Myopia is now one of the biggest threats to eye health.1 In the past 20 years, the number of people with myopia has nearly doubled—by 2050, it is projected that more than half the world’s population will have this chronic, progressive disease.2,3,4,5 The outdated perception is that myopia is simply refractive error. However, myopia is associated with increased risks to eye health in adulthood, including:
- Myopic macular degeneration (MMD)6
- Staphyloma7
- Retinal detachment8
- Primary open-angle glaucoma9
- Cataracts10
It’s been shown in clinical studies that each diopter increase in myopia results in a 67% increased risk of myopic macular degeneration (MMD).11 MMD and retinal detachment can be devastating and have the strongest relationship to myopia and longer axial lengths.11,14 In people with axial length > 26mm, 25% will develop visual impairment by age 75.12
It’s important to note there is no safe level of myopia.13 In fact, over 30% of MMD occurs in people with mild to moderate myopia, measuring at -6.00 diopters or less.14
The following sections detail why Johnson & Johnson ACUVUE® Abiliti™ Overnight Therapeutic Lenses may be an effective, lifestyle-positive option that has demonstrated safety in use for children. Plus, the high rate of fitting success with customized lens-fitting software (FitAbiliti™ software) makes it easier for inexperienced practitioners to fit patients with orthokeratology lenses. Experienced practitioners also benefit with a reduction in chair time and cost associated with the lengthy process of using trial lenses to find an optimal fit.
Table 1: The increased likelihood (odds ratio) of a myopic person > 60 years developing eye disease versus an emmetrope by degree of myopia.15
What are Abiliti™ Overnight Lenses?
Johnson & Johnson Abiliti™ Overnight Lenses are FDA-approved gas permeable orthokeratology (ortho-k) lenses approved for the management of myopia. A non-surgical treatment that temporarily reshapes the cornea through central flattening and mid-peripheral steepening, ortho-k lenses are specially designed to be worn while sleeping to correct refractive error and offer the wearer clear, spectacle-free vision throughout the next day.16
Just as myopia affects all patients uniquely, Abiliti™ Overnight Lenses and Abiliti™ Overnight Lenses for Astigmatism are approved to treat a range of prescriptions including astigmatism up to 1.50 DS. Leveraging the latest technology, FitAbiliti™ software has guided eyecare professionals into consistent and successful first fit rates with a 90% success rate for spherical prescriptions and a 95% first-fit success rate for astigmatic prescriptions up to 1.50 DS.‡ Its precise algorithms also help eyecare practitioners make the critical judgment of whether a toric or spherical lens is needed.§
Mechanism of action of ortho-k lenses
Specifically, ortho-k lenses create special fluid dynamics behind the lens due to the action of the lids that result in a Positive Push Force (compressive) on the central cornea, causing a central flattening and leaving a thin (1-10µm) tear film below.17 Simultaneously, a Negative Pull Force (suction) is created in the mid-peripheral region, resulting in thickening and steepening of the mid-peripheral cornea. The resulting shape change provides an optical correction for the patient.17 Myopia is often corrected within the first week of overnight wear to result in clear vision during the waking hours, but the greatest change has been observed to occur after the first night and typically stabilizes by 7-14 days with roughly three weeks needed for full treatment effect.16
Image 2: A model of forces acting in orthokeratology.17
Abiliti™ Overnight Lens Material
Abiliti™ Overnight lenses are crafted with Menicon Z (Tisilfocon A)—an ultra-permeable copolymer made of siloxanylstyrene and fluoromethacrylate, which enable copious oxygen transmission of Dk 182 x 10-11 (cm2/sec) [mLO2/(mL * mmHg)] (ISO 18369-4).18
Image 2: Depiction of standard curve of ortho-k lens.
Diagnostic vs. empirical fitting techniques
Contact lens fitting today can be broadly divided into two common approaches: diagnostic and empirical. While diagnostic fitting is the traditional method favored by those who like to see a lens on a patient’s eye prior to ordering, as lenses become more specialized, diagnostic fittings can become costly and time consuming.
The empirical method has at its roots the collection and interpretation of data, even before the first trial lens is manufactured. While empirical fitting is only as successful as the quality of data provided upfront, today’s instruments and precise methods can mean less chair time and fewer follow-up visits for patients.
Most consider the empirical approach to be the most user-friendly way to fit ortho-k lenses as it can help reduce the number of re-fits. This is a critical consideration when the patient is young and parents of ortho-k patients may potentially drop out if the schedule of follow-ups and chair time become a burden.
How FitAbiliti™ software simplifies ortho-k fittings
One of the key benefits of Abiliti™ Overnight lenses is that they are used in tandem with highly-efficient, easy-to-use FitAbiliti™ software, which provides a fully guided walkthrough for every patient fit. FitAbiliti™ software technically fits into the empirical software approach, although it’s actually more of an experiential fitting software because it goes beyond empirical fitting with guidance at every step. As a result, FitAbiliti™ software delivers a fitting success rate of more than 90%—even for first-time practitioners.‡
Using data from corneal topography in combination with cloud-based design software that simulates treatment effect and fluorescein patterns, FitAbiliti™ software makes fitting simpler, more efficient, and more accurate. Once practitioners have concluded that a patient is a good candidate for ortho-k and does not possess any contraindications, they can input measurements of best-corrected visual acuity (BCVA) and horizontal visible iris diameter (HVID), and the software will calculate the most appropriate lens with which to begin treatment.
FitAbiliti™ software also offers help with troubleshooting and improving lens fittings. In cases that need a second fitting or a modified lens fit, FitAbiliti™ software will process the information obtained from wearing the lens, together with the corneal topography results along with clinical decision making from the eyecare professional, the optimal next lens can be determined.
Doctors can lean on FitAbiliti™ software to:
- Ease the process of fitting lenses for patients
- Simulate fluorescein patterns
- Troubleshoot fits
- Calculate power modifications
- Determine the optimum fitting lens
- Order the lenses
Extending beyond the first fitting, FitAbiliti™ software enables eyecare professionals to stay on top of a patient’s experience with comprehensive guidance for conducting follow-on assessments and managing the patient journey and recommended follow-up visits, including:
- Initial visit
- Collection visit when patients pick up lenses
- Follow-up visits at 1 day, 1 week, 3 weeks, and every 3 monthly
The SeeAbiliti™ app
Treatment success also includes patient education and support. The patient companion app called SeeAbiliti™, supports treatment adherence and helps patients by providing information and protocols they need to effectively care for their lenses and communicate with their eyecare practitioner. Downloadable onto any device, the SeeAbiliti™ app enables parents to track outdoor time for myopic children, set reminders to insert and remove lenses, get treatment support for daily tasks and progress, and access a library full of myopia resources.
Parents can also review the information they’ve captured with eyecare practitioners at follow-up visits, which helps support the myopia management protocol and strengthens the partnership between eyecare providers and their patients.
Experience with Abiliti™ Overnight lenses§**
Cary Herzberg, O.D., FIAOMC, President IAOMC
Dr Herzberg is co-founder, president, board member, and fellow of the International Academy of Orthokeratology & Myopia Control (IAOMC) and the founder and former Chairman of the Board of the American Academy of Orthokeratology and Myopia Control (AAOMC)—formerly The Orthokeratology Academy of America (OAA). He has visiting professor status at He Eye Hospital/University, Shenyang, China and is a speaker and consultant for Johnson & Johnson. Dr. Herzberg has been practicing Optometry for over fifty years and orthokeratology/myopia Management for over four decades.
The fitting process for Abiliti™ Overnight Lenses for my patients has been seamless. The biggest challenge is sometimes obtaining a topography not compromised by lid physiology and having well-defined mire images. Making sure you have good “eye capture” means pulling lids back if necessary, without altering the corneal shape. Once you have obtained the high-quality images you select the “one” among the many that demonstrates the cornea you’re about to fit. The next step is uploading those images to the FitAbiliti™ software and entering the key patient data. After that the software takes over and designs the best-fitting lens.
Fitting Abiliti™ Overnight lenses has been easy. I have certain things I look for in my ortho-k fits and the FitAbiliti™ software allows me to modify the final lens outcomes to meet those needs. Most doctors can at this point in the process accept the Abiliti™ Overnight lens design with full confidence and can rest easy when proceeding with the proposed lens design offered by FitAbiliti™ software.‡
I am really intrigued by the FitAbiliti™ software. Throughout the fitting process, it offers practitioners fitting simulations focusing on sodium fluorescence as well as axial, tangential, and difference maps demonstrating expected outcomes. This is an advanced feature available through this system which allows doctors to learn how to evaluate and process all the opportunities available with Abiliti™ Overnight lenses. Yet the whole process remains simple allowing even the least experienced doctors a window into ortho-k fitting.
Practitioners who have hesitated in the past to get into ortho-k because it can be intimidating can embrace the Abiliti™ platform knowing that they will be guided to the fit design.‡ With an incredible staff of caring and technically savvy individuals on their team, Johnson & Johnson Vision has gone that extra mile to offer amazing support to each practitioner. So even in the case where the fit is not meeting expectations, great support is only a keystroke or phone call away.
Patients are excited both by the results of the fitting process and to experience how these designs were derived. They intuitively understand the state-of-the-art vibe that is offered through a topography-based system. Abiliti™ Overnight lenses are comfortable to wear and the “magic” of ortho-k itself is on display as patients experience a life-changing clarity of vision without spectacles. The period of adjustment for any ortho-k design is anywhere from two to three weeks, but in most cases, the patients are already going without their spectacle prescription after the first few days.
For someone like myself who has fit literally thousands of ortho-k lenses, I find the Abiliti™ Overnight lenses and the accompanying FitAbiliti™ software to be an advancement over most fitting systems available today. I prefer using the latest in contact lens technology—and topography-based systems are our future.
— Cary M. Herzberg O.D., FIAOMC, President IAOMC
Glenda Aleman-Moheeputh, OD, founder of OK Love
Dr. Aleman-Moheeputh previously served as the President of the American Academy of Myopia Control and Orthokeratology (AAOMC) South Florida Chapter (2019-2020). She also holds the position of lead ambassador for the Optometry Divas Miami Chapter and acts on the Chair Advisory committee of the Broward College Opticianry program. The founder and CEO of OK Love, Dr. Aleman-Moheeputh offers consulting for local optometrists on the implementation of efficient techniques and treatments for myopia control and helps doctors use all the current methodologies available. She has over 25 years of experience in the field of optometry and is certified on several orthokeratology designs.
When I started fitting ortho-k, I used a trial set of lenses to fit my ortho-k patients. Since then, most ortho-k manufacturers have switched to empirical fittings. I am excited for ACUVUE® Abiliti™ Overnight Therapeutic Lenses because the FitAbiliti™ software has made the initial process so much easier. Previously I used a trial set of 100 lenses in order to find the correct fit for my patients, which could be a time-consuming process. During the fitting session with the patient, I would determine which of the trial lenses would fit best and I would then sterilize them. Aside from this, in case that lens didn’t work, I would have other lenses disinfecting.
Once the lenses were ready, I placed them in the patient's eye and had them settle for another 10 to 15 minutes. Then I would evaluate how the lenses looked. If that pair did not give me the desired results, I had to move onto the next pair of lenses and repeat the process. If a patient needed to try three different pairs of lenses, the trial lens fitting could take up to two hours.
The FitAbiliti™ software really takes the background work out of ordering the right lenses and takes on most of the questions you have as a fitting doctor. It walks you step-by-step through the process and makes the ortho-k fitting process seamless while simultaneously making it more enjoyable and comfortable for the patient.
This is not only an advantage for experienced fitters like myself; but for new ortho-k fitters as well. FitAbiliti™ makes it easy for new fitters to begin implementing ortho-k into their office and offer this service to their patients.‡
What used to be a 45-minute to one-hour consultation with a patient is now a fifteen-minute conversation. When the patient returns for follow-up when the lenses are ready, because they are custom-designed, my first time success rate has been 95%, making what could potentially be a challenging process so much easier.
Ortho-k lens considerations and hygiene
Special consideration for lens hygiene and cleaning is required to optimize eye health especially due to overnight wear.19 As with any eyecare product, it’s critical to maintain good hygiene, including washing and drying hands before use and cleaning lens cases and suction holders daily.20
Overnight wear means that blinking any of the debris away doesn’t happen when the wearer is asleep, so regular cleaning and protein removal are required.21 Regular protein-deposit cleaning is recommended in addition to the daily routine cleaning and disinfecting (disinfecting will not remove protein deposits). Finally, no water should be used in any part of the care process as it increases the risk of Acanthamoeba infection,22 which is responsible for about one third of ortho-k related infectious keratitis.23,24
It’s best—especially with young patients—to thoroughly discuss, demonstrate and reinforce lens care processes at the initial and follow-up appointments. Most non-compliance is caused by simple forgetfulness of young wearers rather than lack of the desired lens-care practices or willful intent to not comply.25
Best practices for optimal ortho-k care and cleaning:16
- NEVER use tap water on the lenses.
- Always thoroughly wash and dry your hands before handling lenses.
- Clean lenses by gently placing a lens in the palm of your hand and adding 2-3 drops of cleaning solution to the outside of the lens. Rinse the lens thoroughly to remove the cleaning solution.
- Use a dedicated, intensive cleaner designed for gas permeable lenses weekly or bi-weekly, as recommended by the eyecare professional.
- Disinfect and store your lenses in fresh, multipurpose solution compatible with gas permeable lenses for at least 4 hours.
- Rinse the case daily with the sterile rinsing solution and allow to air-dry. Do not use tap water.
- Replace the lens case with every new bottle of solution.
Why Choose Abiliti™ Overnight Lenses?
Specially designed to enable wearers to be glasses-free, Abiliti™ Overnight lenses allow clear vision during the day typically without the need for spectacles, which is ideal for active children and teens participating in athletics and water activities—both of which have been characterized as lifestyle benefits investigated in clinical studies for efficacy at having a protective effect on the rate of progression.26 Abiliti™ Overnight lenses also offer subjectively improved appearance and social self-perception compared to glasses.27 And with sufficient corneal oxygenation, the lenses provide safe, comfortable wear with a DK of 182.28
Abiliti™ Overnight lenses have been in use for fifteen years and have been worn by thousands of patients.28 In addition to the experiential FitAbiliti™ software making ortho-k fitting easier, Abiliti™ Overnight lenses enjoy support that includes concierge service to support the practitioner in successful myopia management. For parents, the SeeAbiliti™ app enables parents to record data about their child’s myopia management regimen so they can communicate with their doctors. The app also sends reminders about sticking to a daily regimen and developing healthy habits like spending time outdoors.
Each annual purchase of an Abiliti™ product will provide a free comprehensive eye health exam to a child in need through Sight For Kids® — a joint program from Johnson & Johnson Vision and the not-for-profit Lions Clubs International Foundation (LCIF).
Important Safety Information
Important safety information: ACUVUE® Abiliti™ Overnight Therapeutic (tisilfocon A) Contact Lenses are indicated for use in the management of myopia. They are indicated for overnight wear for the temporary reduction of myopia and should only be disinfected using a chemical disinfection system. As with any contact lens, eye problems, including corneal ulcers, can develop. Some wearers may experience mild irritation, itching or discomfort. These lenses should not be prescribed if patients have any eye infection, or experience eye discomfort, excessive tearing, vision changes, redness, other eye problems, or if patients have any allergy to any ingredient in a solution which is to be used to care for these lenses. Complete information is also available from Johnson & Johnson Vision Care, Inc. by calling 1‐877‐334‐3937, or by visiting www.seeyourabiliti.com.
**Orthokeratology lenses should be prescribed under the care of an eye care practitioner. Any patient with ocular disease may not be suitable. Please seek professional advice for suitability in using orthokeratology.
‡Final lens fit is determined by the ECP—software is for decision support only
§JJV Data on File 2021. ACUVUE® Abiliti™ Overnight Therapeutic Lenses for Myopia Management-Consolidated, Approved Claims List; U.S. Only Claims
References
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- Holden BA et al. Global Prevalence of Myopia and High Myopia and Temporal Trends from 2000 through 2050. Ophthalmol 2016;123:1036-42.
- Flitcroft DI. The complex interactions of retinal, optical and environmental factors in myopia aetiology. Prog Retin Eye Res. 2012;31(6):622-660.
- Donovan L, Sankaridurg P, Ho A et al Myopia progression rates in urban children wearing single-vision spectacles. OVS 2012;89(1):27-32.
- Pärssinen O, Kauppinen M. Risk factors for high myopia: a 22-year follow-up study from childhood to adulthood. Acta Ophthalmologica. 2019;97(5):510-518.
- Ohno-Matsui K et al. Updates of Pathologic Myopia. Prog Retin Eye Res 2016;52:156-87.
- Ohno-Matsui K, Jonas JB. Posterior staphyloma in pathologic myopia. Prog Retin Eye Res 2019;70:99-109.
- Mitry D et al. The Epidemiology of Rhegmatogenous Retinal Detachment: Geographical Variation and Clinical Associations. Br J Ophthalmol 2010;94:678-84.
- Marcus MW et al. Myopia as a Risk Factor for Open-Angle Glaucoma: A Systematic Review and Meta-Analysis. Ophthalmol 2011;118:1989-94.
- Pan CW et al. Myopia and Age-Related Cataract: A Systematic Review and Meta-Analysis. American Journal of Ophthalmology 156.5 (2013): 1021-1033.
- Bullimore MA, Brennan NA. Myopia Control: Why Each Diopter Matters. Optom Vis Sci 2019;96:463-5.
- Tideman JW et al. Association of axial length with risk of uncorrectable visual impairment for Europeans with myopia. JAMA Ophthalmol 2016;134:1355-63.
- Flitcroft DI. The complex interactions of retinal, optical and environmental factors in myopia aetiology. Prog Retin Eye Res. 2012;31(6):622-660.
- Wong, Yee-Ling, et al. Prevalence, risk factors, and impact of myopic macular degeneration on visual impairment and functioning among adults in Singapore. Investigative Ophthalmology & Visual Science 59.11 (2018): 4603-4613.
- Haarman AE et al. The Complications of Myopia: A Review and Meta-Analysis. Investigative Ophthalmology & Visual Science. 2020 Apr 9;61:49.
- Vincent SJ, Cho P, Chan KY, Fadel D, Ghorbani-Mojarrad N, González-Méijome JM, Johnson L, Kang P, Michaud L, Simard P, Jones L. CLEAR - Orthokeratology. Cont Lens Anterior Eye. 2021 Apr;44(2):240-269.
- Mountford J, Ruston D, Daves T (eds), Orthokeratology: Principle and Practice Lond: Butterworth-Heinmann 269-301, 2004.
- JJV data on file, CSM ACUVUE® Abiliti™ Overnight Therapeutic Lenses for Myopia Management, 2021.
- Liu YM, Xie P. The Safety of Orthokeratology—A Systematic Review. Eye Contact Lens. 2016. Jan;42(1):35-42.
- Choo, J. D., Holden, B. A., Papas, E. B., et al. Adhesion of Pseudomonas aeruginosa to orthokeratology and alignment lenses. Optom. Vis. Sci. 2009, 86, 93–97.
- Cho P, Poon HY, Chen CC, Yuon LT. To rub or not to rub? - effective rigid contact lens cleaning. Ophthalmic Physiol Opt. 2020;40(1):17-23.
- Wu J, Xie H. Orthokeratology lens-related Acanthamoeba keratitis: case report and analytical review. J Int Med Res. 2021 Mar;49(3).
- Scanzera AC, Tu EY, Joslin CE. Acanthamoeba Keratitis in Minors With Orthokeratology (OK) Lens Use: A Case Series. Eye Contact Lens. 2021;47(2):71-73.
- Kam KW, Yung W, Li GKH, Chen LJ, Young AL. Infectious keratitis and orthokeratology lens use: a systematic review. Infection. 2017;45(6):727-735.
- Liu YM, Xie P. The Safety of Orthokeratology—A Systematic Review. Eye Contact Lens. 2016 Jan;42(1):35-42.
- Wolffsohn JS, Flitcroft DI, Gifford KL, et al. IMI - Myopia Control Reports Overview and Introduction. Invest Ophthalmol Vis Sci. 2019;60(3):M1-M19.
- Santodomingo-Rubido, Jacinto, et al., Myopia control with orthokeratology contact lenses in Spain: a comparison of vision-related quality-of-life measures between orthokeratology contact lenses and single-vision spectacles. Eye & Contact Lens 39.2 (2013): 153-157
- JJV Data on File 2021. ACUVUE® Abiliti™ Overnight Therapeutic Lenses for Myopia Management -Consolidated, Approved Claims List; U.S. Only Claims
