her. Was there poor compliance? Maybe. I think initially when we were fitting myopia control glasses, they were often falling down the patients’ faces. Was she wearing them full time? Was she taking them off at the computer? I don’t know. However, I do know that there was an undesirable change in the axial length and refractive error even with these glasses. How do we look at that compared to norms? Based on the study by Bullimore and Cheng, a Caucasian child with myopia will have an axial length change of about 0.28 mm per year on average. Sara exceeded that. They’ll also change about 0.69D a year. Sara exceeded that as well in a myopia control lens.”
Switching Treatments
After seeing Sara’s myopia continue to progress with the myopia control spectacles, Dr. Thakrar knew it was time to change treatments.
“The parents had already denied atropine several times. I offered her contact lenses, and she was fit in soft myopia control contact lenses. Six months later, she was -5.25D OU. Her vision with the soft contact lenses was 20/25 in each eye. The over-refraction was plano, so I couldn’t further correct her. The axial length was 24.28 mm and 24.14 mm. Unfortunately, I wish I could have kept her in the contact lenses at that time, but again, the vision bothered her so much that she returned to glasses.”
The Introduction of ACUVUE Abiliti
At this point, Dr. Thakrar shared that another myopia control treatment, Johnson & Johnson Vision’s ACUVUE Abiliti 1 day, was made available in Canada, and she adopted the treatment with Sara.
“ACUVUE Abiliti launched at the end of 2021, which came, in a way, late for Sara, but timely for us because we were running out of options. I put Sara in ACUVUE Abiliti at -5.25D in each eye. The visual acuity with each lens was 20/20, the fit was great, and she was happy.
“Six months later, the refractive error was about -5.50D in the right eye and -5.25D in the left. Once we fit Abiliti, her axial length changed by 0.01 mm in the right eye and 0.04 mm in the left eye. Refraction changed by -0.25D, and the patient reported good compliance. Now, there’s a few factors to consider here. She’s also older, but before this point, she was still changing very rapidly. Looking again at the data from Bullimore and Cheng, on average for myopes, there will be an axial length change of 0.25 mm. Sara was down to 0.01 mm and 0.04 mm. When it comes to spherical equivalent refraction, -0.50D is average for myopes, and Sara was at -0.25D.
“I’ve continued to see Sara over the last few years, and there has been very little change in her refractive error and axial length. She’s stable now and she’s very happy. I’ve put many patients in the ACUVUE Abiliti lens in the past three years, and I’ve had very good success. I’m sure some of us have dabbled in it, but I invite you to try it more. In putting this case together, I was looking at a lot of my patients to track them and see what’s happened over the past three years. Have there been advancements in their myopia? In my clinic, there has been excellent stability with the ACUVUE Abiliti 1 day lens. When I’m putting patients into a soft lens, I always reach for the ACUVUE Abiliti lens first over any other brand.”
Key Takeaways:
- Compliance is an important consideration for driving treatment efficacy.
- The patient was progressing in myopia control specs due to poor compliance, and her visual needs did not meet her active lifestyle.
- For this patient, Abiliti 1-Day was able to offer better vision for her hobbies and activities such as dancing and lead to better compliance and treatment efficacy.
