Singapore Optometric Association

Myopia Control & Specialty Contact Lens Updates

Recently I’ve attended three different conferences ; one in Vegas USA – GSLS ( Global Specialty Lens Symposium ), one in Shanghai – COOC ( International Congress of Ophthalmology & Optometry China ), one in Houston USA – Vision by Design. Each of them have different focuses & interesting information and I would share the updates here.

In GSLS, the symposium was attended by about 600 delegates from 36 countries, it is a record turn out of its kind. As the name implies, this symposium is about the latest developments of the  Specialty Contact Lenses. The two main theme of this Symposium are Ortho-k & Scelral Lens.

In US, Myopia Control have take on a whole new meaning, as it is no longer a Chinese population epidemic. The Myopia prevalence in US have increase 15% over years – from 25% in 1979 to 40% in 2004, it is estimated to be closed to 50% currently.

Prominent figures like Brian Holden, Earl Smith, Thomas Aller, Lyndon Jones, Pat Caroline etc share theirs latest study & there are many others excellent speakers presentations. From these studies – Hyperopic Periphery Retinal Defocus have been shown to be a major contributor for Myopia Progression. Soft Multifocals lenses like Proclear & others have also been shown to work well & similar lens design will likely be available commercially soon.

For specialty contact lens, it is probably not exaggerating to say that nowadays we can fit almost everyone with a contact lens to suit their needs. Not only because of the type of lens we have at our disposal , but also the cutting edge design & precision we are can getting now. 

Ortho-k, Scelral lens, Hybrid lens, Custom Multifocal Soft/RGP/Toric are & should be at some stage in our professional life be employed in our arsenal of expertise fitting. 

There are especially huge interest in Ortho-k among delegates because of the results seen in controlling for Myopia Progression. There are also study showing for low myope using Ortho-K, the peripheral retina myopic defocus may not be enough to achieve good myopia control. Therefore the newer approach will be to put in high enough plus near the reverse zone design to achieved that. Free form designs like Wave, Orthotools, Eyespace etc are gaining more popularity as they can be used on all sorts of cornea shapes & achieved good results.

Ortho-k have also been used to correct Presbyopic & Hyperopic patients with good success.

For Scelral lens, whether the patient have severe dry eyes, keratoconus, very high cyl, more & more OD are starting to consider this as 1st lens of choice over using RGP. The newer Scelral designs also allow better fitting results on Post graft, post Lasik , Multifocal. More & more practitioner are also utilizing OCT to enhance their fitting & problems solving in their specialty contact lens practice.

Moving on to COOC Shanghai, the conference presentation is a mix of ophthalmology & optometry . Interestingly, majority of the Ortho-k fitting done in China are fitted by Eye Doctors who are based in or affiliated to the hospital. There are some hospital who have a dedicated Ortho-k dept/clinics that fit hundreds of cases every month. 

Tremendous turnout in the COOC in Shanghai for the Ortho-k conference was seen & the commitment of the delegates to learn was obvious. China Ortho-k association have over the past few years build & established a strong link with American Academy of Orthokeratology & there is a constant upgrading effort & training going on.

Currently, there are estimated 1.5 millions Ortho-k wearers in China but only eight designs of  Ortho-K lenses are allowed to be prescribed in China. China eye doctors predominantly prefer prescribing Ortho-K as treatment option compare with using Atropine in treating Myopia Progression.

Last but not least, Vision by Design in Houston, the conference was attended by about 400 participants, breaking all past year records.

Vision by Design conference was totally committed to Ortho-K & Scelral Lens latest designs & fittings, as well as Myopia Control latest understandings.

The different workshops & wet labs are cater for both seasons fitter or newbies, there are a slew of different lens company with different designs you can choose for your practice needs. 

Passionate practitioners of Ortho-K & Scelral fitting share their knowledge through various platform& talks. Intricate part of fitting, aftercare, practice management, problems solving was explore & discussed. 

Axial length measurements are also being recommended & used for a reliable measurements on whether Myopia Control treatment in Ortho-K is successful.

Most doctors now used H2O2 instead of RGP solution as their 1st choice of care for Ortho-k, but some would add a cleaning step to enhance the lens performance, most also advocate yearly replacement. The doubt of whether Scelral lens are providing enough Oxygen to cornea are also put to rest with various studies results

There is also clinical trials trying to find out a design better suited for Asian Chinese eyes in Orthokeratology.

Future development of Refractive Cross Linking for Myopia Control was also talked about.

Hope the updates help & wish to see more Singapore familiar faces in the future meetings

By Mr Chew Wai Kwang