Myopia Treatment Options and Pathways in Canada

With myopia becoming increasingly prevalent in Canada,¹ it has become a crucial clinical focus in modern optometric practice. The World Council of Optometry (WCO) advocates for myopia management as the Standard of Care, emphasizing that it should go beyond simple vision correction to include evidence-based treatment options and pathways.² This article breaks down the variety of myopia treatment options available in Canada that can be prescribed to patients for myopia management.

What options are available in Canada?

The Canadian Association of Optometrists (CAO) recommends that optometrists offer evidence-based treatments early to actively manage myopia progression.³ With the growing range of myopia control treatments and an expanding body of research, determining the best option for each patient can seem challenging. The positive news is that multiple effective treatments options are available, allowing Optometrists to tailor their approach based on a patient’s vision, lifestyle needs, and myopia control goals. These evidence-based treatment options available in Canada include:

• Myopia control spectacle lenses
• Myopia control soft contact lenses
• Orthokeratology
• Atropine

Myopia control spectacle lenses

Myopia control spectacle lenses are designed to correct vision and also to actively slow the progression of myopia. They do this by incorporating a clear central zone in the lens, with a treatment zone in the periphery of the lens. Spectacles are often a more accessible starting point for both practitioners and patients, particularly for children who may not yet be comfortable wearing contact lenses. The options available which have evidence from randomized controlled trials (RCTs) and longer term studies include:

• Hoya MiYOSMART®: This lens design uses Defocus Incorporated Multiple Segments (DIMS) technology involving an annular treatment zone which contains multiple 1.03 mm diameter lenslets with a relative power of +3.50D. There is a central clear zone of 9mm diameter without lenslets. The lenslets, set in a honeycomb array with spaces between them, create a pattern of myopic defocus across the peripheral retina to slow eye growth.⁴ There is a two-year RCT and six-year clinical study published on this lens.

• Essilor® Stellest®: This lens design uses H.A.L.T. (Highly Aspherical Lenslet Target) technology which includes 11 concentric rings of aspherical lenslets across the lens periphery that creates a volume of myopic defocus in front of the retina rather than just a two-plane defocus effect. Each ring of lenslets is a different aspherical power, and there is a central 9mm diameter clear zone without lenslets.⁵ There is a two-year RCT and five-year clinical study published on this lens.

• MiSight® Spectacle Lenses: This design uses Diffusion Optics Technology™, which instead of using lenslets to create myopic defocus, employs thousands of microscopic light-scattering elements (microdots) across the lens to modify retinal contrast. Each microdot is around 0.1mm diameter. There is a central aperture of around 5mm diameter without lenslets for lens power measurement. This technology is based on the contrast theory of myopia, which suggests that high or artificial contrast stimulation may trigger excessive eye growth.⁶ There is a three-year RCT and four-year clinical study published on this lens.

• Zeiss MyoCare®: This lens design uses Cylindrical Annular Refractive Element (C.A.R.E) technology which leverages high-order aberrations (HOAs) instead of myopic defocus or contrast modulation. The treatment zone is covered with concentric annular micro-cylinders arranged in a radial pattern: each micro-cylinder introduces +8.00D cylindrical power to the peripheral retina. There are two designs: MyoCare with a central clear zone of 7mm diameter and average defocus power of +4.6D; and MyoCare S with a central clear zone of 9mm diameter and average defocus power of +3.8D.⁷ There is a one-year RCT published on this lens.

Hoya MiYOSMART®, Essilor® Stellest®, and MiSight® spectacle lenses each have at least 12 months of randomized controlled trial data demonstrating at least 50% efficacy in slowing axial elongation.^4-6 Zeiss MyoCare® also has 12-month RCT data, showing approximately 40% reduction in axial elongation.⁷ Read more in the article The next generation – DIMS, H.A.L.T., DOT and CARE spectacle lenses for myopia control on MyopiaProfile.com for a comprehensive breakdown of each of these lens designs.

Myopia control soft contact lenses

Myopia control designs provide the dual benefit of correcting vision and also helping to slow myopia progression. Wearing soft contact lenses has been found to enhance confidence, satisfaction, and engagement in activities among children and teenagers.⁸ This makes them a great option for any child due to these unique advantages over spectacles, not just for those involved in sports and active lifestyles. The soft contact lenses for myopia control that are approved by Health Canada are:

• MiSight® 1 day: The MiSight® 1 day contact lens uses a dual-focus optical design with concentric rings that alternate between correction and treatment zones. While the central zone provides clear vision, the treatment zones introduce +2.00D of myopic defocus.⁹

• Acuvue® Abiliti™ 1-Day:  The Abiliti™ 1-Day contact lens uses RingBoost™ technology, which creates a unique ring-shaped focus in front of the retina to help slow myopia progression. Unlike traditional myopia control lenses that use spherical zones for myopic defocus, RingBoost™ incorporates plus power in a toroidal shape, generating a noncoaxial ring focus around the line of sight. This distributed defocus signal is designed to optimize myopia control while maintaining clear central vision. It has been studied in children aged 7-12 years old.¹⁰

• Visioneering Technologies NaturalVue® Multifocal 1 Day: The NaturalVue® Multifocal 1 Day contact lens uses catenary optics to create a smooth, continuous power progression with a small central correction zone and a gradually steepening periphery. This design extends the depth of focus while generating widespread myopic defocus across the retina.¹¹

These soft contact lens designs are all daily disposable which are associated with the lowest rate of microbial keratitis compared to other contact lens wear modalities.^12-15 The MiSight® 1 day has 3 years of RCT data that show slowing of axial elongation of at least 50%, and clinical study data up to six years has been published.⁹  6-month RCT data for the Abiliti™ 1-Day also shows at least 50% efficacy.¹⁰ The NaturalVue® Multifocal 1 Day contact lens currently has 12-month data in an abstract showing efficacy of at least 50% axial elongation reduction.¹¹

Orthokeratology

Orthokeratology (ortho-k) is a well-established and effective method for managing myopia progression, slowing myopia progression by at least 50%. It works by temporarily reshaping the cornea overnight, creating a peripheral myopic defocus effect that helps slow eye growth. Studies have shown ortho-k to be safe and effective for children as young as six years old, with approvals for use in prescriptions up to -4.50D of myopia and -1.50D of astigmatism,¹⁶ although this can be subject to practitioner skill and experience.

Proper patient selection, strict hygiene practices, and regular follow-ups are essential for ensuring both safety and effectiveness, particularly in reducing the already low risk of corneal infections—estimated at 1-2 cases per 2,000 patient-wearing years.^17,18 A unique advantage of ortho-k is that it is the only proven intervention that slows eye growth in the more myopic eye of children with anisometropic or monocular myopia,¹⁹ offering a targeted solution for these cases. Additionally, ortho-k has the widest body of evidence for combination therapy with 0.01% atropine, making it a leading dual-treatment option for myopia control.

Atropine

Atropine, a muscarinic receptor antagonist, has been extensively researched for its ability to slow the progression of myopia in children. While the precise way it works is not fully understood, evidence suggests that it acts through mechanisms unrelated to accommodation, possibly by influencing eye growth regulation signals from the retina to the sclera.²⁰ Being the only pharmacological intervention currently available, it can be used as a monotherapy or as part of combination therapy.

The LAMP study which looked at atropine use in 4-12 year old children has shown that, over 12 months, 0.05% atropine slowed myopia progression by 51% for axial length (AL) progression, 0.02% by 29%, and 0.01% by 12%.²¹ The effectiveness and tolerability of low-dose atropine (0.05% or less) can differ among populations, with Asian children generally demonstrating better tolerance to higher concentrations compared to children in Western countries, where higher doses may lead to more pronounced side effects of mydriasis and impaired accommodation.²² Newer data on atropine in children of White / Caucasian / European ethnicity has found 0.01% atropine may be slightly more effective, but 0.05% is still likely more effective.²³ Long-term studies indicate that atropine use does not increase the risk of cataracts or other serious ocular complications. Research is also indicating the efficacy of atropine for delaying myopia onset in pre-myopic children, offering new possibilities for early intervention.²² Read more in the article Atropine for pre-myopia on MyopiaProfile.com.

Pathways for choosing a treatment option

Choosing the right myopia management strategy requires a thoughtful, evidence-based approach, as no single treatment works best for every child. The decision-making process should consider treatment effectiveness, the child’s lifestyle, prescription needs, and risk factors for progression:

1. Identify the Most Effective Treatments: The first step is determining the most effective treatments available, considering randomized controlled trial data on axial elongation reduction and selecting from options with evidence of at least 50% myopia progression reduction. There are numerous such options available in Canada, as described above.
   1. Decide Between Spectacles or Contact Lenses: After identifying an effective treatment, the next step is deciding between spectacle lenses or contact lenses, based on lifestyle, comfort, and patient preference. Spectacle lenses are often the preferred choice for younger children or those who aren’t ready for contact lenses. On the other hand, contact lenses may be more suitable for active children or those for whom compliance with all-day vision correction may be improved with contact lens wear.
   1. Choose the Right Contact Lens Option (If Applicable): If contact lenses are the preferred choice, it’s important to consider prescription needs, corneal shape, and astigmatism. For children with higher levels of astigmatism (>0.75D), options like orthokeratology or toric myopia control soft lenses may be the best fit.
   1. Consider Binocular Vision and Risk Factors for Rapid Progression: Some children may have binocular vision issues that should be considered when prescribing myopia treatments, to ensure they achieve comfortable vision as well as myopia management. Additionally, children with a higher risk of fast progression – those who are younger or have two myopic parents – may benefit from combination therapy, such as optical treatments paired with low-dose atropine.
   1. Ensure Treatment Compliance for Best Results: Success in myopia control depends on consistent, full-time wear of the prescribed treatment. Educating both children and parents on the importance of following the treatment plan is key. Regular follow-ups allow for monitoring progress, adjusting prescriptions as needed, and reinforcing adherence to ensure the best long-term outcomes.

For full guidance on how to prescribe for myopia management, you can access the The Managing Myopia Guidelines Infographics on MyopiaProfile.com, and read their article What to prescribe for myopia control which outlines how to use their infographic.

Key takeaways

With myopia rates on the rise, proactive management is essential to preserve long-term eye health and reduce the risks associated with high myopia.²⁴ Fortunately, a variety of evidence-based treatments are available in Canada, including myopia control spectacle and soft contact lenses, orthokeratology, and atropine. The growing body of research supports early intervention and tailored treatment plans that consider efficacy, patient lifestyle, and risk factors.²⁵ By following a structured decision-making process, Optometrists can optimize myopia control outcomes while ensuring clear vision and comfort for young patients.

References:

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