For Erin Tomiyama, OD, MS, PhD, FAAO, her research and clinical interests intersect with myopia and the astigmatic patient. After earning her optometry degree from Southern California College of Optometry (SCCO) at Marshall B. Ketchum University, she completed a cornea and contact lenses residency at the University of Houston College of Optometry. She also completed her master’s and PhD in Houston. “Myopia management was starting to take off, and we had more options for treatment, but patients with a certain level of astigmatism were out of luck. So that’s where my interest started during my master’s research,” she says.
Her PhD work built on that, looking at soft toric multifocal lenses versus toric orthokeratology lenses from a clinical performance and patient satisfaction level. Encouraged by Kathryn Richdale, OD, PhD, her master’s and PhD advisor, Dr. Tomiyama pursued this area of study to look for evidence-based answers for how to handle astigmatic patients who were seeking myopia management.
In her work in the clinic, “When we had discussions with patients, we looked at all the treatment options, and NaturalVue® Enhanced Multifocal 1 Day contact lenses were always one of the options presented,” she says.
ESTABLISHING A MYOPIA PROGRAM
After Dr. Tomiyama finished her PhD program in the spring of 2022, she became an assistant professor at SCCO. “It was my goal to join the faculty and be closer to where my family is,” she says. And she brought her passion with her. “I wanted to hit the ground running to establish a myopia program at our clinic,” she says.
Patients with myopia had been seen at Ketchum Health before, but it wasn’t always clear where the ownership of the myopia program was. “It had a foot in both the contact lens and pediatrics departments, so my goal was to establish it in its own house. We see patients three half-days a week, mostly in the evenings and on Saturdays—because those are the times that kids can come in,” she says.
“We offer atropine, orthokeratology and soft multifocal contact lenses including NaturalVue Enhanced Multifocal.” Of particular interest to Dr. Tomiyama is that the NaturalVue lens design can be worn by patients who exhibit up to 2.00 DC of astigmatism or less that does not interfere with visual acuity.
“That finding would be huge because the only option for soft toric multifocals is monthly lenses. For most patients – and especially younger ones – a one-day lens is ideal. You don’t have to worry about losing or ripping the lens over the course of a month,” she says.
She is looking into the visual performance of the NaturalVue Multifocal in her astigmatic patients. “If we can put patients with 1.25 D cylinder into a daily disposable lens, I’d much rather do that,” she says.
PATIENTS OFTEN PREFER A SOFT LENS OPTION
Many patients prefer the soft contact lens option over orthokeratology, too, she says. “The parent’s comfort level is a big factor. Presbyopes as well as parents of children with myopia have a greater familiarity with soft contact lenses and are often wearers themselves. Parents feel that they can help their child with the application and removal,” she says.
Even so, a clinic working with patients with progressive myopia needs to emphasize patient education. “All of our patients have a comprehensive eye exam before being referred to our myopia management service for a consultation. The consultation offers dedicated time to discuss our program and answer questions since myopia management is still a new topic to much of the public,” she says. Whether patients agree immediately or delay the decision, they appreciate hearing about it.
“At the end of the consult, we’ll make our recommendation based upon the findings and conversations. In an ideal world, all the treatment options would be the same price, but at this time, we have different annual packages–based on the treatment,” she says. Patients receive a year of care, special testing, and the ortho-K or soft lenses; patients will need to order atropine directly from a compounding pharmacy, she says. “We have two tiers in our soft lens choices. Because our pricing for NaturalVue is lower, we can pass that savings along to patients. When we present our recommendation for a soft lens, parents often opt for the NaturalVue as the more affordable option” for this out-of-pocket service, she says.
CLINICIAN UNDERSTANDING
Dr. Tomiyama says that the advocates for managing the progression of myopia have done well in raising awareness on the long-term effects of high myopia. “We have dedicated conferences on the topic, and at every meeting, there are usually several presentations on myopia,” she says.
In the academic curriculum at SCCO, there is also more emphasis on myopia management. “Students should be prepared to offer these treatments,” she says.
As treatment options undergo clinical studies, having those results is helpful. For example, in January 2024, Visioneering Technologies, Inc. (VTI) released results from the first year of its three-year randomized controlled trial. Here are some of those findings:
- The average refractive error reduction was 71%, or 0.41 D vs. control group for year one.
- Children wearing NaturalVue Multifocal showed an average refractive error change of 0.17 D
- The average axial length reduction was 0.17 mm (61%) vs. the control group for year one
- The average axial length change in children wearing NaturalVue Multifocal was 0.11 mm
Dr. Tomiyama is as fascinated now by the research and clinical applications of myopia, especially with the astigmatic patient, as she was when she started to delve into the research. In the academic and clinical setting, she is hoping to inspire tomorrow’s ODs to share her passion.
Dr. Tomiyama was compensated her time in preparing this article.
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See other stories about ODs working with NaturalVue lenses here.
Photos courtesy of Dr. Tomiyama and Visioneering Technologies.
