First myopia correction - A clinical leader case study

GS is an 8-year-old girl with a father from Brazil and mother from Poland, who presented with difficulties seeing the board at school. On her previous visit, she was R&L: -0.25DS. However, this eye examination showed a myopic refraction of R:-1.75D L:-2.00D. Both of her parents are emmetropic with no myopia family history.

• Initial diagnosis was a shock and overwhelming
• Concerns about child's age for contact lenses
• Concerns about cost

• Providing information and using an online calculator
• Reassuring parents of successful contact lens fitting in children
• Giving parents the time to understand the diagnosis

GS is a keen reader and plays netball at school. She also swims once a week at school. Being an active person, contact lenses would be a more convenient vision correction option for the child, as well as offering the ability to slow myopia progression.

The key concerns in communicating myopia management were:

• GS' parents were shocked at the diagnosis of myopia because there was no family history. They were worried about their child's performance at school and how she would manage now that she needed a spectacle correction. The parents were still coming to terms with the initial diagnosis of myopia so wanted to 'wait to see' with a spectacle option first, before considering contact lenses.
• While the initial diagnosis was overwhelming for the parents, the child was less concerned about having to wear spectacles in the first instance, and proceeded well with them. As no myopia management spectacles were available at that time, the only spectacle option was single vision.
• Contact lenses for myopia management were discussed as the better option compared to single vision spectacles, but the parents thought that their 8-year-old child was too young for contact lenses.
• The mother was initially concerned about the cost but also wanted to do the best for her child.

The discussion points which helped to address these concerns were:

• As they had no prior knowledge about myopia, the parents were given the relevant information about myopia and the option of MiSight® 1 day contact lens as a modality for correction of her sight and also to slow the rate of myopia progression.
• Her mother was directed to the practice website to read more about contact lenses for children and myopia management.
• An online myopia calculator was used to demonstrate the potential risk of not commencing active myopia management.
• Her mother was also reassured that for the vast majority of children who wear contact lenses, it is a healthy way to correct their refractive error. They were advised not to wear contact lenses while swimming, while maintaining a wearing time of at least 6 days per week, 10 hours per day.
• As they were new to myopia, just the fact that their daughter need spectacles was a shock to them. They needed time to process this information, so we agreed to review GS in 3 months time.

At the 3-month follow-up, the child had progressed in her single vision spectacles to R -2.50DS L -2.50DS. The mother already had the information at hand from the last visit where contact lenses had been discussed, and upon seeing her daughter's myopia progression, wanted to proceed contact lenses immediately. I applied a pair to the child's eyes and the mother could see how well her child managed.

MiSight® 1 day R:-2.50D L:-2.50D

The child loves wearing contact lenses. She likes that she can play netball without spectacles, and feels more comfortable with her vision in contact lenses compared to when wearing spectacles.

• Having an honest and empathetic conversation with the parent (and child) is important. Discovering the parents' understanding of myopia is crucial in guiding the conversation - you may have to start from scratch with an emmetropic parent, compared to a myopic parent who understands the frustration and visual impact of progressive myopia and the impediments of spectacles.
• Providing information through the conversation, which is then backed up with written or web-based information, helps the parents to understand and process the information in their own time.
• The decision to undertake myopia management is usually built on trust. Sometimes you may have to see a child 3 months later and monitor progression, in order to earn trust over time.

FDA Indications for use (US only): MiSight® 1 day (omafilcon A) soft (hydrophilic) contact lenses for daily wear are indicated for the correction of myopic ametropia and for slowing the progression of myopia in children with non-diseased eyes, who at the initiation of treatment are 8-12 years of age and have a refraction of -0.75 to -4.00 diopters (spherical equivalent) with ≤0.75 diopters of astigmatism. The lens is to be discarded after each removal.