By Jaclyn Chang, OD

On Wednesday, April 7th, I joined over 400 live participants watching the Hoya-sponsored Canadian Myopia Management Event: Controlling Myopia Today for a Better Tomorrow. Speakers included professor and Dean of the University of Montreal School of Optometry, Dr. Langis Michaud; optometrist, Dr. Devan Trischuk; and INNOVA product specialist, Wayne Stobie.

Dr. Langis Michaud: Any Child Progressing is a potential high myope
Dr. Michaud started off with a detailed overview of the current literature in the field of myopia control. With what we now know, myopia control should be a priority in our offices.

Our goal as optometrists is to prevent our patients from progressing to high myopia, which leads to an increased risk of developing severe ocular pathology, including glaucoma, cataracts, retinal detachments, and myopic maculopathy.

While we can assess a patient’s risk factors, we do not necessarily know which of our patients will progress to high myopia.  Thus, any myopic child who is progressing should be considered for treatment as a potential high myope in the future.

Dr. Michaud stressed the importance of using a customized approach to treatment with the many effective evidence-based options that we now have available. Prescribing single vision glasses or contact lenses to a myopic child who is progressing is no longer the standard of care.

Dr. Trischuk:  In-practice Experience
Dr. Trishchuk, owner of Family Focus Eyecare in Saskatoon, SK, talked about his experience as one of the first offices to fit the Hoya MiYOSMART lens, which uses D.I.M.S. (Defocus Incorporated Multiple Segments) Technology. Since starting in July 2020, he has seen good results with refractive and axial length control in his patients.

With a passion for myopia control, and as a focus of his practice in more recent years, Dr. Trischuk shared his management tips based on years of experience; he emphasized that the initial education is not where chair time should be saved and discussed the importance of setting expectations, early treatment, following up, and involving your whole office.

Wayne Stobie: Axial Length Equipment
Finally, Wayne Stobie discussed equipment available from INNOVA to measure axial length, a key measurement for myopia management.

All speakers then joined for a Q & A session with the audience.

This comprehensive talk provided participants with the up-to-date information needed to more effectively educate and manage our patients. The recording was made available to anyone who signed up and I hope you enjoyed this recap in case you missed it!

For more information please contact your Hoya representative and visit the website.

JACLYN CHANG, OD

Editor NewOptometrist.ca

Dr. Jaclyn Chang graduated from the University of Waterloo (UW) with an Honours Bachelor of Science in Biomedical Sciences before continuing at Waterloo to complete her Doctor of Optometry degree. She is currently a practicing optometrist in Toronto.

Dr. Chang is committed to sharing information and bringing new resources to her colleagues. As a student, she sat on the Board of Trustees for the American Optometric Student Association, organizing events to connect students with industry. She was the Co-Founder/Co-President of the award-winning UW Advancement of Independent Optometry Club, the first club at UW dedicated to private practice optometry. Dr. Chang is also a passionate writer, who aims to make information accessible and easily digestible to her colleagues. She has published in Optometry & Vision Science and Foresight magazine and contributed to Optik magazine. She is excited to bring valuable resources to Canada’s next generation of optometrists with NewOptometrist.ca.


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By Jaclyn Chang, OD

I recently had the chance to discuss how myopic control can benefit our patients with contact lens residency trained optometrist, Dr. Rosa Yang.

Here is the conversation.

Dr. Rosa Yang

Dr. Yang pursued a post-graduate residency program in Cornea and Contact Lenses at the University of Waterloo.

She is the recipient of the Sheldon Wechsler Contact Lens Residency Award from the American Academy of Optometry and was awarded First Place in Clinical Poster from the Global Specialty Lens Symposium.

Dr. Yang has particular interests in myopia control (including ortho-K), dry eye and corneal disease management.

 

Jaclyn:  What myopia control options are available?

Rosa:  There are several options including the MiYOSMART spectacle lenses by Hoya, MiSight soft contact lenses or off-label use of soft multifocals, Atropine, and ortho-K.

As a clinician, I think it is good to be aware of all the options so you can choose the most appropriate option for your patient.

Jaclyn: How do you choose one myopia control option over another for a patient? Is it very individual to that patient’s comfort level and particular case?  

Rosa: I don’t want to oversimplify, but, yes, there are selection criteria where we weigh one option over another. These include prescription, the parents’ budget, and the underlying eye condition.

A big factor is also how comfortable the patient is with handling contact lenses. Do they want to handle the contacts themselves or is it something that the parents might want to be more involved with? For the latter, ortho-K might be the better option because it’s mainly done at home at night.

For a patient who doesn’t want to wear hard contact lenses or glasses, and if the parents are hesitant about putting their kids on a medication (Atropine), soft contact lenses are the option we would be considering.

The only FDA approved soft contact lens for myopia control is MiSight, but it is limited by the fact that it is not available with astigmatism. In patients who have astigmatism, multifocal soft contact lenses can be used to implement the peripheral defocus effects.

Jaclyn: Under what circumstances might you select specifically designed spectacle lenses (like  MiYOSMART) for the patient?

Rosa: Some patients have been wearing spectacles and would like to continue wearing them. For them, it makes sense to keep them in myopia control lenses like MiYOSMART.

There are also patients who are uncomfortable pursuing contact lenses (i.e. they have trouble handling CLs, they are poor CL candidates) or the parents are uncomfortable having their kids on long-term atropine drops, then we would consider spectacles.

MiyoSmart lenses may also have larger prescription ranges than the contact lenses.

Jaclyn: When would you initiate myopia control treatment? Do you monitor until you see progression or initiate at the onset of myopia?

Rosa: Currently there is no consensus amongst clinicians, but when I see evidence of fast progression, then I initiate myopia control. Average progression is -0.50D per year, so anything above that might urge me to start myopia control; sometimes you may want to monitor a little bit more to see.

There are also clinicians that see myopia control as a preventative treatment that should be used more widely, especially considering the global myopia pandemic, so it’s a grey area.

Jaclyn: Are there certain things that we can say to our patients to help them better understand the importance and benefit of myopia control treatment? How can we help them understand the health implications associated with myopia?

Rosa: This is a very good question, because this is a topic that I discuss with every parent when we talk about myopia control. I tell them that the reason we pursue myopia control is not just the high prescription itself, it’s not just the inconvenience of having really thick glasses, it’s the ocular health implication.

“When you have a high prescription, the eyeball is usually more elongated, which means that the tissues in the eyeball get stretched out and are thinner; this predisposes them to certain ocular health complications, some of which are vision threatening. There is a higher risk of retinal detachment, maculopathy, and glaucoma.”

When I emphasize this, parents usually understand. With myopia control, it’s very important that parents understand what you’re doing, why you’re doing it, and how you’re doing it.

Jaclyn: Thanks for that – hearing the way that other doctors counsel always helps me with how I counsel my patients. Education makes such a big difference to patient care. 

Rosa: Yes, exactly, with myopia control, sometimes parents wonder why their child’s prescription still increases. That’s why with myopia control, it’s very important to have a consultation.

The management we’re doing is not to stop myopia, it’s to slow down the progression of myopia; regardless, the child is still going to progress.

Another thing to realize, for example, with ortho-K, is that some parents may think that once you wear the ortho-K lenses, that the prescription is completely gone, so explaining the process and treatment is very important.

Jaclyn: Thank you so much Dr. Yang! This gives our audience some things to think about and implement into everyday practice. 

Previous discussions with Dr. Rosa Yang: 
Pursuing a Contact Lens Residency: 

JACLYN CHANG, OD

Editor NewOptometrist.ca

Dr. Jaclyn Chang graduated from the University of Waterloo (UW) with an Honours Bachelor of Science in Biomedical Sciences before continuing at Waterloo to complete her Doctor of Optometry degree. She is currently a practicing optometrist in Toronto.

Dr. Chang is committed to sharing information and bringing new resources to her colleagues. As a student, she sat on the Board of Trustees for the American Optometric Student Association, organizing events to connect students with industry. She was the Co-Founder/Co-President of the award-winning UW Advancement of Independent Optometry Club, the first club at UW dedicated to private practice optometry. Dr. Chang is also a passionate writer, who aims to make information accessible and easily digestible to her colleagues. She has published in Optometry & Vision Science and Foresight magazine and contributed to Optik magazine. She is excited to bring valuable resources to Canada’s next generation of optometrists with NewOptometrist.ca.


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Dr. Devan Trischuk was born and raised in Yorkton, Saskatchewan

Interest in optometry started from a young age with yearly visits to his OD for stronger glasses due to rapidly progressing myopia

Lectures across Canada to other ODs and health care professionals on myopia management

Dr. Devan Trischuk

Doctorate of Optometry from the University Of Waterloo.

He received the Michael Gutwein Memorial Award for his graduating class at Waterloo (2011)

Selected as one of the top “40 Under 40” optometrists in Canada by Johnson and Johnson Vision (2018)

 

Why did you choose your field?

I was a young, rapidly progressing myope. From age 7 I needed a bump in Rx every ~6 months before eventually plateau-ing in my early 20’s. My childhood optometrist, Dr. Ron Rogoza, always brought such positive energy, laughter and smiles to my appointments that I always looked forward to them. (I also looked forward to more minus, like all good myopes 😉 )

These fond memories paired with an interest in math/science/healthcare directed me towards optometry as a career.

What changes to eye care do you see coming down the pipe?

I see myopia management becoming the standard of care for myopic children. I look forward to the day when the awareness in the general population of this specialty area results in parents/guardians expecting myopia management for their child.

Hopefully this increased awareness also results in preventative measures being taken – time outdoors, appropriate amounts of near work, future preventative treatments (?) – so that there is an improvement in the global projections of increasing myopia and severity.

What is something you have done in your practice to set you apart.

Offering a wide range of myopia treatment options.
The ability to tailor a treatment plan to each child’s exam findings/visual needs/family dynamic coupled with the constantly increasing number of evidence-based, effective treatment options has allowed more families to access myopia management than ever before.

What business books would you recommend other ECPs read?

‘How to Win Friends and Influence People’ – Dale Carnegie.
A great book for anyone to read – improve your work and personal life.

What advice would you give a new grad today?

Shadow more senior practitioners – there is an immense amount that can be learned from observing those years of experience in action.

Last time you laughed?

Being a human jungle gym for my kids.
Listening to my 4.5 year old daughter describe her perception of the world around her.

What’s your Favorite food?

My wife’s Prime Rib with a nice red wine.

Favorite past-time/hobby?

Previously it was taking in outdoors/sports for my own enjoyment, but it has now shifted to instilling (forcing?) a love of outdoors/active lifestyle in my children.

You can listen to Dr. Trischuk discuss his perspective on myopia control on our Eyes Wide Open Podcast. 


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Dr. Devan Trischuk, OD shares his perspective on myopia control with host Dr. Glen Chiasson. In particular, they discuss the place for a truly effective new spectacle lens option, MiyoSmart, as part of the myopia management kit tool.


About the Guest

Dr. Devan Trischuk’s interest in optometry started from a young age with yearly visits to his optometrist for stronger glasses due to his rapidly progressing myopia. He was born and raised in Yorkton, SK, completed his Bachelor of Science – Honours Physiology degree at the University of Alberta in 2007 and his Doctor of Optometry at the University of Waterloo in 2011. He received the Michael Gutwein Memorial Award for his graduating class at Waterloo.

Dr. Trischuk has taken his interest in Myopia Management a step further and has begun lecturing across Canada to other optometrists and health care professionals on this topic. He is in private practice in Saskatoon.

 


Episode Notes

Dr. Devan Trischuk discusses his personal motivation to pursue help for young myopes and improve their quality of life.

He shares information on the evolution of spectacle lenses in the treatment of myopia and the reasons he is impressed with the the most recent addition to the tool kit – MiyoSmart lenses from Hoya.

Dr. Trischuk deems this new option as effective as the best conventional myopia management options available based upon the results of clinical trials. He outlines why and when he considers the spectacle lens as a first choice treatment option and discusses how his patient follow up plans have evolved with experience.

Dr. Trichuk provides an overview of the D.I.M.S mechanism of action to slow down axial growth.

Finally, Dr. Trichuk discusses how to address, or preempt, the pricing discussion with patients’ given the differential between standard single vision lenses and this specialty lens option.

Resources

 

 

Dr. Glen Chiasson

Dr. Glen Chiasson

Dr. Glen Chiasson is a 1995 graduate of the University of Waterloo School of Optometry. He owns and manages two practices in Toronto. In 2009, he co-hosted a podcast produced for colleagues in eye care, the “International Optometry Podcast”. He is a moderator of the Canadian Optometry Group, an email forum for Canadian optometrists. As  a host of  “Eyes Wide Open”, Glenn  looks forward to exploring new new technologies and services for eye care professionals.

Dr. Chiasson enjoys tennis, hockey, and reading. He lives in Toronto with his wife and two sons.

Dr. Chiasson splits EWO podcast hosting duties with Roxanne Arnal.


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Eyes Wide Open Podcast Host, Dr Glen Chiasson explores the field of myopia management, particularly the use of new spectacle lens options from ZEISS that are specifically designed to reduce myopic progression in children.

Glen interviews Dr. Jeff Goodhew, who launched their optometric practice into myopia management four years ago. Along the way, Jeff and business-life partner Dr. Tina Goodhew, learned about the new technologies and evolved their practice protocol to optimize how patients and parents were educated about treatment options for myopia control.

Best Quote:

“We can’t think that glasses are simply a fix for the refractive error, they are a therapeutic option to treat myopia.”

 


Dr. Jeff Goodhew

About the Guest

Dr. Goodhew graduated from the University of Waterloo with his Optometry degree in 1993 and became therapeutically licensed in 2000. He enjoys being an active part of his profession, having served as the President of the Ontario Association of Optometrists from 2014 through 2016. Dr. Goodhew also served as the co-chair of the National Public Education Committee for the Canadian Association of Optometrists. Dr. Goodhew has served as a consultant/speaker for ZEISS, Alcon, Johnson & Johnson Vision Care and Cooper Vision.

 


Episode Notes

The Brien Holden Institute predicts that ½ the world’s population will be myopic by the year 2050 and the linkage of severe juvenile-onset myopia to later-in-life serious eye diseases is well-known.

Jeff offers tips on integrating myopia management into your practice, and the need for well-defined processes to optimize patient care and define a practice protocol.

He discusses ZEISS spectacle lens options for myopia management, and what role these more benign treatment options play in myopia management, including their mechanism of action, which lens option to use for various cases and what results might be expected.

Dr. Goodhew stresses the opportunity in myopia control for Optometry and shares an interesting anecdote about an encounter with a Family Physician on the role of Optometry versus Ophthalmology.

Resources

 

Dr. Glen Chiasson

Dr. Glen Chiasson

Dr. Glen Chiasson is a 1995 graduate of the University of Waterloo School of Optometry. He owns and manages two practices in Toronto. In 2009, he co-hosted a podcast produced for colleagues in eye care, the “International Optometry Podcast”. He is a moderator of the Canadian Optometry Group, an email forum for Canadian optometrists. As  a host of  “Eyes Wide Open”, Glenn  looks forward to exploring new new technologies and services for eye care professionals.

Dr. Chiasson enjoys tennis, hockey, and reading. He lives in Toronto with his wife and two sons.

Dr. Chiasson splits EWO podcast hosting duties with Roxanne Arnal.


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According to the Brien Holden Institute the number of global myopes will reach 2.5 billion by 2020.  While the alarming incidence rates, severity and sight-threatening consequences are often reported in the context of Asian populations, Canada is not immune to the myopia epidemic. Myopia is not just an issue in the high Asian populations in our urban centers.

A Canadian pilot study in a suburban area by M. Yang et al. (Univ. of Waterloo) reports an increasing rate of myopia from 6% in 6-8 year olds and 29% in the 11-13 year cohort, and that 35% of myopic children were uncorrected.  Canadian Optometry needs to be ready to answer the call.

MYOPIA AND OPTOMETRY: IT’S OURS TO OWN.
Scott Mundle, makes the case for Optometry to take the lead in Myopia Control before others do.

Click Here to View Article.

Historically, the treatment options included the use of specialized contact lenses using Ortho keratology, atropine eye drops and lifestyle counselling. Ortho-K has garnered loyal advocates and remains a very useful tool in the armamentarium of the eye care practitioner.

New Convenient Modalities are Welcomed Additions
More recently newer medical device options, specifically indicated for myopia management, offer more familiar choices device options in the form of spectacle lenses and soft contact lenses.  Do these new treatment options offer a possibility of broadening the number of optometrists that engage in myopia management? Only time will tell. But the addition of well researched, clinically effective, practical, and well-accepted modalities is a welcome development. addition.

Bifocal and Progressive spectacle lenses have, of course, been widely used by practitioners for many years, and there are many studies which have evaluated their efficacy.

Dr. Farah Sunderji, Calgary, has done an excellent job of summarizing the historical use and clinical results of traditional spectacle lenses in a recent article in Clinical & Refractive optometry.

Her review of studies using traditional bifocal and progressive spectacle lenses shows a limited efficiency in the use of such lens designs, except in a relatively small sub-set of children with near esophoria.

New Specifically Designed Spectacle Lenses Now Available
Dr. Sunderji also documents the extensive design analysis and clinical assessments of new lens designs for myopia management.

These new spectacle lens designs have their basis in the widely accepted causal theories of myopia, including the accommodative lag (AL) theory and the peripheral defocus theory that hyperopic blur on the periphery of the retina stimulates myopic onset and progression.

ZEISS MyoKids Pro, a customized PAL design specifically for myopia management, was developed from extensive design analysis of various PAL designs. This analysis points to lens design with more negative horizontal mean power gradients adjacent to the near zone are more effective. Also, beyond standard PALs, this new lens design coupled with advanced technology facilitates optimization for children’s unique facial characteristics.

ZEISS MyoVision Pro, based on the peripheral defocus principles, is a good choice for childing currently wearing single vision lenses looking for the easy wearing and adaptation properties of Single Vision Lenses.

The use of new spectacle lens designs provides a familiar and comfortable option to eye care practitioners wishing to engage in myopia control and offer an opportunity to bring more ECPs into the arena and supports long-term benefits to patients and their families.

FOR MORE INFORMATION:

New Spectacle Lens Designs Specifically for the Management of Juvenile-Onset Myopia
Farrah Sunderji, OD

This article is available as a complimentary COPE-Accredited Course online at Clinical & Refractive Optometry made possible by an unrestricted education grant from Carl Zeiss Canada Ltd.


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I’m honoured to be speaking to you along with my colleagues, friends and people within our optometric community whom I respect and admire for the impact they have on our profession.  I will start us off in my capacity with the World Council of Optometry (WCO) to give you a global perspective of myopia and the impact that its upcoming epidemic will have on our patients, our practices, but even more so its impact the world over.  I hope to illustrate to you the etiology, some new findings and current realities, and the risks to adult vision.

I think it is important, first, for everyone to have a brief history, specifically of WCO’s role and its relationship with myopia and myopia control and how central it is to this talk in a broader sense.

The reason WCO is important to us in Canada is because even though we are the beneficiaries of all those who have created our position and our role in the Canadian healthcare system, there currently is no official national strategy on vision care in Canada.  One of the reasons that Canada is not mandated to have one is because the vision care sector has virtually no presence at the World Health Organization.  There is no secretariat or office dedicated to vision.  As a matter of fact, we are under Non-Communicable Diseases and currently in Disabilities and Rehabilitation.  It’s actually very difficult to find us there!

Because there is no such directive from the WHO to its member countries, including Canada, there is no formal national mandate.  This is a bigger issue globally where optometry is often not recognized as a healthcare player, including in much of Africa, Asia and Latin America.  And you will be shocked to hear that even France does not recognize our profession and, as a matter of fact, it’s illegal to be an optometrist in France.

The World Health Organization estimates that 285 million people suffer from moderate to severe vision loss with 39 million considered blind.  Of these, 123 million or 43% have uncorrected distance refractive errors.  Uncorrected refractive error is the leading cause of visual impairment globally which places a financial burden on the economy, is a significant contributing factor to poverty, and is avoidable.

Our WCO Councils and Presidents have done a tremendous job of advocacy with our federal governments in recent years.  In the last 15 years, Canada has signed on to the only two WHO-recognized vision care sector programs: VISION 2020: The Right To Sight, and the Global Action Plan for the Prevention of Avoidable Blindness and Visual Impairment 2014 to 2019, where the goal is to reduce avoidable blindness by 25% by 2019.

So why is WCO and its relationship with the WHO important to us as Canadian optometrists?  The next wave of WHO Sustainable Development Goals will be passed at the General Assembly for the WHO in 2020 and one item under the mandate of the new Director General is Universal Health Coverage.  It is our aim, along with our partners in the International Agency for the Prevention of Blindness, to have the vision care sector recognized globally by the WHO within the broader public health arena.  That has never happened before, and if we don’t get in this time it will be 10 years before we have another chance at this.

This directive runs until 2030.  We have the attention of WHO and this directive is not being led by ophthalmology, and that is a first.  Having such a WHO directive given to the federal government officially opens the door for formal dialogue for a National Vision Care strategy that is good for the public and our profession.

Remember, we own myopia and this impending crisis is ours to lead.  But if we don’t take the lead, others are already lining up to own it.  Along with the Brien Holden Vision Institute, the WCO recently announced Myopia Awareness Week for 2019. There are details to follow.

I felt it imperative to lay the groundwork for this talk by giving everyone an update on how optometry is recognized globally and what role we need to play in the management of myopia both here in Canada and globally.

 

SCOTT MUNDLE

OD, President, World Council of Optometry


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