THE FIRST GENERATION of myopia control spectacle lenses employed lenslets to achieve simultaneous vision correction and myopic defocus, delivering a gaze-independent optical treatment—the kind that was only previously possible with contact lenses and orthokeratology (Lam et al, 2020; Bao et al, 2022). Now, the engineers behind these lenses have turned up the dial. Could contact lenses be next?
Proof of Concept in Spectacle Lenses
Augmented power and asphericity of the established highly aspherical lenslet design have achieved an additional 0.107 mm axial elongation reduction over 12 months compared to the standard design and comparable visual acuity (Nallour Raveendran et al, 2025). This could represent a dose-response relationship: greater optical signal, greater effect. Studies with a modified defocus incorporated multiple segments (DIMS) lenslet design are also underway.
Optical Dose in Soft Contact Lenses
A dose-response relationship is not a new concept in the soft contact lens (SCL) arena. The Bifocal Lenses in Nearsighted Kids (BLINK) study showed that high add power (+2.50 D) in center-distance multifocal SCLs slowed myopia progression, whereas medium add (+1.50 D) did not (Walline et al, 2020). In theory, more defocus could mean more myopia control—but 2 tested powers do not necessarily prove a dose-response effect.
Higher adds in conventional multifocal SCL designs carry a visual cost: acuity and contrast sensitivity suffer, and halos become an issue at +3.00 D and +4.00 D (Bickle et al, 2021). A large add power is needed to generate a meaningful shift in peripheral refraction, and the peripheral optical profile remains substantially weaker than that achieved by ortho-k (Ticak and Walline, 2013).
The non-coaxial ring-focus SCL design aimed to address this, incorporating high power (+7 D to +10 D) off the central visual axis to maintain acuity. This lens has shown robust efficacy, with mean acuity close to 20/20 (Cheng et al, 2022). While only 6-month data is published, it indicates that a stronger defocus signal is achievable without visual compromise.
Orthokeratology Optics
Ortho-k offers an equivalent concept. Reducing the back optic zone diameter (BOZD) from 6 mm to 5 mm produces a smaller corneal treatment zone, a steeper power profile within the pupil, and greater higher-order aberrations (Li et al, 2023; Guo et al, 2023). A meta-analysis of 17 studies confirmed that smaller BOZD lenses yield less axial elongation (Yang et al, 2025). Yet the Variation of Orthokeratology Lens Treatment Zone (VOLTZ) randomized controlled trial found that this benefit appears to be front loaded: 6 months growth rates between BOZD groups paralleled, though the short-term gain was retained at 2 years (Guo et al, 2023).
Based on these studies, it appears that increasing the optical profile of both spectacle and contact lens designs can boost the myopia control effect in the short term. The long-term results have yet to be seen.
Defining the Goal
Before asking whether contact lenses can achieve 100% efficacy in myopia control, we should ask what this means. Implying zero axial elongation is an unrealistic biological target in a growing individual. A better benchmark may be emmetropic eye growth: slowing a myopic eye to the rate of an age-matched nonmyopic eye. By this metric, some treatments already perform impressively. Children wearing dual-focus SCLs showed eye growth similar to that of age-matched emmetropes over 3 years (Chamberlain et al, 2021), along with 90% of children wearing highly aspherical lenslet (HAL) spectacle lenses over 2 years (Wong et al, 2024).
Although we still have much to learn about slowing the progression of myopia, current treatments achieve robust results.
References
1. Lam CSY, Tang WC, Tse DY, et al. Defocus Incorporated Multiple Segments (DIMS) spectacle lenses slow myopia progression: a 2-year randomised clinical trial. Br J Ophthalmol. 2020;104:363-368. doi: 10.1136/bjophthalmol-2018-313739
2. Bao J, Huang Y, Li X, et al. Spectacle lenses with aspherical lenslets for myopia control vs single-vision spectacle lenses. JAMA Ophthalmol. 2022;140(5):472-478. doi: 10.1001/jamaophthalmol.2022.0401
3. Nallour Raveendran R, Ong WS, Wong YL, et al. Effect of increased power and asphericity of highly aspherical lenslets on myopia control efficacy: a contralateral crossover study. Transl Vis Sci Technol. 2025 Nov 3;14(11):9. doi: 10.1167/tvst.14.11.9
4. Walline JJ, Walker MK, Mutti DO, et al; BLINK Study Group. Effect of high add power, medium add power, or single-vision contact lenses on myopia progression in children. JAMA. 2020;324(6):571-580. doi: 10.1001/jama.2020.10834
5. Bickle KM, Mitchell GL, Walline JJ. Visual Performance with Spherical and Multifocal Contact Lenses in a Pediatric Population. Optom Vis Sci. 2021;98(5):483-489. doi: 10.1097/OPX.0000000000001695
6. Berntsen DA, Kramer CE. Peripheral defocus with spherical and multifocal soft contact lenses. Optom Vis Sci. 2013;90(11):1215-1224. doi: 10.1097/OPX.0000000000000066
7. Ticak A, Walline JJ. Peripheral optics with bifocal soft and corneal reshaping contact lenses. Optom Vis Sci. 2013;90(1):3-8. doi: 10.1097/OPX.0b013e3182781868
8. Cheng X, Xu J, Brennan NA. Randomized trial of soft contact lenses with novel ring focus for controlling myopia progression. Ophthalmol Sci. 2022;3(1):100232. doi: 10.1016/j.xops.2022.100232
9. Li N, Lin W, Zhang K, et al. The effect of back optic zone diameter on relative corneal refractive power distribution and corneal higher-order aberrations in orthokeratology. Cont Lens Anterior Eye. 2023;46(1):101755. doi: 10.1016/j.clae.2022.101755
10. Guo B, Cho P, Cheung SW, Kojima R, Vincent S. Optical changes and association with axial elongation in children wearing orthokeratology lenses of different back optic zone diameter. Eye Vis (Lond). 2023;10:25. doi: 10.1186/s40662-023-00344-3
11. Yang X, Wen L, Xiao K, Liu Y, Zhou Y. Therapeutic efficacy of orthokeratology lenses with different back optic zone diameters in myopia control: a systematic review and meta-analysis. Cont Lens Anterior Eye. 2025 Mar 13:102400. doi: 10.1016/j.clae.2025.102400
12. Guo B, Cheung SW, Kojima R, Cho P. Variation of Orthokeratology Lens Treatment Zone (VOLTZ) Study: a 2-year randomised clinical trial. Ophthalmic Physiol Opt. 2023;43(6):1449-1461. doi: 10.1111/opo.13208
13. Chamberlain P, Lazon de la Jara P, Arumugam B, Bullimore MA. Axial length targets for myopia control. Ophthalmic Physiol Opt. 2021 May;41(3):523-531. doi: 10.1111/opo.12812
14. Wong YL, Li X, Huang Y, et al. Eye growth pattern of myopic children wearing spectacle lenses with aspherical lenslets compared with non-myopic children. Ophthalmic Physiol Opt. 2024;44(1):206-213. doi: 10.1111/opo.13232
