How do myopia control soft contact lenses work?

• Myopia progression in children and teenagers is caused by the eye growing faster than intended
• Myopia control soft contact lenses are designed to slow this accelerated eye growth based on how images are focused in the different parts of the retina, at the back of the eye
• They work by directing a portion of incoming light rays to focus in front of the retina and act as a stop signal for eye growth
• Center distance multifocal soft lenses weren't originally designed for myopia control, but were the first type of soft contact lenses shown to slow progression of myopia in children
• Specific myopia control soft contact lens designs have been shown to provide effective myopia control in children and teenagers.

Soft contact lenses offer an alternative option to spectacles for correcting vision. They are made from a flexible clear oxygen permeable material and fit to closely align with the front surface of the eye.

Contact lenses can be either soft or rigid. Soft contact lenses are disposable and typically replaced daily, two-weekly or monthly. Rigid contact lenses can last 6-12 months or longer, one example being ortho-k which are worn overnight and removed upon waking.¹

Daily disposable soft contact lenses are the healthiest type of soft contact lenses, with the lowest risk of eye infection.² The safety of reusable (two-weekly or monthly replacement) soft contact lenses is similar to ortho-k.^2-4

Children (8-12 years) and teenagers (13-17 years) wearing soft contact lenses have show improved vision-related quality-of-life compared to wearing spectacles. Both groups report improved ability to participate in activities and satisfaction with their vision correction and their appearance.⁵

Myopia, also known as short-sightedness or near-sightedness, causes vision to become blurred in the long distance, and the need for glasses or contact lenses to bring the eye back into focus.

In most cases, myopia starts in childhood, and then progressively worsens until early adulthood when it stabilizes.⁶ Myopia is a lifelong condition and increases risk of potentially sight threatening conditions in later life, causing the World Health Organization to classify myopia as a global health concern.⁷

Myopia is caused by either the the depth from the front of the eye to the back too long (called axial myopia), or the focusing power of the eye being too strong (called refractive myopia). Both cause the image of far distance objects to be focused in front of the retina. For the eye to see clearly the image needs to be focused on the retina.

Childhood myopia is the most concerning, because it can progress quite rapidly as children grow, and the fast eye growth that causes it can stretch some of the eyes structures, which increases risk of eye disease in later life.⁸ The aim of myopia control in children is to slow eye growth, to reduce myopia progression and also to lower the risk for eye problems in later life.⁹

Myopia control soft contact lenses are designed to slow the accelerated eye growth of childhood myopia based on how images are focused in the different parts of the retina.¹⁰ The retina is the light sensitive layer which lines the inside back of the eye, receving all information about sight. Light needs to be accurately focussed on the retina for clear vision.

When standard vision correction is used, like single vision contact lenses or glasses, it has been found that the central part of the image is focused on the retina for clear vision, but the peripheral light rays instead focus behind the retina. Research indicates that this generates a 'grow faster' signal for the eye, but the myopic eye in childhood is already growing too quickly.¹⁰

The principle of myopia control spectacles and contact lenses is to create the opposite profile, by making the peripheral light rays focus in front of the retina. Vision is still clear centrally, but this type of peripheral optical profile generates a 'slow down' signal for eye growth. The result is that any slowing of eye growth will similarly slow progression of myopia.¹⁰

Because contact lenses sit on the eye surface and move with the eye, they have a natural advantage over spectacles in being able to create this desirable peripheral focus profile, and they do this using some clever optical designs.

The first type of soft contact lenses that were shown to provide a myopia control effect weren't actually designed for children. These contact lens types were instead designed to correct loss of close-up eye focus in adults over 40-45 years (a common condition called presbyopia) and are called center distance multifocals.

Center distance multifocal soft contact lenses are designed to offer distance vision correction at the center of the lens and near vision correction in the outer peripheral areas of the lens. Adults who need help to see clearly for reading (called presbyopia) benefit from the lens doing the close-up focusing for them.

It just happens that this type of lens design also moves peripheral light rays in front of the retina. Remembering what you just learned in the section above, this is a desirable outcome because the peripheral light rays focusing in front of the eye should slow myopia progression. The research indeed shows this to be the case.^11,12

Building on this success, major contact lens manufacturers embarked on developing new types of multifocal lenses specifically to provide a myopia control effect. Myopia control designs are designed to optimize vision correction in children and at the same time provide an enhanced myopia control effect compared to standard center distance multifocal lenses.

How myopia control lens designs achieve this varies across designs, but they all essentially target the same profile of peripheral light rays being brought to focus in front of the retina. Most myopia control lens designs have been shown to provide a better myopia control effect than traditional soft center distance multifocal lenses.

These myopia control soft contact lens designs, shown in the image below, include the CooperVision MiSight 1 day,¹³ Johnson & Johnson Acuvue Abiliti 1-Day,¹⁴ Visioneering Technologies NaturalVue Multifocal 1 Day (which can also be used for presbyopia)¹⁵ and Mark'ennovy Mylo monthly replacement lens.¹⁶

Each of these contact lenses have some research evidence for myopia control, although some have more evidence than others. The contact lens with the most supportive data is MiSight 1 day, which has reported outcomes of a 6 year study.¹³

For any medical device, professional advice should always be sought, and contact lenses are medical devices. Anything that you read on MyKidsVision.org should always be considered as research supported general information only, and should never be considered to substitute for the advice of an eye care professional.

The lens which is most suitable for your child or teenager will depend on a variety of individual factors such as their prescription in glasses, eye health evaluation, wearing preferences, activities and more. Your optometrist or eye doctor will discuss these options with you.

Not all of these myopia control soft contact lenses are available in all countries or eye care practices. A further consideration is local regulatory approvals - in the USA for example contact lenses are approved for use by the Federal Drugs and Administration (FDA). Myopia control contact lenses can be prescribed without FDA approval as 'off-label' use, but FDA approval provides assurance that a lens has been extensively tested and approved for safety and effectiveness. Currently the CooperVision MiSight 1 day lens¹³ is the only myopia control soft contact lens to have FDA approval.

The Mark'ennovy Mylo lens¹⁶ and Visioneering Technologies NaturalVue Multifocal 1 Day¹⁵ have European CE marking, which indicates suitability for the European market and is recognized in many countries, but is not an ‘approval’ of safety and efficacy as for the FDA indication. The Johnson & Johnson Acuvue Abiliti 1-Day,¹⁴ has received Health Canada approval for slowing myopia progression in children aged 7-12 years at the start of treatment.

A soft contact lens should fit as intended, be comfortable, and provide good vision. These factors need to be balanced alongside predicted myopia control efficacy. For example, an optometrist or eye doctor may suggest a soft lens with lesser evidence for myopia control if it fits better and/or provides better vision correction than a soft lens with predicted higher myopia control efficacy.

Fitting contact lenses to children and teenagers to slow myopia progression has many benefits, including slower changes in prescription and functional and quality-of-life benefits. There are also the long-term benefits of reducing the risk of eye disease and vision impairment which comes with higher levels of myopia.

Contact lenses do carry the risk of eye infection, even though the risk is relatively small. Researchers have made comparisons of the short-term risks of contact lens wear to the long-term risks of eye disease and vision impairment due to higher levels of myopia.

One comparison found that the lifetime risk of vision impairment from myopia is higher than the risks of a child wearing any type of contact lens for 10 years throughout childhood.¹⁷

Another comparison found that someone with only -3.00D of myopia is likely to experience an average of 4.4 years of visual impairment due to myopia-associated eye diseases. Whereas only 1 in 263 contact lens wearers might experience one year of vision loss due to eye infection.¹⁸

For specific information relevant to your child's age, check out the following articles.

• Why babies and toddlers might wear contact lenses
• Soft lenses for myopia control in children
• Soft lenses for myopia control in teenagers
• Soft lenses for myopia control in adults

1. Wolffsohn JS, Dumbleton K, Huntjens B, Kandel H, Koh S, Kunnen CME, Nagra M, Pult H, Sulley AL, Vianya-Estopa M, Walsh K, Wong S, Stapleton F. CLEAR - Evidence-based contact lens practice. Cont Lens Anterior Eye. 2021 Apr;44(2):368-397.
2. Stapleton F, Keay L, Edwards K, Naduvilath T, Dart JK, Brian G, Holden BA. The incidence of contact lens-related microbial keratitis in Australia. Ophthalmology. 2008 Oct;115(10):1655-62. 
3. Bullimore MA, Sinnott LT, Jones-Jordan LA. The risk of microbial keratitis with overnight corneal reshaping lenses. Optom Vis Sci 2013;90:937-944.
4. Bullimore MA, Mirsayafov DS, Khurai AR, Kononov LB, Asatrian SP, Shmakov AN, Richdale K, Gorev VV. Pediatric Microbial Keratitis With Overnight Orthokeratology in Russia. Eye Contact Lens. 2021 Jul 1;47(7):420-425.
5. Walline JJ, Gaume A, Jones LA, Rah MJ, Manny RE, Berntsen DA, Chitkara M, Kim A, Quinn N. Benefits of contact lens wear for children and teens. Eye Contact Lens. 2007;33(6 Pt 1):317-321. 
6. Hou W, Norton TT, Hyman L, Gwiazda J; COMET Group. Axial Elongation in Myopic Children and its Association With Myopia Progression in the Correction of Myopia Evaluation Trial. Eye Contact Lens. 2018 Jul;44(4):248-259. (link)
7. The impact of myopia and high myopia. Report of the Joint World Health Organization-Brien Holden Vision Institute Global Scientific Meeting on Myopia. 2015 (link)
8. Tideman JW, Snabel MC, Tedja MS, van Rijn GA, Wong KT, Kuijpers RW, Vingerling JR, Hofman A, Buitendijk GH, Keunen JE, Boon CJ, Geerards AJ, Luyten GP, Verhoeven VJ, Klaver CC. Association of Axial Length With Risk of Uncorrectable Visual Impairment for Europeans With Myopia. JAMA Ophthalmol. 2016 Dec 1;134(12):1355-1363. (link)
9. Gifford KL, Richdale K, Kang P, Aller TA, Lam CS, Liu YM, Michaud L, Mulder J, Orr JB, Rose KA, Saunders KJ, Seidel D, Tideman JWL, Sankaridurg P. IMI - Clinical Management Guidelines Report. Invest Ophthalmol Vis Sci. 2019 Feb 28;60(3):M184-M203. (link)
10. Smith EL 3rd. Optical treatment strategies to slow myopia progression: effects of the visual extent of the optical treatment zone. Exp Eye Res. 2013 Sep;114:77-88. (link)
11. Walline JJ, Walker MK, Mutti DO, Jones-Jordan LA, Sinnott LT, Giannoni AG, Bickle KM, Schulle KL, Nixon A, Pierce GE, Berntsen DA; BLINK Study Group. Effect of High Add Power, Medium Add Power, or Single-Vision Contact Lenses on Myopia Progression in Children: The BLINK Randomized Clinical Trial. JAMA. 2020 Aug 11;324(6):571-580. (link)
12. Mutti DO, Sinnott LT, Berntsen DA, Jones-Jordan LA, Orr DJ, Walline JJ; BLINK Study Group. The Effect of Multifocal Soft Contact Lens Wear on Axial and Peripheral Eye Elongation in the BLINK Study. Invest Ophthalmol Vis Sci. 2022 Sep 1;63(10):17. (link)
13. Chamberlain P, Peixoto-de-Matos SC, Logan NS, Ngo C, Jones D, Young G. A 3-year Randomized Clinical Trial of MiSight Lenses for Myopia Control. Optom Vis Sci. 2019;96(8):556-567. (link)
14. Cheng X, Xu J, Brennan NA. Randomized trial of soft contact lenses with novel ring focus for controlling myopia progression. Ophthalmol Sci 2022:Oct 18. (link)
15. Cooper J, O'Connor B, Aller T, Dillehay SM, Weibel K, Benoit D. Reduction of Myopic Progression Using a Multifocal Soft Contact Lens: A Retrospective Cohort Study. Clin Ophthalmol. 2022 Jul 4;16:2145-2155. (link)
16. Sankaridurg P, Bakaraju RC, Naduvilath T, Chen X, Weng R, Tilia D, Xu P, Li W, Conrad F, Smith EL 3rd, Ehrmann K. Myopia control with novel central and peripheral plus contact lenses and extended depth of focus contact lenses: 2 year results from a randomised clinical trial. Ophthalmic Physiol Opt. 2019 Jul;39(4):294-307. (link)
17. Gifford KL. Childhood and Lifetime Risk Comparison of Myopia Control with Contact Lenses. Contact Lens Ant Eye 2020;43:26-32.
18. Bullimore MA, Ritchey ER, Shah S, Leveziel N, Bourne RRA, Flitcroft DI. The Risks and Benefits of Myopia Control. Ophthalmology. 2021 Nov;128(11):1561-1579.