Vision Victory on the Hockey Stage

Oh, let me share a tale about my daughter, the dynamo of the field hockey pitch! She's a real force to be reckoned with out there. So, picture this: she's all kitted up in her field hockey gear, donning that fierce-looking face mask for protection, and then she drops this gem of a request on me. She says, "Hey, Mom, I need contact lenses!" And I was like, "Contact lenses for a budding field hockey star?" But she's got her reasons, and they're pretty clever. She goes, "Wearing glasses during field hockey is like a comedy show in itself. They fog up, slide down my nose, and make me look like a goalie playing dress-up!" I can't help but crack up at her witty remarks. But you know what? She's got a point! The idea of her sprinting across the field with crystal-clear vision and no more glasses hassles is downright hilarious. So, we're all in, cheering her on as she takes her field hockey game to a whole new level with those nifty contact lenses! Get ready, world, for the unstoppable field hockey whirlwind! 

I took my daughter to the optical shop for her regular eye checkup. Once the optometrist confirmed that her short-sightedness was stable, they presented us with an overwhelming array of contact lenses to choose from. There were so many options that it felt a bit daunting. How on earth were we supposed to pick the right one? It seemed like a never-ending maze of choices, each promising to be the best fit for her vision needs. We took our time to carefully consider each type, but it was still a challenging decision. Finding the perfect contact lenses turned out to be quite the task, but we were determined to make the right choice for our daughter's comfort and clear sight.

6 Factors to Consider When Choosing Contact Lenses 

1. Lens Material

Lens material can make a big difference in vision, comfort, and eye health, so it’s essential to know the advantages and disadvantages of different lens materials.

Hydrogel – Hydrogels are flexible, gel-like polymers that easily adhere to the surface of the eye. Hydrogels allow optimal levels of oxygen to reach the eye, and they can hold a large percentage of water.

Silicone hydrogel – Silicone hydrogel is a hybrid material composed of silicone and hydrogel. Contacts made of silicone hydrogel offer high oxygen permeability, making them suitable for overnight or extended wear.

Rigid gas-permeable – Modern rigid gas-permeable (RGP) lenses are made of firm, durable plastics that transmit oxygen. Unlike hydrogel and silicone hydrogel lenses, RGP lenses don’t contain water, so they’re less likely to collect deposits and harbor bacteria.

2. Wearing Schedule

Daily-wear contacts are intended for use during the day only. They should be removed, cleaned, and stored properly before. They are discarded at the end of the day (daily disposables).Some of the most popular brands of daily-wear contact lenses on the market include 1-DAY ACUVUE MOIST, Biotrue ONEday, and AIR OPTIX AQUA.

Extended wear contacts are FDA-approved for overnight wear ranging from one to six nights or up to 30 days. Popular brands of extended-wear contacts include ACUVUE 2, AIR OPTIX NIGHT & DAY AQUA, and PureVision.

3. Vision

Contacts correct vision problems caused by refractive errors, including:

nearsightedness (blurry distance vision), 

farsightedness (blurry near vision), 

astigmatism (blurry vision at all distances), and

presbyopia (blurry near vision in aging adults)

Contacts come in many different lens designs to correct refractive errors, such as:

Spherical – Standard spherical lenses correct nearsightedness and farsightedness. Both refractive errors can occur alongside astigmatism and presbyopia.

Toric – Toric lenses correct astigmatism. These lenses are usually thicker at the top than  the bottom, so they don’t move in the eye.

Multifocal – Multifocal lenses correct presbyopia. These lenses have multiple prescriptions, so the wearer can see clearly at any distance.

Most toric and multifocal contacts are made of soft lens materials. But RGP lenses can be made to correct astigmatism and presbyopia as well. RGP toric and multifocal lenses may be better for people with high prescriptions or whose soft toric or multifocal lenses don’t produce the desired visual acuity.

4. Replacement Schedule

Contact lenses may be replaced daily, monthly, or bi-weekly. In the case of RGP lenses, contacts may be replaced yearly with proper handling.

When you go in for a contact lens fitting, your optician will ask you about your lifestyle, so they can figure out which replacement schedule works best for you. Daily disposable contacts require minimal cleaning, making them the ideal choice for frequent travelers and lens wearers with busy schedules or active lifestyles. Monthly lenses need daily cleaning, so they’re more suitable for people who can commit to a lens care routine. Annually disposable contacts are worn daily for at least a year and then thrown away. These contacts are usually RGP lenses, which are more durable than soft lenses. Annually disposable contacts typically need to be removed and cleaned nightly.

5. Brand

You also can consider specific brand based on several factors, including:

Diameter – This is the distance across the lens’s surface. It determines how the lens sits on the eye. If a contact lens doesn’t have the right diameter for your eye, it will feel uncomfortable. 

Base Curve – This is the depth of the contact lens’s curve. If a contact lens doesn’t have the right base curve for your eye, it may not adhere correctly to your eye, causing blurry vision and/or discomfort.

Lens Material – Contact lens brands differ in terms of the materials they use. For example, contacts in the ACUVUE OASYS product family are made of silicone hydrogel, while contacts in the Biotrue ONEday family are made of hydrogel. 

6. Cost

When browsing for contact lenses online, you may notice that their prices vary.

That’s because many different factors affect the cost of contact lenses, including lens type, brand, and replacement schedule. 

Check out the picture below for general contact lens prices.

Picture above taken Jul 2023. 

After taking in all the factors, we decided on daily silicon hydrogel type as she only wears on the training day but once she put on, we will wear more than 8 hours.

P/S: For first timer, some optical shop have a package (consultation on how to apply, maintain and remove the contact lenses + 2 boxes contact lenses; consultation fees around $80-$100). If you want to save the money, which we did, I personally teach her myself. There is also some good resources online as below:

Contact Lenses for Beginners | How to Put in Contacts

Contact Lenses for Beginners | How to take out Contacts easily

updated 2 Aug 2023: Recently went over to Johor City, Malaysia, I found out the prices of contact lenses is 45% cheaper than Singapore. That is a huge difference. It will be an option for us in future to get our supplies.

Through the Looking Glass: My journey with My Child's Myopia

The recent visit to the eye clinic with my younger boy left me shocked and confused. The results revealed that his left eye had a staggering 800-degree myopia, while his right eye had 675 degrees. It was a significant increase from the previous examination, just six months ago, where the doctor assured us that his myopia was stable. The sudden jump in degree left me with a whirlwind of emotions—concern, worry, and a sense of urgency to understand what might have contributed to this drastic change. 

As a mother, I couldn't help but question what steps I could take to address this issue and ensure the best possible outcome for my child's vision health. As we discussed the options with the eye clinic, I couldn't help but feel limited in the choices presented to us. The doctor advised us to either switch to special myopia glasses or increase the concentration of atropine to the highest level of 1%. I found it perplexing that these suggestions were only brought up now, when my child's degree had significantly increased. It left me questioning why these options weren't discussed earlier when his myopia was at a lower level. Additionally, I couldn't ignore the potential side effects of using 1% atropine, such as increased sensitivity to light, and the need for transition glasses. Furthermore, the special myopia glasses had their own limitations, with Stellest supporting up to 800 degrees and Myosmart up to 1000 degrees. I found myself grappling with the decision, searching for more information, and seeking alternatives that could provide the best solution for my child's vision health.

Child Myopia

Child myopia, also known as nearsightedness, is a prevalent concern in Singapore. The city-state has one of the highest rates of myopia globally, with an alarming number of children affected. This condition, characterized by blurry distance vision, can have significant implications on a child's quality of life and academic performance. Factors such as excessive near-work activities, lack of outdoor time, and genetic predisposition contribute to the high prevalence. Recognizing the importance of addressing this issue, Singapore has implemented various strategies to combat myopia, including promoting outdoor activities, reducing screen time, and implementing vision screenings in schools. Additionally, innovative technologies and interventions, such as orthokeratology and specialized eyewear, are being utilized to slow down the progression of myopia. 

Options Treatments for Child Myopia

1. Atropine. Atropine eye drops have shown promising results in managing myopia (nearsightedness) in children. When prescribed by an ophthalmologist, Atropine eye drops are used to dilate the pupils and temporarily relax the focusing mechanism of the eye, which helps to slow down the progression of myopia. By inhibiting the eye's ability to accommodate, Atropine eye drops reduce the strain on the eye and limit the elongation of the eyeball, a major contributing factor to myopia development. It is essential to follow the prescribed dosage and usage instructions carefully to ensure its effectiveness and safety. Regular monitoring by an eye care professional is recommended to assess the child's progress and adjust the treatment plan as necessary. Atropine eye drops offer a potential non-invasive approach to managing myopia in children, improving their visual health and potentially reducing the risk of high myopia-related complications in the future. 

Side effects Using 1% Atropine. The treatment typically begins with the lowest percentage of Atropine and gradually increases the dosage to achieve stabilization of myopia progression. The highest dosage used is 1%, which has been associated with certain side effects. One common side effect is photophobia, which is increased sensitivity to light, causing discomfort and excessive squinting when exposed to bright light. Additionally, some individuals may experience glare, where bright lights appear excessively intense and may hinder their ability to see clearly. Pupil dilation caused by Atropine can also result in blurred vision and difficulties in focusing on nearby objects, leading to near vision disturbances. While these side effects are generally mild and temporary, they can affect daily activities and might necessitate adjusting the dosage or using the drops at specific times of the day. 

Therefore, a step-wise approach is adopted, starting with a milder concentration and carefully monitoring the child's response before considering higher doses to strike the right balance between effectively managing myopia and minimizing potential side effects.

2. Myopia Specialized Glasses. 

Stellest and Myosmart glasses,  are the two popular brands, offer a promising solution for children with high degrees of myopia. Designed specifically to address the progression of nearsightedness, these innovative glasses provide a range of benefits. With advanced lens technology and specialized coatings, they aim to reduce eye strain, control the elongation of the eyeball, and slow down the progression of myopia. These eyewear options are carefully crafted to provide clear vision while maintaining a comfortable fit for long-term wear. The lenses are specifically designed to correct the refractive error associated with myopia and minimize aberrations. By opting for myopia specialized eyewear, parents can have peace of mind knowing that they are taking proactive measures to safeguard their child's eyesight and potentially reduce the need for stronger prescriptions in the future.

	Essilor Stellest	Hoya MiYOSMART
Clinical available data	4 years2	6 years1
Effectiveness	67%	59%
Lens material	Polycarbonate	Polycarbonate
Coating	UV protection  Anti-reflective  High scratch resistant   Easy to clean	UV protection  Anti-reflective   Water repellent  Easy to wipe
Blue light protection	Available with a top up (Crizal Prevencia)	Not available
Method used to control myopia progression	Myopic defocus	Myopic defocus
Lens Design	A constellation of aspherical lenslets on 11 rings	Hundreds of small segments of constant myopic defocus evenly distributed (honeycomb structure)  at the peripheral portion of the lenses
Technology used  to design the lens	H.A.L.T Technology  (Highly Aspheral Lenslet Target)	D.I.M.S Technology  (Defocus Incorporated Mutliple Segment)
Central clear zone	9mm	9.4mm
Power available	sph 0 to -10.00 cyl -4.00	0 to -10.00 cyl -4.00
Adaptation	Minimum	Minimum
Safety	Safe and non-invasive	Safe and non-invasive
Aesthetics	Good	Good
Price	$490  Top up Crizal Prevencia: $80	$530

 

3. Orthokerathology (Hard lense). 

Orthokeratology, also known as Ortho-K, is a non-surgical treatment option for myopia (nearsightedness). It involves the use of specially designed rigid gas-permeable contact lenses that are worn overnight while sleeping. These lenses gently reshape the cornea temporarily, providing clear vision during the day without the need for glasses or contact lenses.

It’s effectiveness can be up to 59% which is similar to MiYOSMART or Stellest.3  With cost ranging from $1500 - $2000 per year, your child will not need to bear the weight of the spectacle throughout the day and will be able to have a wider field of vision as compared to wearing spectacles with MiYOSMART or Stellest. There were two types of Ortho-K: Standard and Custom. 

Standard Ortho K is like buying a ready-made suit from a department store — pre-made in set sizes, simply select the closest size to fit and off you go. It might fit well enough but it's not perfect.

Custom Ortho K is like having a tailored suit made just for you — each one is made individually based on precise measurements of you. That means the perfect fit.

Why Ortho-K is uncommon to be recommended as treatment to control child myopia? 

a. Wearing contact lenses can bring a higher risk of eye infection for your child. However, the risk can be lowered by having good hygiene and proper maintenance of the lens.

b. Limitation in prescription range: in the range of +2.00 to -6.00 with no more than -1.75 diopters of surface astigmatism. Ortho-K may not be as effective in children with high levels of myopia. There are some optometrists claimed they are able to correct up to -10 diopters which I am not comfortable. Clinical trial of using ortho-K in children with high levels of myopia is ongoing (click here if you want more information about partial correction of high myopia with ortho-K lenses).  

c. Compliance Issues: Ortho-K requires strict adherence to wearing schedules and proper lens care. Children who are unable to comply with these requirements may not achieve the desired myopia control. 

Conclusion. After conducting thorough research and consulting with an eye specialist, my options for controlling my child's myopia were limited. Considering all relevant information, it was determined that Myosmart lenses were the most suitable choice for my child's condition. Although I regret not being presented with this option earlier, I now understand the importance of seeking second opinions and early intervention. To other parents facing a similar situation, I highly advise seeking suitable myopia control treatments at an early stage and obtaining second opinions if necessary. Early intervention can make a significant difference in managing myopia progression and ensuring the best possible visual health for our children in the long term. Regular follow-ups with eye care professionals will help monitor the effectiveness of the chosen treatment and make any adjustments as needed.

Adding in more info recently found (Updated Aug 2023):

Soft lenses. 

a. MiSight® 1 day - Child-friendly daily disposable contact lenses proven to slow the progression of short-sightedness in children. MiSight® 1 day with ActivControl® Technology not only correct short-sightedness – they’re also the first soft contact lenses proven to significantly reduce the progression of myopia in children. Prescription available in the range of +2.00 to -6.00. It reduced myopia progression on average by 59% compared to a single vision contact lens.4  

b. ACUVUE® Abiliti™ 1-Day - A new myopia control soft contact lens released by Johnson&Johnson. Instead of using a traditional concentric ring presbyopic lens design, it is designed with novel ring focus technology to slow down myopia progression in children.5 Prescription available in the range of -0.75D and -4.50D and 1.00D or less astigmatism.

Reference:

1. Lam CSY, Tang WC, Zhang A, Tse D, To CH. Myopia control in children wearing DIMS spectacle lens: 6 years results. The Association for Research in Vision and Ophthalmology (ARVO) 2022 Annual Meeting, May 1-4, Denver, US 

2. Li X, Huang Y, Yin Z, Liu C, Zhang S, Yang A, Drobe B, Chen H, Bao J. Myopia Control Efficacy of Spectacle Lenses with Aspherical Lenslets: Results of a 3-year Follow-up Study. Am J Ophthalmol. 2023 Apr 9: S0002-9394(23)00147-2. 

3. Jakobsen TM & Møller F. Control of Myopia Using Orthokeratology Lenses in Scandinavian Children Aged 6 to 12 Years. Eighteen-Month Data from the Danish Randomized Study: Clinical study Of Near-sightedness; Treatment with Orthokeratology Lenses (CONTROL study). Acta Ophthalmol. 2022 Mar;100(2):175-182 

4. Sulley A, et al. Wearer experience and subjective responses with dual focus compared to spherical, single vision soft contact lenses in children during a 3-year clinical trial. Poster presented at AAO 2019, San Francisco, Calif.

5. www.clinicaltrials.gov is a website maintained by the NIH. The 4 clinical studies evaluated subjective comfort as a primary or secondary endpoint for ACUVUE® OASYS Brand daily disposable family. Review conducted as of April 25, 2021.

JJV Data on file, 2021. Development of Optical Design of ACUVUE® Abiliti™ 1-Day Soft Therapeutic Lenses for Myopia Management.

JJV Data on file 2021. Stand-alone Performance Claims; ACUVUE® Abiliti™ 1-Day Soft Therapeutic Lenses for Myopia Management.

JJV Data on File 2021. Mechanical Design of ACUVUE® Abiliti™ 1-Day Soft Therapeutic Lenses for Myopia Management- Effect on Fit and Handling.

JJV Data on file, 2021. Efficacy of ACUVUE® Abiliti™ 1-Day Soft Therapeutic Lenses for Myopia Management: Comparative Claims vs. Single Vision and Dual Focus Lenses.