Launched in some markets in mid-2018, the MiyoSmart spectacle lens from Hoya Vision Care was developed in cooperation with the Hong Kong Polytechnic University to address myopia.

The spectacle lens uses patented defocus incorporated multiple segments (DIMS) technology, which provides children with sharp vision, can be placed in any child’s eyeglass frame, and appears as a regular lens.

MiyoSmart is comprised of a central optical zone for correcting refractive error and multiple defocus segments evenly surrounding the central zone (extending to the mid-periphery) of the lens to control myopia progression. According to Hoya, this provides clear vision and myopic defocus simultaneously at all viewing distances.

Additionally, because children are active, Hoya realized that there was a need for the lens material to be impact resistant to offer their eyes the protection they need. MiyoSmart uses polycarbonate 1.59, which is light, highly impact resistant, and provides UV protection.

Note: MiyoSmart lenses are not currently available in the U.S.

Here we share the clinical experiences of practitioners who are prescribing MiyoSmart lenses in their practices.

Please tell us about your general experience with the Hoya MiyoSmart lenses.

Devan Trischuk, OD, BSc, who practices in Saskatoon, Canada, has used Hoya MiyoSmart at his office since June 2020, when it was first released in Canada.

“It was great to finally have an effective, evidence-based spectacle option enter the myopia management market,” he says.

But Dr. Trischuk notes that starting to use the product did not come without a lot of questions. “Initially, I did have some uncertainty regarding ‘Would kids be able to adapt?’ ‘What does it look like cosmetically?’ and ‘Will it be effective?’ among other questions. Once I began prescribing the lens and having children wear them, the MiyoSmart lens passed all those questions with flying colors.

“Kids have been able to adapt seamlessly, the lenses look great, and my patients have experienced a slowing of myopia progression similar to the DIMS study, [Lam et al, 2020],” he continues. “On top of that, parents have been excited to engage in a treatment and to not simply allow their child’s myopia to continue to progress.”

PD Dr. med. Hakan Kaymak of Duesseldorf, Germany, also believes that MiyoSmart is an easy-to-use therapeutic option for myopic children. “It is noninvasive and offers correction and therapy of myopia in one,” he says. “Compared to wearing contact lenses, children have a longer daily wearing time of spectacles, which has a positive impact in terms of myopia therapy. Studies have shown a duration dependent peripherally defocusing lenses effect; the longer the children wore the contact lenses, the less the refraction increased after two years” (Lam et al, 2014).

Dr. Kaymak has also had great experiences with MiyoSmart with regard to its tolerability. “Some children need a few days to get used to the new kind of lenses, but after around two weeks most children do not report any difficulties,” he says.

However, because he is just starting to do one-year follow-ups with patients who are using the product, Dr. Kaymak cannot report any results yet concerning the therapeutic effect of the lenses. “Until now, the refraction of the treated children remained stable, and there was no need to prescribe new lenses,” he states.

Who are the best candidates for this product and why?

Dr. Kaymak says that MiyoSmart is appropriate for nearly every child who has myopia and accepts spectacles as a way to correct myopia. “The best candidates are those children who need new glasses anyway and, therefore, just start using the MiyoSmart lenses.

“Of course, the dioptric power a child needs must be within the range of power that is offered by the manufacturer,” he explains. “Since the spectacle lenses need to be aligned very precisely, so that the child looks through the defocusing-free central area, it can be difficult to properly fit those lenses for children who have strabismus.”

Dr. Trischuk concurs that young, progressing myopes are the best candidates. “More and more research continues to be released showing the increase in ocular health risk as axial length and myopia progress,” he says. “Being able to intervene and slow that progression not only results in the obvious short-term refractive and quality-of-life benefits for that child, but it sets that child up for years of healthy vision.”

How has MiyoSmart helped with troubleshooting for particular patients? Tell us about any success stories in that regard.

Dr. Trischuk says that having one more tool in the myopia toolbox when a patient is not a suitable candidate for contact lenses or pharmaceuticals has been fantastic because that child may have otherwise not started any treatment at all. “Some of the best candidates have been children and families who have been interested in myopia management, but due to the barriers of other treatment modalities (pharmaceuticals or contact lenses) have been unable to initiate treatment,” he adds. “A spectacle option has been great as the child requires some type of correction, and parents and children are often more familiar and comfortable with this form of treatment.”

Dr. Trischuk has also found the MiyoSmart lenses are a great option for children who are interested in wearing contact lenses part time for sports/activities and glasses the rest of the time. “Being able to pair MiyoSmart spectacles with daytime peripheral defocus contact lenses has been really nice to offer children who don’t want to be full time in one or the other, and [it has] really allowed me to prescribe to that specific patient’s lifestyle,” Dr. Trischuk says. “Those children get to enjoy the benefits of contact lenses for their sports, glasses for the fashion aspect, and I have peace of mind that we are achieving full-time myopia treatment, as they are always wearing one or the other!”

He tells of one young boy who has progressive myopia and valiantly attempted contact lens training sessions in hopes initially to use orthokeratology lenses, then tried a daily soft lens, but after tears and frustration eventually had to give up. Also, unfortunately for that patient, 0.05% atropine alone was not controlling his progression adequately and a higher dosage couldn’t be tolerated. “As it was 2019, the only other option to add to his treatment was an executive bifocal. It worked well for six months in combination with his atropine, but the child was not pleased with the cosmetic appearance of the lens and struggled to adapt to using the different portions of the lens for day-to-day tasks,” says Dr. Trischuk. “He was one of the first children at my office to pick up a pair of MiyoSmart spectacles and he was thrilled with the vision and cosmesis. And, he has continued to have an excellent treatment effect in combination with atropine.”

Dr. Kaymak agrees that this product comes in handy for children who do not tolerate low-dose atropine eye drops or contact lenses. As an example of this, he shares the story of his daughter’s vision. “She had strong myopia progression from age 9 to 13, even though we tried low-dose atropine, multifocal contact lenses, and the combination of both in this time period. But since she started to use the MiyoSmart lenses two years ago, her refraction has remained stable,” he says. “One could argue that progression of myopia might have become less anyway, just because she got older, but in my opinion, this does not matter. What counts is that the progression of myopia has stopped.” CLS

References

1. Lam CSY, Tang WC, Tse DY-Y, et al. Defocus Incorporated Multiple Segments (DIMS) spectacle lenses slow myopia progression: a 2-year randomized clinical trial. Br J Ophthalmol. 2020 Mar;104:363-368.
2. Lam CSY, Tang WC, Tse DY-Y, Tang YY, To CH. Defocus Incorporated Soft Contact (DISC) lens slows myopia progression in Hong Kong Chinese schoolchildren: a 2-year randomised clinical trial. Br J Ophthalmol. 2014 Jan;98:40-45.