Please note: transcript not 100% accurate.
00:00
Basically, the theory is that if we can project light rays in front of the back of the eye, then we could theoretically control the myopia progression. So then the problem becomes, how do we develop a spectacle lens that brings the light rays in front of the back of the eye, so it’s creating peripheral defocus, while still maintaining natural vision and not closing in our peripheral field of view?
00:33
This is Dr. Meenal and welcome to Uncover Your Eyes, where we uncover reality. As a mom and eye doctor, I wanna know it all. There is so much buzz around nearsightedness or myopia globally. Why so much buzz? And like you guys, I also wanna know some insider information about this. So today I have with us
01:00
a very special guest who is the professional affairs manager for HOYA Vision Canada, one of the biggest lens companies globally. I have Kim Kochendorfer. She is a licensed optician who is passionate about managing myopia in children and knows all the insider details on the original myopia control lens, MiYOSMART. Welcome Kim. Thank you so much for being on today. Thanks, Meenal. I’m happy to be here.
01:31
So, you know, tell me, I know you work with Hoya. So why would such a, you know, enormous lens company, global lens company care, you know, to venture into myopia control? So myopia has been rapidly increasing in the population. We have seen the rates of myopia steadily increase year over year, and we recognize that it’s a global health concern. And so…
02:01
it’s important to Hoya to constantly be innovating and providing people the best quality of life through vision care. And so myopia management really felt like a good place for us to focus. The peripheral defocus theory, which is what MiYOSMART is based in, was something that had been proven and to be a viable way to treat myopia.
02:27
And so Hoya started to research ways to put that into a spectacle lens from early on. So you guys are, you know, the trailblazers, I want to say, in myopia control, myosmart was the first lens, you know, for myopia control. So what did that involve? Like, you know, what did those early stages involve? Like, you know, was it somebody pen and paper trying to figure this out? Like, what does it involve?
02:55
Yeah, so we developed Myosmart in partnership with the Hong Kong Polytechnic University. And it, like I said, it was based in that peripheral defocus theory. So basically the theory is that if we can project light rays in front of the back of the eye, then we could theoretically control the myopia progression. So then the problem becomes, how do we develop a spectacle lens?
03:22
that brings the light rays in front of the back of the eye, so it’s creating peripheral defocus, while still maintaining natural vision and not closing in our peripheral field of view. And so the scientists that were working on this theory, trying to develop ways to create peripheral defocus, make it easy to get used to and keep the effectiveness of the treatment.
03:47
One of the engineers was actually riding a bus one day and he looked through one of those window posters, you know, the ones that have all the little holes in them, and had this light bulb eureka moment where he went, oh, okay, this could be a way that we could create simultaneous focus and defocus while still maintaining the natural ability and good peripheral vision.
04:14
And so he went back to the drawing board and tried to create a lens design where we can make that happen. And that was the birth of the DIMMS technology, which is in Myosmart. So DIMMS stands for Defocus Incorporated Multiple Segments. And so basically what it is, is the little tiny islands that have that peripheral defocus, little bit of plus power to create that myopia control, but they’re all surrounded by the patient’s actual distance correction as well.
04:44
So what happens is our brains really easily adapts to that. They can focus on the clear vision and ignore the blurry vision part so that kids have a really easy time getting used to it. And so they developed that prototype and then they started to study it to see if it was effective. So once they got that initial design, back in 2014, we started the study at Hong Kong Polytechnic University.
05:12
to see if this would actually work in real life. Wow. So, okay, would you say that myopia is as far as a global pandemic? Yeah, absolutely. We’re trending right now to have about 50% of the population myopic by 2050. We even saw significant increases since COVID. Of course, we’re spending more time indoors.
05:40
This is absolutely a global public health concern, and as healthcare professionals, we need to be addressing it. Liking it to a disease makes a lot of sense, right? Myopia is a condition where the eyeball is growing too long too fast, and that can result in other pathologies down the road as the patient ages. So we can be proactive and address the myopia when the patient is young, and hopefully change those.
06:09
projections and have fewer high myopes in the future, and then less people with eye disease later on. So do you think that, you know, as eye doctors, you know, we’re obviously cognizant of myopia and we know about it. Do you feel that other healthcare providers need to be talking about this more? Yeah, you know, I think that there’s a lot that we can do in the healthcare field to raise awareness, right? A lot of people
06:39
Just think that myopia is requiring eyeglasses, right? Needing a correction, no big deal. You can get glasses, you can get contacts, you can get LASIK later when you grow up. But it is, a lot of people, even healthcare professionals don’t always realize that it does impact eye health. And it’s something that we should be treating like a disease rather than just, you know, putting a bandaid on it by correcting the vision.
07:07
even when you correct the vision with LASIK, the underlying problem of the eyeball being too long is still there and the health impact is still significant. And in fact, if you have a lower myo, they’re gonna have better surgical outcomes when they get LASIK surgery too. So their corneal being more stable and things like that. So yeah, absolutely. If you’re working with children.
07:33
Let’s say you’re a pediatric MD and you’re doing a general site test and you see that that kid might be struggling a little bit to see in the distance. There’s things we can do about it. They should go see their eye doctor and ask about myopia control options if the child is myopic. And I think actively referring out and co-managing care for myopic children. Let’s say you’re an ophthalmologist, you don’t want to take…
08:01
on the myopia management follow-up and things like that, refer back to an optometrist that can do it and make a relationship with eye care providers in your area so that you can provide your young patients with holistic healthcare for their eyes as well. So I know a lot of people when they go to get glasses, they think of, like you said, single vision progressives. How easy is it to make a single vision or progressive lens?
08:31
versus a myopia control lens? Like in these labs and stuff that, you know, I’m just curious, is it more difficult to make a myopia control lens? Yeah, certainly. Cause we need to create that simultaneous focus and defocus. So there’s a lot of technology that goes into it. There was a lot of initial development to go into that design, to make it work. The lens surface is different than a normal lens surface. It’s not perfectly smooth. Like there’s those little changes in the topography where those defocus islands are.
09:01
So certainly we need to consider not only how we produce the lens and make a surface that is still smooth and aesthetically pleasing, we also have to consider how to apply the different layers of coating for scratch resistance and easy to clean and extra protection like that. So absolutely not only is there more research and development that goes into it ahead of time to develop the design and to prove its effectiveness in treatment,
09:30
then we have to think about the practical aspect of how do we make this lens work in real life, look good, feel good, and be durable enough for children. So yeah, definitely more goes into it than a standard single vision lens. So tell me, I mean, I like to call the MyoSmart lens the OG lens, but you know, there are…
09:54
there’s a lot of other lenses out there, you know, whether they’re tagged with certain names or nameless. Like how do people know as parents, how do we know which lens we should be going with and why? It’s such a great question. So you know, myopia management, like we said, it’s a global, myopia is a global pandemic. We’re seeing higher rates in children. And as eye care professionals,
10:24
vulnerable population. And so there’s more and more products and treatments hitting the market all the time. And we see like big lens suppliers creating treatments, contact lenses, spectacle lenses, all kinds of different options that way. And then we do have like some of those second string kind of knockoff type products hitting the market as well. And so then the question becomes, are you getting a product that we actually know is going to work?
10:50
Right? And so that’s where you want to really be savvy and look for clinical evidence. Because anybody can say, hey, this is branded as a myopia management product, but if they don’t have the science to show you that yes, this is truly an effective mode of treatment, you should proceed with caution, right? Investing in myopia management for your child, it does carry a significant commitment in terms of time and cost. And the other thing with myopia,
11:19
is it’s progressive. We cannot go backwards. So, you know, if you receive a prescription, a myopic prescription for your child and you maybe choose a new product to the market that doesn’t have the same clinical evidence behind it, you’re risking progression that you can’t take back, right? So even if you switch treatment modalities and go to something that does have a long history of clinical.
11:48
behind it, you will not be able to get back that progression that they had when you were experimenting with something that’s maybe newer or less expensive and that kind of thing, right? So we’re talking about children’s futures here. We want to make sure that the claims attached to a product are legitimate. So my recommendation is to look for published clinical studies. Look for
12:16
treatment that has proven long-term efficacy with myopia. We often see the first year of clinical evidence coming in really strong. We see significant slowdown and progression in year one, but it’s not linear. So then the next year we might see less, we might see a little bit more, it goes back and forth. So you wanna have, the recommendation is to have at least three years of clinical evidence to allow for any washout and variation that happens over the years.
12:45
And then you’re also gonna wanna look for different things being tested. So with MyoSmart, we actually have eight years of data available, six years that are published. We have tested, we’ve gone further to test like, what happens if you discontinue treatment? Is there a rebound effect? We’ve proven with MyoSmart lenses that there is no rebound. We have proven that we see sustained efficacy over six years.
13:09
We also looked at other clinical scenarios. If you have a child who is a faster progressor, ECPs often consider combining in other treatments like Atropine, which is a pharmaceutical treatment for myopia management. Myosmart’s been already tested with Atropine in combination so that you can have confidence in making that recommendation that it will improve the efficacy. So we’ve answered clinical questions like that. We’ve looked at different age groups. We’ve looked at-
13:39
ethnicities in different areas around the globe. So there’s over 50 publications actually right now on MyoSmart Lenses available and all of these contribute to a large body of credible evidence. And I would encourage parents and healthcare professionals alike to take a little bit of time. You can do a lot of research on the internet. Look for studies that are directly associated with
14:08
you’re investigating and ask yourself, is this a marketing claim or is this a scientific claim? And go with evidence that you feel is trustworthy. You mentioned the ethnicities. Can you touch on the demographics that were studied in these studies? Yeah, for sure. So the original study that we started in Hong Kong,
14:34
obviously, that’s on the Chinese population, started in 2014. Those children are now up to the age of 21. So we’ve been following them since they were aged 8 to 13 at the beginning. And now we’re followed them until some of them are already 21 years old. So we see that wide age range in that eight year study. We’ve also looked at children in Italy and in the UK. So we see more of a variety of different…
15:03
in those studies and we see pretty consistent results, right? People are people no matter where you are in the world. And we have seen that Myosmart proves to perform similarly in different areas and different age groups. So, you know, a company like Hoya, what do they have to invest to do all these studies? Like, I’m assuming it’s…
15:29
a lot more studies than a progressive or single vision lens or just a regular lens or a coding. So what kind of investment is this like? So with a myopia control treatment, it’s really, we’re looking at the investment more like a medical treatment than just a spectacle lens utility kind of thing, right? There’s a lot more time and energy that goes into the clinical research, obviously much
15:59
looking at how this actually performs in a treatment setting, having those randomized controlled masked trials. We’re looking at 10 years now of research, but not only that, we’re investing in other healthcare providers around the world doing further research, right? So, you know, if somebody wants to investigate MyoSmart in their population or in combination.
16:27
We’re happy to support that, of course, because we want to continue to see MyoSmart’s body of evidence grow. And we’re confident that the product works really well. So we want to continue to see the results in all different kinds of scenarios. So yeah, it’s a much larger undertaking when we’re looking at a treatment as opposed to a utility product.
16:54
I know you can only speak to Myosmart, so let’s just kind of speak to that lens, but how do we know the studies aren’t fake, for lack of a better word, or biased? You know, Hoya’s conducting these studies, so as a healthcare practitioner, I’m going to think it’s all marketing, or as a parent, I’m going to think it’s marketing, or everybody’s getting a kickback for selling the lens. So how do we know that there’s no…
17:23
bias in these studies? That’s an awesome question. So one of the easiest ways to tell is to find a study that’s been published in a scientific journal, right? So we want to look what it means for a study to be published, of course, is that it’s been peer reviewed. And so it’s been reviewed by other peers in that area, and they’ve assessed it whether
17:52
is credible and accurate. So finding a peer-reviewed study is important, but then when you’re looking at that peer-reviewed study, you also want to look and make sure there’s enough people in that study, right? That you have a large enough sample group. If you’re familiar with reading research, you would look at the p-value and the lower the p-value is, the more statistically significant that study is.
18:18
So there’s certainly ways that you can tell because I think anybody that’s doing research probably has an outcome that they would like to see. There’s always that little bit of projected bias, right? So once a study has been peer reviewed, we know that other people have kind of tested that to see if that bias has come through in the data. Another way, especially for…
18:43
parents, you know, if you’re looking at some material, let’s say you’re looking at an ad or you’re looking at a pamphlet, there might be a splashy claim on there. And what you’ll want to look for is a reference and then the small print and see what that says, right? Because that’s often where the true evidence lies. It might say, you know, in our case, we say an average slowdown of 60%.
19:12
for myopia progression slowdown. And then there’ll be a little claim and then it references back to our peer reviewed published journal that was published in the British Journal of Ophthalmology from our original RCT study. So then you can say, okay, you know what? That’s a claim. I can go straight to that study and see that that’s accurate. Or there might be a disclaimer attached to that claim. And it might say, there’s a very specific scenario that this happened in. And then you might wanna question that.
19:42
and look a little bit deeper, maybe go to the actual study and read what the key takeaways were from that result. So just being a little bit savvy and questioning, because anybody can say a claim, right? It’s substantiating that claim. We want to look for that substantiation and we want to look for credible substantiation. Does that answer your question? Absolutely. I didn’t know that about the disclaimer, so thank you for that. I want to
20:12
know what can our listeners know about Hoya? What’s some insider information about the lens that you feel has been disclosed from us or we haven’t been told that you feel you can speak to? Well, I’m really excited to share with you that Myosmart hit the market in Canada in 2020. You mentioned we’ve been a leader in this space.
20:39
We were also really proud to launch a photochromic option. So it’s a light reactive option that gets dark when children go outside. So two in one, clear and sun. We have a polarized option as well. So nice, good polarized sunglass myopia management lens. We have just launched our full control coding. So now you can get MyoSmart lenses with full control and full control includes additional UV protection.
21:07
It includes blue light protection and it includes antibacterial protection, which is really cool. It has silver ions incorporated into the coating layer to kill bacteria on the lens surface, as well as reducing blue light. Kids are spending so much time on screens these days. That’ll give them a little bit more comfort when they’re looking on their digital devices. And outdoor time is super important for myopia management. We know that we see…
21:34
Myopia progression slow down, we can also delay myopia progression through spending more time outdoors in natural sunlight. So having that added UV protection is key. So that new full control coating is really exciting. And we’re going to take that another step further and we are expanding the prescription range that we have available. So we originally went up to minus 10. We are now going to be going up to minus 13.
22:02
We’re going to have bigger blank sizes and flatter base curves along with that. And what that means is that we’re going to have slightly better aesthetics and more options in terms of frame choice that you can, you know, choose some of those bigger oversized fashion frames and it’ll address like older kids, teens, that kind of thing. So we’re really excited that MyoSmart is available as a total solution. You know, you’ve got a full package.
22:30
or sorry, I should say a full portfolio available to address your patient’s individual needs. And you should be able to address a very wide variety of prescriptions with that new extended range. We know it’s that much more important for high myopes that we slow down that progression because the higher the myopia, the greater the risk for ocular disease down the road. Yeah. I mean, there are…
22:59
are still a lot of parents who do not invest in myopia control, whether it’s financial reasons or just not having that awareness. And also health care providers that don’t talk about it enough or, you know, don’t believe in it. So what are your thoughts on that? Well, I’m glad you asked. I’m very passionate about this. I’m a high myop myself. I’m about a minus six. And so personally it’s near and dear to my heart.
23:27
that we could do anything we can for the children of today to reduce their myopia. The thing about myopia is like often when it first presents, it doesn’t seem like that big of a deal, right? They can still function, they’re okay. Yeah, sure, they need glasses, but when they’re alone myope, they can take their glasses off and they can move around and go swimming or whatever.
23:54
But as myopia increases, we really see the quality of life impact. So if I take myself for an example, I cannot tell you how many times I have stared in an Airbnb where I couldn’t get close enough to the mirror to see to put on eyeliner. It’s like little things like that. When you’re a high mile and you can’t see this far away from your face, how vulnerable you are, you’re reliant on.
24:23
or contact lenses and how difficult simple day-to-day things are, right? So when we’re looking at why we’re investing in myopia management from a young age, we’re really looking at impacting the child’s overall quality of life. If they could end up being a minus one or a minus two versus a minus six, they’re gonna have a way easier time. Their glasses, if they’re getting glasses or contact lenses, aren’t gonna cost as much.
24:53
They’re not going to need to update their prescription as often if they’re in myopia management. They’re not going to need to spend extra on high index lenses and an eyewear wardrobe. As they get older, if they want to get LASIK, they’re going to have better clinical outcomes if they have corrective surgery. And beyond that, of course, you know, and I’ll use another personal example. My grandmother, my OMA,
25:22
As she aged, she developed macular degeneration. And it took a long time. She didn’t really start to feel the impacts till she was in her 80s. But when it did happen, it severely impacted her quality of life. She was a woman who loved to read. She loved to do crosswords and she loved to watch TV, but she was also hard of hearing. So she had to read the subtitles on the TV.
25:50
And once her macular degeneration got to that certain point where she couldn’t read, she couldn’t watch TV, she couldn’t do her crossword puzzles anymore. And her cognition went downhill fast. And it was really sad to see. And so, you know, when we’re investing in myopia management, we’re investing in our child’s quality of life now and all the way into their old age.
26:14
And so I think it’s well worth it. You know, maybe a little bit of pain now, it costs a little bit more. You have to go for a few more appointments. Um, but long-term you’re going to see a financial benefit and you’re going to see, uh, quality of life benefit. Absolutely. I mean, I’m with you because I do get a lot of parents when I practice who say the same thing that, you know, it’s expensive or, you know, it’s hard for them. But like you said, the prescriptions.
26:43
changing less year on year. So, I mean, that one investment, that one year kind of lasts a few years, which is great. But for me, you know, Kim, I’m a minus 10. I did have Lasik, but I’m still prone to all the pathologies that a minus 10 would be despite Lasik. But prior to having Lasik, it really affected my self-esteem. So, you know, I want to add that because I do have a couple of patients in particular who I know of.
27:10
who also feel like it’s affecting their self-esteem. And I feel for those kids, and we have put them in myopia control lenses, but self-esteem is a big thing. When you have those thick lenses, some of them, you can’t really, your parents can’t afford then the sunglass version of it, then you get the transitions. And sometimes, you’re kind of bullied. I was bullied with transitions because they weren’t.
27:33
cool back then. So, you know, when I had these heavy lenses, thick lenses, so, you know, even though we opted for the highest index, so I think for me it was a big self-esteem kind of a factor. And, you know, now my daughter is starting to become myopic, so she is a proud user of a myopia control lens, myosmart, because, you know, for me it hit home, right? It’s that what happened to me or how I became myopic.
28:01
If we have these therapies available, why would I not offer it to my child and there’s no risks and that’s the biggest thing. Exactly. Yeah. It’s like, look at it like an investment like braces, right? Very similar. Big investment now. Long-term huge impact, especially in terms of self-esteem. I was spoiled because I was raised by an optician, so I always had fantastic glasses.
28:30
But it really does. Having those thicker lenses, they minimize your face behind them so your eyes look smaller, your glasses are heavier, you’re more limited in frame choices. It impacts so much. And why wouldn’t you invest in your child’s future and well-being? Absolutely.
28:53
Thank you so much, Kim. I thank you, I thank Hoya for kind of coming out with this lens and investing so much in making such a groundbreaking lens that I really, again, say it’s the OG lens. So thank you for that. Where can our listeners, we have a lot of parents, healthcare providers who want to know where they can get this lens, where is it available?
29:18
So if you go to HoyaVision.ca, you can access our ECP locator there. So you can find a eye care provider that has Hoya lenses. And actually you can filter it for a Myosmart certified eye care provider. So you can search for somebody who has done the education to dispense Myosmart lenses in your area. And you can also find a lot of great information on it.
29:48
website. If you go to our myopia simulator, you can see what it looks like to be a myopia at different levels. You can look at minus six like me and you can look at minus 10. And you can read more about the clinical evidence there too. You can see all the different publications and studies that have been done on MyoSmart. So I highly encourage you to go to the Hoya Vision Canada website and find a local ECP.
30:17
Perfect. Thank you so much, Kim, for your time today. Thank you, Meenal. Thank you, listeners and viewers, for tuning in. If you want to catch more episodes of Uncover Your Eyes, make sure to Follow or Subscribe on your favorite podcast platform and on YouTube. To learn more about me, follow me on Instagram @Dr.MeenalAgarwal Until next time, keep those eyes uncovered!