French OPHTAMYOP study reveals trends in myopia control

There is a significant difference in accessibility of eye care in different regions and for families with different lifestyles. Image credit: ©Chanintorn.v – stock.adobe.com

Myopia is a rapidly increasing global health concern and is one of the leading causes of vision impairment today.^1-4 By 2030, the World Health Organization (WHO) predicts that 40% of the global population will be living with this condition. Although myopia has historically been considered untreatable, innovations, especially in ophthalmic optics, now offer a chance to halt its progression in children with the condition. One such innovation is Defocus Incorporated Multiple Segments (DIMS) spectacle lenses, the technology behind HOYA Vision Care’s MiYOSMART.

Conclusions and limitations of a French-based study

Data from an interim analysis of the observational French study OPHTAMYOP has demonstrated a significant trend of myopia control with DIMS spectacle lenses in children aged 4 to 16 years with progressive myopia and spherical equivalent refraction from
–0.25 D to –8.00 D. Obtaining country-specific efficacy data is essential for unlocking access to this treatment for children globally through approvals and reimbursement support.

The research from this study is in line with a larger bank of clinical data supporting the efficacy of DIMS spectacle lenses; 6-year data on their use in Chinese children found that, on average, the technology slowed myopia progression by 52% and axial elongation by 62%. However, these averages include extremes on both ends of the spectrum: spectacle lenses completely stop myopia progression in some children but are ineffective in others.

Large study populations are essential to understand myopia physiopathology

More research is required to deepen our understanding of myopia physiopathology and why children respond differently to treatment. To do this, we must study large population sizes. Key DIMS studies in China⁵ have the largest populations, so future Chinese studies present the best chance of performing this data drill down.

To increase opportunities to grow our study populations, we must increase awareness. Not enough parents know that myopia control is a possibility. To ensure that as many children as possible have access to this treatment, education on their options is essential.

Myopia’s causes are multifaceted

Looking at the bigger picture, we see different trends in myopia prevalence and treatment efficacy in populations around the globe for geographic, environmental and genetic reasons. Myopia progresses faster in Asian children and begins at an earlier age on average than in European children.⁶ We understand that early-onset myopia tends to progress fast—in these circumstances, myopia can sometimes be more difficult to control.

The highest prevalences of myopia worldwide are seen in urbanised East Asian regions such as Taiwan, Singapore and Shanghai, China; in Australia and European countries such as the Netherlands and UK, the prevalences are much lower.⁷ When discussing European populations, however, it is worth noting the environmental and behavioural differences between countries. In Spain or Italy, for example, children tend to spend a lot of time outside. In Nordic countries, where there are long periods of darkness, children may spend less time outside.

Living conditions are a key prevalence factor, again with a strong link to behavioural trends. Myopia is less common in rural areas than in urban areas worldwide, and weather and pollution levels can impact its prevalence.⁷ An epidemiological study conducted by HOYA Vision Care found a strong correlation in Scottish children between residing in flats and myopia prevalence, which increased following the COVID-19 pandemic with a link to increased screen time.

Treatment choices depend on how easy it is for children to access eye care. For example, there is a significant difference in accessibility of eye care between a big city such as Paris and a small town in the centre of France.^8,9

Education, personalisation and affordability are critical

As the global population of children with myopia increases, eye care stakeholders should focus on three key action areas: education around preventative action, personalisation of treatment and affordability.

Mitigating environmental and lifestyle factors is widely recognised as critical for preventing the development and progression of myopia.^10-13 Parents and policymakers must be educated on implementing vision-friendly behaviours such as limiting screen use and encouraging time outdoors. The WHO has underlined the importance of this with the launch of its SPECS 2030 initiative, which intends to raise awareness, develop advocacy and strengthen refractive error services to help tackle myopia.

Secondly, myopia control protocols should be personalised to fit the specific needs of each child and their parents’ capacities, especially through the utilisation of combination management systems; for example, alternating between DIMS spectacles and contact lenses if the child plays a lot of sports, or combining DIMS spectacles with atropine drops if the myopia is progressing very rapidly. In clinical practice, I have seen a positive difference utilising combination systems in these patients—especially those who don’t respond as well to DIMS. We need more data to support this being rolled out on a larger scale.

The final area of focus is affordability. In France, DIMS lenses have been recognised as a treatment for myopia progression and will soon be eligible for insurance reimbursement. However, across much of Europe, there is no such reimbursement for myopia treatments, putting them out of reach for many children. This access barrier underlines the importance of prioritising myopia management by governments, policymakers and healthcare stakeholders. It also emphasises the importance of the study itself, as this data is required to support reimbursement by highlighting the value of myopia treatment.

The bright future

As we look to the future, I hope we deeply understand myopia’s
physiopathology, explore combination systems further, develop protocols to associate different treatment modalities with individual needs and stop rapid myopia progression in its tracks. Moving forward, I also hope we improve screening for myopia in children and can swiftly enact management solutions once the condition has been detected.

The evolution of myopia management over the past decade has been fantastic. Children and their parents now have choices. It is a great pleasure to be a part of this adventure, contributing to a better future for children’s visual health, which is so important for their lifelong well-being.

*MiYOSMART spectacle lenses have not been approved for use in the management of myopia in all countries, including the US, and are not currently available for sale in all countries, including the US.

References

1. Chua SYL, Foster PJ. The economic and societal impact of myopia and high myopia. In: Ang M, Wong T, eds. Updates on Myopia. Springer; 2019:53-63. Accessed November 8, 2024. https://link.springer.com/
chapter/10.1007/978-981-13-8491-2_3

2. Tomiyama E. Myopia: an epidemic of global proportions. Optometry Times. March 21, 2024. Accessed November 8, 2024. https://www.optometrytimes.com/view/myopia-an-epidemic-of-
global-proportions

3. Sankaridurg P, Tahhan N, Kandel H, et al. IMI impact of myopia. Invest Ophthalmol Vis Sci. 2021;62(5):2. doi:10.1167/iovs.62.5.2

4. Bremond-Gignac D, Le Meur G, Bonifas C, Colliot JP, Mortemousque B; study group OPHTAMYOP. OPHTAMYOP study myopia control in French children treated with defocus incorporated multiple segment spectacle lenses: interim analysis. Presented at: 49th European Paediatric Ophthalmology Society Annual Meeting; September 12-14, 2024; Paris, France.

5. Lam CSY, Tang WC, Zhang HY, et al. Long-term myopia control effect and safety in children wearing DIMS spectacle lenses for 6 years. Sci Rep. 2023;13(1):5475. doi:10.1038/s41598-023-32700-7

6. Lam CS, Tang WC, Lee PH, et al. Myopia control effect of defocus incorporated multiple segments (DIMS) spectacle lens in Chinese children: results of a 3-year follow-up study. Br J Ophthalmol. 2022;106(8):1110-1114. doi:10.1136/bjophthalmol-2020-317664

7. Matsumura S, Ching-Yu C, Saw SM. Global epidemiology of myopia. In: Ang M, Wong T, eds. Updates on Myopia. Springer; 2019:27-51.
Accessed November 8, 2024.
https://link.springer.com/chapter/10.1007/978-981-13-8491-2_2

8. Jones-Jordan LA, Sinnott LT, Chu RH, et al; CLEERE Study Group. Myopia progression as a function of sex, age, and ethnicity. Invest Ophthalmol Vis Sci. 2021;62(10):36. doi:10.1167/iovs62.10.36

9. Fricke T, Morjaria P, Sankaridurg P. Who is at risk of myopia? Community Eye Health. 2019;32(105):16. Accessed November 8, 2024. https://pmc.ncbi.nlm.nih.gov/articles/PMC6688409/

10. Biswas S, El Kareh A, Qureshi M, et al. The influence of the environment and lifestyle on myopia. J Physiol Anthropol. 2024;43(1):7. doi:10.1186/s40101-024-00354-7

11. Conway M. Increasing myopia and associations with deprivation and rural/urban environments in children aged 3.5-5.5 years in Scotland. Presented at: 19th International Myopia Conference; September 23-28, 2024; Sanya, China.

12. Robert MP, Daruich A, Bremond-Gignac D. Myopia: insights from a population-based survey. Acta Ophthalmol. 2024;102(5):e869–e870. doi:10.1111/aos.16687

13. SPECS 2030. World Health
Organization. Accessed November 8, 2024. https://www.who.int/initiatives/specs-2030

Dominique Bremond-Gignac, MD, PhD, FEBO

Bremond-Gignac is a professor and head of ophthalmology with paediatric ophthalmology subspecialties at University Hospital Necker-Enfants Malades and Paris Cité University in Paris, and head of the Paris Orthoptic Department in innovation therapy, CLAIROP Research Clinical Center, and OPHTARA – Reference Center for Rare Diseases in Ophthalmology. She is active in clinical practice, teaching and research across the paediatric anterior segment, ocular surface, strabismus and myopia control in children. She has contributed over 240 peer-reviewed publications in ophthalmic literature and over 50 books and chapters. In 2019, she received an Al Biglan Medal of Distinction from Pittsburgh University, and has received the French Legion of Honour from the French Government. She is an executive member of the World Society of Paediatric Ophthalmology and Strabismus, and joined the International Myopia Institute Advisory Board in 2024.