Currently Available Myopia Control Soft Lenses: How Do They Compare?

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September 3, 2024

By Rebecca Dang, BOptom/BSci (Hons), MOptom

Soft myopia control contact lenses (CLs) present an effective intervention for progressing myopes,¹ and they are also able to provide significant improvements in a child’s quality of life.² As an optical method of myopia control, they are based upon animal studies that show that refractive error development is a visually guided process and myopic retinal defocus specifically inhibits axial elongation.^3–5 Thus, their optical design incorporates areas of distance refractive error correction, and “treatment” zones, which aim to provide myopic defocus or modulate higher order aberrations to impose a myopia control effect.

There is a wide range of soft myopia control contact lenses, which is constantly expanding, and practitioners prescribe those that are specifically marketed towards myopia management as well as certain off-label options. While optical designs vary, they tend to be rotationally symmetric, with power variations occurring from the lens center to the periphery.⁶ Differences arise in the location of the distance correction zone relative to the “treatment” zones, the magnitude and type of power incorporated into the “treatment” zones, and the rate at which these power changes occur. Thus, they can be categorized as center-distance or center-near, “progressive” if they display gradual unidirectional power changes, “stepped” if they display sharp unidirectional power changes, or “concentric,” a derivative of stepped power profiles where there are alternating zones of relative positive and negative power. Lastly, Extended Depth of Focus (EDOF) lenses have variable power profiles, aimed at manipulating higher order aberrations. Most CLs used for myopia control are center-distance or EDOF designs; however, anecdotal evidence suggests that some center-near MFCLs can also be used for myopia control.^11,12

Different Commercially Available Lenses
The availability of different soft myopia control CLs varies between countries and regions, with many of these CLs having regulatory approval for the control of progressive myopia in certain countries. CLs described as concentric rings include the MiSight 1-Day CL (CooperVision), Abiliti 1-Day (Johnson & Johnson Vision), and Relax (SwissLens, France). Progressive designs include the Biofinity Centre-Distance Multifocal Add +2.50D CL (CooperVision). There are also numerous EDOF CLs available and marketed for the use of myopia control, including the Bloom Day (Menicon), SEED 1dayPure EDOF (SEED), NaturalVue Multifocal 1-Day, and MYLO (markennovy). Other soft myopia control CLs that have yet to have their power profiles published include the DISC-1Day (Hong Kong Polytechnic University and Vision Science and Technology Co., Hong Kong) and Esencia (Eurolent servicios Opticos S.L). 

Most soft CLs for myopia control are daily disposable, which is favored in children for their association with the lowest risk of microbial keratitis¹³ and their simplicity for use without lens cleaning and maintenance.¹⁴ Most lenses are only available in spherical powers, but a few, including the Biofinity MF and MYLO, also have toric parameters available. While not specifically investigated for myopia control, these provide an option for patients who have astigmatism. Of additional interest is the number of lenses that are customizable to individual patient anatomy, where practitioners can control a broader range of powers, as well as base curves and diameters. This includes Relax, MYLO, and Esencia, and it allows practitioners to prescribe for a wide range of patients.  

 

Clinical Efficacy
Currently, it is not possible to determine the relative efficacy of various soft MFCLs. No studies directly compare two lenses, and the comparison of the efficacy results from two studies is limited in interpretation as they are often conducted in different populations, ages, ethnicities, and durations of time. Table 1 summarizes the Cumulative Absolute Reduction in Axial Elongation (C.A.R.E.) amongst various myopia control studies, but these differences in study design should be considered in its examination and interpretation. 

Some patterns have emerged that can help us determine how different CL designs can impact myopia control efficacy. Superior myopia control is observed with higher add lenses compared to MFCLs with low add powers.^7,15–17 This has been attributed to the greater peripheral myopic defocus induced by these lens designs. One meta-analysis has also identified that concentric ring design MFCLs may provide more effective myopia control compared to progressive designs, although this remains an area of further investigation.¹⁸ Children with better visual experience and visual acuity have also been identified as having greater treatment adherence, which has been associated with superior myopia control outcomes.^10,19,20 Practitioners should ensure these factors are taken into consideration when prescribing and choosing between soft CLs for myopia control. 

Take Home Points 

• Currently available soft myopia control CLs have a wide range of different optical designs and various parameters that can be prescribed for a wide range of children and adolescents. 
• The availability of soft myopia control CLs will vary between countries and regions.
• There is insufficient evidence to support a single stand-out CL with superior myopia control efficacy. However, practitioners should ensure sufficient myopic defocus and good visual experience/visual acuity, especially at distance, to ensure adherence to the recommended wearing time.

 

Rebecca Dang is a PhD candidate at UNSW’s School of Optometry and Vision Science, researching therapeutic adherence in multifocal contact lenses for myopia control. She is also an education-focused lecturer at UNSW, where she instructs and supervises students in pediatric clinical optometry and myopia control. Additionally, she serves as an Associate Editor at Clinical Experimental Optometry.

Some products covered in Review of Myopia Management are prescribed off-label in the United States because they are not FDA-approved for slowing the progression of myopia in children.

MiSight 1 Day soft contact lenses are FDA-approved for the correction of myopic ametropia and for slowing the progression of myopia in children with non-diseased eyes who, at the initiation of treatment, are 8-12 years of age and have a refraction of -0.75 to -4.00 diopters (spherical equivalent) with less than or equal to 0.75 diopters of astigmatism.

References

1 Wildsoet CF, Chia A, Cho P, et al. IMI–interventions for controlling myopia onset and progression report. Invest Ophthalmol Vis Sci. 2019;60:M106–31.

2 Walline JJ, Gaume A, Jones LA, et al. Benefits of Contact Lens Wear for Children and Teens. Eye Contact Lens. 2007;33.

3 Benavente-Perez A, Nour A, Troilo D. The effect of simultaneous negative and positive defocus on eye growth and development of refractive state in marmosets. Invest Ophthalmol Vis Sci. 2012;53:6479–87. doi: 10.1167/iovs.12-9822

4 Liu Y, Wildsoet C. The Effect of Two-Zone Concentric Bifocal Spectacle Lenses on Refractive Error Development and Eye Growth in Young Chicks. Investig Opthalmology Vis Sci. 2011;52:1078. doi: 10.1167/iovs.10-5716

5 Smith EL 3rd. Optical treatment strategies to slow myopia progression: Effects of the visual extent of the optical treatment zone. Exp Eye Res. 9AD;114:77–88. doi: 10.1016/j.exer.2012.11.019

6 Kim E, Bakaraju RC, Ehrmann K. Power Profiles of Commercial Multifocal Soft Contact Lenses. Optom Vis Sci. 2017;94:183–96. doi: 10.1097/opx.0000000000000998

7 Walline JJ, Walker MK, Mutti DO, et al. Effect of High Add Power, Medium Add Power, or Single-Vision Contact Lenses on Myopia Progression in Children. JAMA. 2020;324:571. doi: 10.1001/jama.2020.10834

8 Chamberlain P, Peixoto-De-Matos SC, Logan NS, et al. A 3-year Randomized Clinical Trial of MiSight Lenses for Myopia Control. Optom Vis Sci. 2019;96:556–67. doi: 10.1097/opx.0000000000001410

9 Ruiz-Pomeda A, Pérez-Sánchez B, Valls I, et al. MiSight Assessment Study Spain (MASS). A 2-year randomized clinical trial. Graefes Arch Clin Exp Ophthalmol. 2018;256:1011–21. doi: 10.1007/s00417-018-3906-z

10 Sankaridurg P, Bakaraju RC, Naduvilath T, et al. 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;39:294–307. doi: 10.1111/opo.12621

11 Hair LA, Steffensen EM, Berntsen DA. The Effects of Center-Near and Center-Distance Multifocal Contact Lenses on Peripheral Defocus and Visual Acuity. Optom Vis Sci Off Publ Am Acad Optom. 2021;98:983–94. doi: 10.1097/OPX.0000000000001753

12 Singh S, Tian E. Comparing distance-center and near-center multifocal soft contact lenses for myopia control. Invest Ophthalmol Vis Sci. 2022;63:260-A0114.

13 Stapleton F, Keay L, Edwards K, et al. The epidemiology of microbial keratitis with silicone hydrogel contact lenses. 2013.

14 Bullimore MA. The Safety of Soft Contact Lenses in Children. Optom Vis Sci. 2017;94:638–46. doi: 10.1097/opx.0000000000001078

15 Fedtke C, Ehrmann K, Bakaraju RC. Peripheral refraction and spherical aberration profiles with single vision, bifocal and multifocal soft contact lenses. J Optom. 2020;13:15–28. doi: 10.1016/j.optom.2018.11.002

16 Kang P, Fan Y, Oh K, et al. The effect of multifocal soft contact lenses on peripheral refraction. Optom Vis Sci. 2013;90:658–66. doi: 10.1097/OPX.0b013e3182990878

17 Lopes-Ferreira D, Ribeiro C, Maia R, et al. Peripheral myopization using a dominant design multifocal contact lens. J Optom. 2011;4:14–32.

18 Li S-M, Kang M-T, Wu S-S, et al. Studies using concentric ring bifocal and peripheral add multifocal contact lenses to slow myopia progression in school-aged children: a meta-analysis. Ophthalmic Physiol Opt. 2017;37:51–9. doi: 10.1111/opo.12332

19 Weng R, Naduvilath T, Philip K, et al. Exploring non-adherence to contact lens wear schedule: Subjective assessments and patient related factors in children wearing single vision and myopia control contact lenses. Contact Lens Anterior Eye. 2021;44:94–101. doi: 10.1016/j.clae.2020.11.015

20 Lam CS, Tang WC, Tse DY, et al. Defocus Incorporated Soft Contact (DISC) lens slows myopia progression in Hong Kong Chinese schoolchildren: a 2-year randomised clinical trial. Br J Ophthalmol. 2014;98:40–5. doi: 10.1136/bjophthalmol-2013-303914