Efficacy of Contact Lens-Based Interventions in Slowing Myopia Progression in Children: A Systematic Review

Myopia prevalence is increasing globally, with early-onset childhood myopia carrying a higher risk of progression to high myopia and associated sight-threatening complications. Contact lens-based interventions, including dual-focus, multifocal, extended depth-of-focus (EDOF), and orthokeratology designs, have been developed to slow progression, but their efficacy and safety remain variably reported. This systematic review aimed to evaluate the efficacy and safety of contact lens interventions in children, focusing on changes in spherical equivalent refraction (SER), axial length (AL), visual performance, compliance, and adverse events. A comprehensive search of PubMed, Web of Science, Scopus, and Cochrane Central Register of Controlled Trials (CENTRAL) was conducted from inception to September 10, 2025, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, with eligible studies including randomized controlled trials and prospective comparative studies in children (<18 years) with myopia, compared with single-vision lenses or spectacles. Data extraction and quality appraisal were performed independently by two reviewers using the modified Downs and Black checklist. Of 8,036 records identified, 14 studies met the inclusion criteria. Dual-focus and high-add center-distance multifocal soft lenses (e.g., MiSight (CooperVision, Inc., San Ramon, California, United States), Biofinity+2.50 D (CooperVision, Inc., San Ramon, California, United States)) consistently reduced SER progression by ~0.40-0.73 D and AL elongation by ~0.23-0.32 mm over two to three years, corresponding to 40-60% relative slowing. EDOF and alternative designs (e.g., Esencia (Mark'ennovy Personalized Care, S.L., Madrid, Spain), MYLO (Mark'ennovy Personalized Care, S.L., Madrid, Spain)) showed variable but generally favorable effects, with short-term contralateral studies indicating efficacy comparable to MiSight. Orthokeratology reduced AL elongation by ~40% in early years, with cumulative long-term benefit (~0.69 mm less over 11 years), though evidence was limited by nonrandomization and attrition. Visual acuity was largely preserved, with small reductions in low-contrast performance (<1 line) that were not clinically significant. Efficacy was strongly adherence-dependent, particularly for high-defocus designs. No vision-threatening adverse events were reported; safety profiles were dominated by mild, self-limited ocular events similar to single-vision comparators. Overall, contact lens interventions, particularly dual-focus and high-add multifocal soft lenses, are effective and safe for slowing childhood myopia progression, with EDOF and orthokeratology also providing meaningful benefits. However, evidence quality and long-term durability vary. Consistent daily wear and early initiation appear critical for maximizing outcomes, supporting the clinical integration of contact lens-based myopia control strategies in pediatric practice while highlighting the need for further head-to-head and long-term comparative studies.