Published in Myopia

CooperVision: Myopia Control with MiSight 1 Day

This post is sponsored by CooperVision
15 min read

In this session from Eyes on Myopia 2023, host Stephanie Woo, OD, FAAO, FSLS is joined by Justin Kwan, OD, FAAO to discuss how CooperVision’s MiSight® 1 day soft contact lens is making a big impact in myopia control.

Bringing better vision to the world

CooperVision is committed to helping people around the world see better every day. Through scientific and technological innovation, operational excellence, and close working relationships with eyecare professional customers, CooperVision has helped improve the vision of millions and stands as a trusted global leader in the contact lens industry.

MiSight® 1 day

MiSight 1 day serves as the cornerstone of a comprehensive myopia management approach. It is the first and only FDA-approved* soft contact lens proven to slow the progression of myopia in children, aged 8-12 at the initiation of treatment.1† MiSight 1 day with ActivControl Technology helps slow the elongation of the eye and myopia progression, while fully correcting refractive error.1 Controlling axial elongation helps to reduce the risk of myopia-related vision complications later in life, including irreversible vision loss.2
MiSight 1 day contact lenses were clinically validated in a multi-year comprehensive study that enrolled children between ages 8 and 12. Over three years, MiSight reduced myopia progression by 59 percent, versus a single vision 1 day lens.1 The clinical study of MiSight 1 day lenses was the first to demonstrate sustained reduction in myopia progression with a soft contact lens over a three-year period.1†

Myopia control with MiSight 1 Day

Justin Kwan, OD, FAAO is Senior Manager, Myopia Management at CooperVision. He says things have been busy since he joined the company three years ago. During that time, Dr. Kwan said CooperVision acquired GP Specialists—the well-known customized orthokeratology contact lens manufacturer and distributor—as well as SynergEyes, a company widely known for hybrid lens technologies and brands, which span the treatment of irregular cornea, presbyopia, and astigmatism.
“We're trying to ensure that we have a contact lens for every patient,” he explained. “We've been busy building a portfolio that can help practitioners deliver the best care for their patients.”

Is myopia management the standard of care?

Dr. Kwan said that both personally and in his role at CooperVision, he believes myopia management is definitely now the standard of care.
“I absolutely believe that, both for myself—since I’m a -10.00D with an axial length of 28.6 millimeters—and for my kids, who are probably future myopes,” he said. “And as a company, CooperVision believes that. That's why we went to such lengths to get MiSight FDA approved. During the many years of planning prior to the approval, we knew myopia management would eventually become the standard of care.”
Although he was pleased by survey results from Eyes On Eyecare and Eyes On Myopia indicating that over 90 percent of those surveyed agreed that myopia management is now the standard of care, there are still others not adopting that mindset nor practice.
“I still encounter colleagues—optometrists and ophthalmologists alike—who question whether there’s enough science, or who say it may be the standard of care in the future, but that it isn’t now,” Dr. Kwan explained.
However, he underscored the fact that myopia management was established as the standard of care in April 2021 by the World Council of Optometry.3
“The standard of care was declared two years ago,” he said. “That’s really good news for these kiddos with myopia, and we have to march forward and embrace it.”

Why is MiSight different from other soft lenses used for myopia management?

Dr. Kwan said there are many factors that help MiSight stand out from competitors.
“Doctors like the fact that it’s a daily disposable, and parents love that it's an FDA-approved product backed by a seven-year study,” he explained. “The patent was actually filed and accepted in 2005, so the technology has been around for some time—but what’s key is that it was specifically designed for children for myopia control.”
Noting that in the past, references to control and management were used interchangeably, Dr. Kwan said the FDA has become much more strict about language in this context.
“The FDA has become very clear that an indication of slowing myopia progression is needed for a device to be described as providing myopia control,” he explained. “To this day, MiSight still remains the only myopia-control device on the market in the U.S.”
Dr. Kwan said MiSight’s strong safety and efficacy profile add to its unique value, as demonstrated by the results of CooperVision’s seven-year study, which were released in November 2021.4
“MiSight slows accelerated myopic growth to emmetropic growth, and that's the benchmark of success we demonstrated in the study, which was the longest-running contact lens trial in children that we're aware of,” he explained. “There are infinite learnings we’re still uncovering, and we’re really excited to share those as time goes by.”

How important is MiSight’s FDA approval to eyecare providers?

Dr. Kwan said MiSight’s FDA-approved status is very important to eyecare providers, noting that for the majority of their doctors, it’s one of the first topics of discussion with parents. He said multiple focus groups with parents revealed how important it is to them.
“We've surveyed thousands of parents over the last few years,” he explained. “Time and again they say they really value the FDA approval, because they need to know that what they’re choosing for their child’s treatment is safe and that it works. That stamp of approval has been instrumental to getting kids in the right treatment.”

What is the impact of myopia on today’s youth?

Dr. Kwan said many in the optometric industry would estimate that 15 million kids in the U.S. have myopia. However, research he conducted with an ophthalmology resident for a poster at the Association for Research in Vision and Ophthalmology (ARVO) conference in 2022 revealed a higher number.
“We used the census from 2020, and we accounted for rural and urban rates of myopia, since prevalence in rural areas is 2.6 times lower than that in urban areas,” he explained. “By our estimates, there are about 19.5 million kids with myopia in the U.S.”
He then provided distribution estimates among eyecare providers.
He then provided distribution estimates among eyecare providers.
“When you consider there are perhaps 65,000 eyecare providers—meaning about 45,000 optometrists and about 20,000 ophthalmologists—that would be approximately 300 kids for every single eyecare provider,” Dr. Kwan said. “Now, we know that many of these eyecare providers may not provide myopia management—because they're focused on glaucoma, retinal surgery, and other specialty areas. But hypothetically, there are 300 kids with myopia for each eyecare provider in the U.S.”
Noting that most estimates are that 2-3 percent of kids are in a myopia management protocol, he said he thinks those numbers are growing.
“With what we see from the companies involved and the awareness that’s building, that number is going up—but it's still far less than the 95 percent of parents who believe eye health is important,” he explained. “Even using the ‘eye health’ phrase can help move the parents toward treatment, because they definitely have their own biases when nearsightedness or myopia are discussed.”

Effective strategies when communicating with myopia patients

Dr. Kwan said when it comes to communicating with parents, he learned a lot from Steve Vargo, OD, MBA—as well as a book called The 3-Minute Rule.
“The book’s about a sales pitch for TV shows, but a lot of it applies to how doctors communicate effectively with parents and patients alike,” he explained. “I think there's a stat that says the optic nerve conducts 25 times faster than the auditory nerve, meaning a lot of us are visual learners. So, showing a picture—like a longer eye compared to a shorter eye—is sometimes all it takes.”
Additionally, he said to avoid “diminishing returns,” it’s important to be concise when talking with parents.
“Otherwise, it starts to sound like white noise,” Dr. Kwan explained. “What’s most important is to make an emotional connection with parents and really ask them questions.”
He added that it’s important to involve the child in the conversation, too.
“As nerdy as it might sound, maybe say to the child, ‘Did you know some eyes are longer than other eyes? And your eye is growing a little faster than it should and longer than it should,’” he said. “And really include the parents. Encourage them to get off their phones and participate in the conversation.”
He said by asking questions instead of providing a lot of data and information, parents can be transformed into active listeners.
“All that data is going to be forgotten within three days,” Dr. Kwan said. “You'll be better off if you spend your time making an emotional connection about what the right treatment would mean for their child during recess, participating in sports or ballet, and all those things—as well as the long-term implications for eye health. It's all about making an emotional connection.”

How long do kids need to be treated, and when should treatment be stopped?

Dr. Kwan said that when it comes to the timing of treatment for myopia control, an early start is key.
“Since we try to lead by example, I’ll tell you that I treat my son, Jake, every other night with 0.025%atropine,” he said. “He's+0.50D, which means he has pre-myopia, and we’re trying to delay that onset as much as possible.”
“Start early, don't wait to see progression,” he added. “We know that 96 percent of kids get worse. You don't have to prove to yourself or to the parents that the myopia will get worse, because the child is growing in other ways. Telling parents that kids grow fast is something that’s very relatable for parents—they see them growing out of their shoes and clothes.”
Although he said the treatment approach varies based on each child’s needs, a good target is to try to get kids through high school with a reading no worse than -3.00D. .
“If you have a -2.00Dsenior, you don't have to treat that -2.00Dvery long,” he explained. “But, if you have a -4.00Dwho's in 6th grade, you're going to have to treat that child much longer because they have already surpassed minus -3.00D. They're nowhere near being done with high school and have a lot of growing years ahead of them.”
“You never want to scare the parents,” he added. “Instead, tell them you’ll take it one year at a time together. Kids grow at different rates, that's just the reality—but do whatever it takes to get them through high school at no worse than -3.00D.”

What is CooperVision's new campaign that just launched during Vision Expo East?

Dr. Kwan said CooperVision’s new campaign ties back to his point about how CooperVision has talked to 1000 parents not once, but twice.
“In 2019, we enlisted the Harris Poll to talk to 1000 parents, and about 37 percent of them said they were either worried or extremely worried about myopia,” he explained. “Those parents had kids in the 8 to 15 year-old range. During this past spring and winter, we talked to a brand new set of 1000 parents. After receiving a diagnosis of myopia for their child, 72 percent of parents said they would look online to learn more.”
Dr. Kwan said the online component is where CooperVision is “really showing up strong.”
“We've built this digital ecosystem between our website and our social media channels on YouTube, Instagram, and Facebook to meet parents where they spend time,” he explained. “We provide bits of education, one-minute videos, really short clips, and really heartwarming patient stories.”
Dr. Kwan said the “Make Children's Sight Your Fight” campaign is based on the premise that “we need to fight for every diopter.”
“It shouldn't be something we passively do,” he emphasized. “We're going to hit this head on and really fight for every diopter when every diopter matters.”
“It's a rallying cry,” he added. “We know that parents, 80 percent of them, will actually look to learn more about MiSight, as well, because they know that it's critical and it works well. It's FDA approved and backed by the seven-year study. That’s a really high number when you think about parent interest.”
Dr. Kwan said since it all starts at the provider’s office—in the exam room and with the staff—they’ve invested a lot of time into education so the staff can serve as a critical resource within the team to support parent education.
“We know that parents will ask the staff different sets of questions than they might ask the doctor, and there needs to be cohesive teamwork to accomplish what's best for that child,” he explained. “We just got started, but you'll see more doctor-facing education and parent-facing education throughout 2023.”
“I think at the end of the day, we may sometimes forget what parents will do for their children,” he added. “We have to position and describe myopia as an eye health condition. And the sooner we start treating it, the sooner we can finish. Waiting is the worst approach, because myopia progression is irreversible—which is why early treatment is so important.”
*Indications for Use: MiSight® (omafilcon A) daily wear single use Soft Contact Lenses are indicated for the correction of myopic ametropia and for slowing the progression of myopia in children with non-diseased eyes, who at the initiation of treatment are 8-12 years of age and have a refraction of -0.75to -4.00 diopters (spherical equivalent) with ≤ 0.75 diopters of astigmatism. The lens is to be discarded after each removal.
†Compared with a standard single vision, 1-day lens over a three-year period.
1. Chamberlain P, et al. A 3-Year Randomized Clinical Trial of MiSight® Lenses for Myopia Control. Optom Vis Sci. 2019;96(8):556-7.
2. Tideman JW, et al. Association of Axial Length With Risk of Uncorrectable Visual Impairment for Europeans With Myopia. JAMA Ophthalmol. 2016;134(12):1355-63.
3. “Standard of Care Resolution Adoption: News Release - World Council of Optometry.” World Council of Optometry -, April 13, 2021.
4. “Pivotal International Seven-Year MiSight® 1 Day Contact Lens Study Indicates No Myopia Control Rebound in Children.” CooperVision, November 2, 2021.
Justin Kwan, OD, FAAO
About Justin Kwan, OD, FAAO

Dr. Justin Kwan is a 2009 graduate of Berkeley Optometry and went on to do a contact lens and dry eye residency at SCCO. He taught and saw patients there for eight years before moving to Chicago four years ago, joining a private practice. In April 2020, he transitioned to CooperVision full time in the role of senior manager, myopia management.

In his 14 year career, he has given over 100 hours of continuing education. Dr. Kwan is the current president of the Chicago North Side Optometric Society, past chair of the Fellows Doing Research SIG of the Academy, and a member of the Intrepid Eye Society.

Justin Kwan, OD, FAAO
How would you rate the quality of this content?