Soft contact lenses for myopia control in young adults

• Contact lenses for young adults with myopia include soft disposable lenses worn during the day, and ortho-k lenses which are worn overnight.
• Myopia typically progresses or worsens until the late teenage years and in some into the early 20s. Soft myopia control contact lenses can slow down myopia progression, ideally starting with wear in childhood and worn into young adulthood.
• Soft myopia control contact lenses include dual-focus, extended-depth-of-focus and multifocal designs. These have evidence for slowing myopia progression in children and teens up to 16-18 years. There is no evidence for their effect for myopia control in young adults but the safety profile is high.

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.

Myopia is a lifelong condition and increases risk of potentially sight threatening conditions in later life, leading the World Health Organization to classify myopia as a global health concern.¹

In most cases, myopia starts in childhood, and then progressively increases typically up until early adulthood when it stabilizes.² For some people, though, myopia can still progress in the 20s, with over one-third showing some worsening of their myopia over that decade.^3-5

Myopia can also onset in early adulthood, after a childhood of normal vision. A large study which examined adults at age 20 and again at age 28 found that 14% developed myopia over that time.³

'Myopia control' has become the increasingly adopted term to describe the use of treatments aimed to slow progression of myopia. These treatments can include spectacles, contact lenses or atropine eye drops. Myopia control is particularly important in children and younger teenagers, because this is the stage in life when myopia is most likely to progress or worsen quickly.⁶

In young adults, myopia progression can occur but is less rapid and frequent than in kids and younger teens. This means there is very little research on treatments to slow myopia progression in this age group.

Despite this, experts recommend that myopia control treatments which are commenced in childhood should ideally continue as long as possible,^6,7 and into early adulthood to have the best overall impact on slowing myopia progression.

Contact lenses can be thought of as like spectacle lenses which sit on the surface of the eye, to correct vision. They have been shown to be a safe option for vision correction in teenagers and adults. Daily disposable contact lenses, which are replaced each day, are the safest way to wear soft contact lenses.⁸

Soft contact lenses can also be reusable, where they are worn during the day and removed, cleaned and stored overnight to wear again for up to a month. Sleeping in soft contact lenses and wearing them 24 hours a day without a break greatly increases the risk of eye infection, and is generally not recommended except in special circumstances.^8,9

Soft contact lenses can be single focus, or have more than one focus which are known as bifocal, dual-focus or multifocal contact lenses.⁷ Single focus contact lenses can be beneficial for young adults to correct their blurred vision, but for those with myopia they do not help to slow down the progression or worsening which can occur.

Instead, soft contact lenses with more than one focus can both correct the blurred vision of myopia as well as slow down the worsening or progression of myopia. It is important to note, though, that the limit of the evidence for these types of myopia controlling contact lenses is in wearers up to 16-18 years.

There are no studies which investigate how well these soft contact lenses work to slow myopia progression in young adults. This doesn't mean that they won't work - just that they haven't been researched in this way, because a majority of young adults tend to show stable myopia^3-5 whereas almost all children and younger teens have progressive or worsening myopia.²

Options to slow myopia progression (called myopia control) include specific types of spectacle lenses, soft contact lenses, ortho-k and atropine eye drops. At this stage, research shows that these can all be effective in children and teenagers, with no clearly superior option.¹⁰

As mentioned above, most evidence for myopia control treatments exists for teenagers up to around age 16-18. Beyond that, there is less evidence as there is less myopia progression in this age group, but it still can occur. There is a very small amount of evidence for ortho-k stabilizing eye growth in young adults with myopia,^11,12 but this is not the same volume or quality of evidence as that for kids and younger teens.

Soft contact lenses can offer numerous benefits for young adults with myopia. Better appearance (especially for social occasions), ability to participate in activities like sport and the visual benefits of not wearing glasses are some of the main reasons young adults choose to wear contact lenses.⁹

1. 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)
2.  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)
3. Lee SS, Lingham G, Sanfilippo PG, Hammond CJ, Saw SM, Guggenheim JA, Yazar S, Mackey DA. Incidence and Progression of Myopia in Early Adulthood. JAMA Ophthalmol. 2022 Feb 1;140(2):162-169. (link)
4. Bullimore MA, Reuter KS, Jones LA, Mitchell GL, Zoz J, Rah MJ. The Study of Progression of Adult Nearsightedness (SPAN): design and baseline characteristics. Optom Vis Sci. 2006 Aug;83(8):594-604. (link)
5. Pärssinen O, Kauppinen M, Viljanen A. The progression of myopia from its onset at age 8-12 to adulthood and the influence of heredity and external factors on myopic progression. A 23-year follow-up study. Acta Ophthalmol. 2014 Dec;92(8):730-9. (link)
6. 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)
7. Bullimore MA, Richdale K. Myopia Control 2020: Where are we and where are we heading? Ophthalmic Physiol Opt. 2020 May;40(3):254-270. (link)
8. 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. 
9. 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. (link)
10. Brennan NA, Toubouti YM, Cheng X, Bullimore MA. Efficacy in myopia control. Prog Retin Eye Res. 2021 Jul;83:100923. (link)
11. Gifford KL, Gifford P, Hendicott PL, Schmid KL. Zone of Clear Single Binocular Vision in Myopic Orthokeratology. Eye Contact Lens. 2020 Mar;46(2):82-90. (link)
12. González-Méijome JM, Carracedo G, Lopes-Ferreira D, Faria-Ribeiro MA, Peixoto-de-Matos SC, Queirós A. Stabilization in early adult-onset myopia with corneal refractive therapy. Cont Lens Anterior Eye. 2016 Feb;39(1):72-7. (link)