How has Ireland embraced the use of myopia control contact lenses?

Paper title: Prescribing patterns of myopia control contact lenses among optometrists in Ireland

Authors: Michael Moore (1), Daniel Ian Flitcroft (1,2), James Loughman (1)

Date: Jan 2023

Reference:   Moore M, Flitcroft DI, Loughman J. Prescribing patterns of myopia control contact lenses among optometrists in Ireland. Ophthalmic Physiol Opt. 2023 Jan 18. [Link to open access paper]

Interventions for managing myopia such as contact lenses^1,2, spectacle lenses^3,4 and pharmaceutical therapies⁵ have been shown to be effective in reducing myopia progression and axial length growth.

Myopia control contact lens (MCCL) options were made available in Ireland in 2017. In 2021, The World Council of Optometry advised eye care practitioners that comprehensive myopia management should adopted as the standard of care for myopic patients.⁶ 

 This retrospective study examined anonymous electronic medical record (EMR) data of children aged 5 to 18yrs from 33 optometry practices in Ireland between 2017 to 2021, with the aim of investigating the uptake and prescribing patterns of contact lenses for myopia control.

The demographic, visual acuity and refractive error data of each child was included in the analysis. They had myopic spherical refractive equivalent errors of -0.50D or stronger and were identified as progressing myopes if they had an annualised myopic progression rate of -0.25D or worse between consecutive visits. Progression as a factor in prescribing MCCLs was considered in 0.25D steps between 0.25D and 1.00D per year.

Patterns of prescribing were considered in terms of patient age, degree of myopia and rate of progression for those fitted with MCCL.

• Data was available for 12,484 myopic children who satisfied the study criteria, 2609 of which were progressing myopes.
• Of the 33 practices who had supplied EMR data, 27 had fitted children with contact lenses but only 10 had prescribed MCCL of any type.
• Usage of MCCL rose from 3% of contact lens fittings in 2017 to 27% in 2021 (initially 3 optometric practices, rising to 10).
• The prescribing patterns for MCCL changed from being predominantly off-label multifocal centre-distance design lenses with either +2.00D or +2.50D addition in 2017 (92%) to MiSight 1 day (CooperVision) being used for 87% of the fittings by 2021.

The predictive factors for children being fitted with MCCL were the practice visited, the year of examination, being younger than average when fitted (12.2yrs vs. 15.4yrs) and being more myopic when fitted (-3.46D compared to -3.03D for standard soft lenses fitting).

When myopic progression and the practice attended was investigated, the multivariate regression modelling found 4 practices where children with progression rates of -0.50D or more were likely to be fitted with MCCL. However, this only held true for those 4 practices and not the other 6 practices which also prescribed MCCL.

Practitioners in Ireland were increasingly willing to prescribe myopia control contact lenses after they were made available and an increasing number of progressing myopes were being fitted with MCCL

• However, uptake was still limited and practice-dependent in 2021 where more than 2/3 of practices were not offering MCCL options and were providing refractive correction only
• Eye care practitioner (ECP) barriers to prescribing MCCL may have included concerns over inadequate training or equipment needed. Parental concerns may be the costs involved or lack of awareness of the importance of myopia control.

MiSight was the first soft contact lens licensed in Europe for myopia control and the high uptake of the lens in this study may signal a parent and practitioner preference for a licensed product

• However, the preference may also be due to a general increase in soft lens fitting and decrease in rigid lens fitting in the UK over the last 20yrs⁷ along with a perceived need for specialist equipment and experience to offer orthokeratology as an alternative.
• At the time of the study, MiSight was available up to -6D but 1.4% had a spherical equivalent error of -6.50D or more and over 13% had astigmatism of 1D or higher.
  • An over-reliance on one product for myopia control with a limited fitting range may have led to some children being offered single vision correction only.

MiSight has since been expanded to include up to -10D, allowing more myopic children to be fitted. Find out more about the options for myopia management where astigmatism is present here.

This study highlighted that although the proportion of progressing myopes being fitted with MCCL had increased each year, many practitioners were still not engaging in active myopia management practice, potentially leaving fast-progressing myopes in single-vision only options.

The EMR data in this study was extracted opportunistically as part of an ongoing optometric epidemiology project.

• However, when the results were compared to those found from practitioner surveys, similar prescribing patterns were found. The surveys also found an increasing rate of MCCL prescribing over recent years.
• Differences included children in this study reaching higher levels of myopia before being fitted with a MCCL treatment option, and more practitioners in the surveys prescribed orthokeratology.

Using the EMR data has provided an accurate sample of prescribing over the 2017-2021 period, especially when there is a lack of data on prescribing patterns in Ireland. Surveys may have potential bias with some practitioners having a particular interest in the area. Limitations for this study include the potential country-specific findings, the lack of multiple practices surveyed, the retrospective study format and lack of ability to confirm cycloplegic refraction.

Title: Prescribing patterns of myopia control contact lenses among optometrists in Ireland

Authors: Michael Moore, Daniel Ian Flitcroft, James Loughman

Purpose: This retrospective analysis of electronic medical record (EMR) data investigated the prescribing patterns of soft myopia control contact lens (MCCL) treatments since their introduction in Ireland in 2017.

Methods: Anonymised EMR data were sourced from 33 optometry practices in Ireland from 2017 to 2021 to determine the number of practices prescribing MCCLs to myopic children 5-18 years old. In MCCL prescribing practices, the proportion of contact lens wearing children fitted with MCCLs and the proportion of progressive (≤−0.25 D/year) myopic children fitted with MCCLs were determined. Logistic regression was used to determine which factors influenced the likelihood of being prescribed a MCCL.

Results: Overall, just 10 practices were found to prescribe MCCLs of any type. The Coopervision MiSight contact lens was used in 85% of all MCCL fittings with most other fits being off-label multifocals. The use of MCCLs rose from 3% of contact lens fits in 2017 to 27% in 2021. Children fitted with MCCLs were on average younger (12.2 ± 2.3 years vs. 15.4 ± 2.1 years) but more myopic (−3.46 ± 1.84 D vs. −3.03 ± 1.69 D) than those fitted with standard contact lenses. The most predictive factors for being fitted with MCCLs were year of examination (OR: 2.54, 95% CI: 2.13, 3.03), younger age (OR: 1.52, 95% CI: 1.39, 1.64) and greater myopia (OR: 1.25, 95% CI: 1.11, 1.39).

Conclusions: Clinician engagement in myopia management has increased in Ireland since the formal introduction of MCCLs, but more than two-thirds of practices included are yet to offer this form of myopia management. The proportion of children with progressive myopia that has been prescribed MCCLs has increased, but the majority of children are still managed for vision correction only. There is significant scope for improving the uptake of evidence-based myopia control treatments and for optimising the age and degree of myopia at which such interventions are initiated.

[Link to open access paper]