In November 2020, CooperVision’s MiSight 1 Day lenses received U.S. Food and Drug Administration (FDA) approval, indicated for the correction of myopic ametropia and for slowing the progression of myopia in children who have non-diseased eyes and who at the initiation of treatment are 8 to 12 years of age and have a refraction of –0.75D to –4.00D (spherical equivalent), with ≤ 0.75D of astigmatism. MiSight’s ActivControl technology utilizes an optic zone concentric ring design. CooperVision says that two vision correction zones provide the label power, and two alternating treatment zones provide 2.00D of defocus to slow myopia progression. This allows a child to see clearly while benefitting from the treatment effect, according to the company.
MiSight lenses are manufactured in omafilcon A material. Parameters include sphere powers of –0.50D to –6.00D in 0.25D steps, 8.7mm base curve, and 14.2mm diameter.
As of March 2020, the lenses were available to certified practitioners as part of the CooperVision Brilliant Futures Myopia Management Program. According to CooperVision, the program includes a transparent, defined protocol for care, meaning that patients are aware of everything included in the program (including services and lenses) while promoting confidence and efficiency for eyecare practitioners (ECPs); free product shipping and returns, creating no-hassle product availability for patients and enabling better compliance for wearers while removing the guesswork from developing and marketing a supply strategy for ECPs; and an interactive mobile app to keep patients engaged with the practice and their program of care, providing convenient access to myopia management information, lens handling instructions and videos, appointment scheduling and reminders, product ordering, and more.
I recently talked with practitioners who are actively fitting the MiSight 1 Day contact lens in their practices. Here we share their clinical experiences.
Please tell us about your general experience with CooperVision’s MiSight 1 Day lens.
According to Carlee Young, OD, who practices in Frisco, TX, the MiSight lens has been a game changer in her office. “As the first and only FDA-approved treatment for myopia, it is my first-choice lens for myopia management,” she said. She notes that the daily wear, single-use lens modality appeals to patients and parents.
She also explains that the lens handles like a traditional spherical daily lens. “This makes it easy to fit, with no add power calculations, and easy to train staff and patients in wear and care because it handles the same as the daily lenses with which we are already familiar,” she says.
“Based on the multi-year clinical trials,” Dr. Young continues, “[eyecare practitioners] can expect a 59% reduction in spherical refraction compared to age-matched untreated myopes when worn 10 hours a day, six days a week.”
Roxanne Achong-Coan, OD, of Ocoee, FL, has also had a positive experience with the MiSight lenses. “They are easy to fit,” she says, “and the explanation of the treatment is simple with the educational materials that are provided by CooperVision, both for [practitioners] and patients.” In addition, she notes that a final prescription can be reached within one to two visits.
Who are the best candidates for this lens and why?
Dr. Achong-Coan recommends this lens design for patients who are currently using soft contact lenses. “Wearing soft contact lenses is already part of their routine, and now there is the added benefit of managing their myopia,” she says.
She also believes that patients who were not successful with orthokeratology lenses are excellent candidates. “It takes patients sometimes weeks to adapt to GP lenses upon [application], while it takes minutes or a day to adapt to soft contact lenses,” Dr. Achong-Coan explains. “Parents are more comfortable when they know that their child has backup lenses versus if they break an orthokeratology lens, having only one lens for each eye.
“They are also more familiar with soft contact lenses because oftentimes they themselves are patients who are also using soft contact lenses,” she added.
Dr. Young has a broad category of patients whom she thinks would be good candidates for this lens and treatment program—every myopic child aged 8 to 12 years. “The myopia epidemic is growing, and standard of care is no longer just optical correction alone,” Dr. Young notes. “We should be actively treating our young patients who have myopia.”
Tell us about the fitting process for the MiSight 1 Day lens and what has worked best for you.
Dr. Young says that the actual fitting of the lens is very straightforward. She says that lens power is determined by vertex-corrected spherical equivalent refraction. “My fitting process is then to [apply] the lenses myself so that patients can experience the feel of the lens and the clarity of vision first thing,” she says. “I then evaluate the fit and visual acuity and proceed with [application] and removal training.”
She also notes that the lens has a dual-focus optical design that simultaneously provides distance optical correction and myopic defocus. “In my experience, initial fit, visual comfort, and handling of the lens are similar to that of conventional single-vision daily [disposable] contact lenses,” she adds. “Some studies report peripheral ghosting or blur complaints with the MiSight lens, but I have not experienced this issue with any of my current patients.”
Dr. Achong-Coan also comments on the simplicity of the MiSight lens fitting process, because she says that it is like fitting any soft lens. “Children rarely complain of glare or blurred vision and easily adapt to the optics of this contact lens,” she says.
Dr. Achong-Coan explains that the initial contact lens prescription is calculated by taking the spectacle prescription and accounting for vertex distance over –4.00D. “In my experience, it is rare for a child to want extra minus over the initial contact lens prescription,” she says. “Centration and movement are also always adequate on the eye, and children are able to wear the lenses without any issues all day long.”
According to Dr. Young, the myopia management discussion is the most critical part of the fitting process. She says that this discussion looks different based on a child’s age at the onset of myopia, current age, and family history. “I educate all parents and patients about the MiSight 1 Day lens as a first-line treatment for children who fit the current criteria and are ready and willing to try contact lenses. I find this to be about 80% of my patients aged 8 to 12 years old,” she says. “The other 20% are usually uneasy about contact lenses or not willing to start treatment for various other reasons. In those instances, I educate and recommend follow up in three to six months.”
How has the MiSight 1 Day lens helped with troubleshooting for particular patients? Tell us about any success stories in that regard.
Dr. Young tells of an 11-year-old boy whom she fit into this lens after he was referred by another optometrist to her office. “He had been wearing glasses since age 6, and his mother was concerned by what she described as constant increases in prescription. [His] mom reported that the initial prescription at 6 years old was –1.25DS in both eyes,” she says. “Now at age 11, when I saw him for consultation, he was a –5.00DS in the right eye and –5.25DS in the left eye.”
Family history revealed one parent who had myopia and no siblings who wore correction. “After a general discussion about myopia management, I recommended the MiSight lens for its ease of fitting and use,” she adds. “[His] mom was a previous contact lens wearer herself....and the FDA approval helped give the mother added peace of mind as to the safety and efficacy of the treatment.”
Dr. Young then fit the patient in –4.75D OD and –5.00D OS MiSight lenses. “His initial reactions to vision and comfort were positive,” she notes. “Slit lamp examination showed good centration and movement, and his visual acuity was 20/20–1 in the right eye and 20/20 in the left eye,” she continues. “He has been wearing the lenses successfully with no visual or comfort complaints for the past two months and will be returning for a three-month follow-up visit soon. I expect to see little to no change in his prescription at that time.”
One of Dr. Achong-Coan’s patients had not been successful in orthokeratology because “she did not like the comfort of the lens upon [application] before bed and upon awakening,” she notes. “Low-dose 0.01% atropine was prescribed as an alternative for orthokeratology for myopia control.
“However, due to her light-colored eyes, her pupils became dilated and she was unable to focus at near,” she continued. “She was successfully fit with MiSight contact lenses.” CLS