Which contact lens should we choose for sports?

When a myopic child and their parents choose contact lenses as the primary vision correction, the prescribing decision is simple - fit a contact lens (CL) design which will both correct myopia and control its progression. What if the patitent is only interested in part-time CL wear? If their primary myopia control strategy is spectacles and/or atropine, which CL should we choose for sports-only wear - would you fit a single vision contact lens or one which provides myopia control?

ME was in a dilemma her 12-year-old progressing myopic patient. Would myopia control CLs be necessary if she’s intending to wear them just for sport? Here is the case.

Contact lenses can be liberating for full-time spectacle wearers engaging in active sports, for these reasons:

• It reduces the risk of eye injuries due to glasses
• Glasses may not able to stay in place all the time, especially with contact sports
• Spectacle lenses can fog and smudge easily, causing blurry vision that could affect the wearer's performance
• Some sports require wearing helmets or headgear that will not accommodate glasses.

Contact lens wear in children has also been shown to increase their own perception of athletic competence. This is an important psychological benefit to add to the physical and functional benefits of CL wear.¹

Myopia controlling vs. single vision contact lenses? Many commenters agreed with the original poster's question on prescribing MiSight 1 day CLs for this patient, as she intends to wear them for three full school days per week. If the patient were to wear single vision CLs for almost half of her week, this would not represent an effective myopia control strategy.

One study on a 'defocus incorporated soft contact (DISC) lens' showed that children achieved a myopia control benefit with at least 5 hours per day of wear, and the benefits increased up to eight hours per day of wear^.2

Another novel contact lens design study found a significant myopia control effect only when the lenses were worn for 6 days a week or more.³ The hours per day were not quantified, and it is unknown if this wearing time effect could be extrapolated to other lens designs.

If the patient wishes to wear CLs only for a few hours per week, and not for full days at school, then a single vision CL could be an acceptable choice. In this case, the patient and parent should be counselled that an increase in wearing time frequency would necessitate re-fitting to a myopia controlling CL.

Part time vs full time CL wear. If the patient is willing to wear CLs for three days per week, increasing to full time wear could be discussed. Changing this patient from multifocal spectacles to myopia controlling CLs represents a shift to a more effective myopia control strategy.⁴

When it comes to cost, an analysis which considered the total cost of professional fees, solutions and adherence to the CL replacement schedule showed that daily disposable multifocal CLs became more expensive than reusable CLs only when worn for more than three days per week.⁵  While cost is an important consideration, in the case of myopia control, the benefit to the patient typically underpins the first recommendation to parents.

What about orthokeratology? Orthokeratology (OK) lens wear was suggested by commenters as a great option for sport. OK provides freedom from optical correction during waking hours. OK typically needs to be worn full time, though, to achieve adaptation and best visual outcomes.

What about safety? Daily disposable CL wear has the highest safety profile of myopia controlling CL options, with the risk of microbial keratitis (MK) being 1 per 5,000 patient-wearing years. OK and reusable soft CL wear is still very safe, with the risk of MK being 1 per 1,000 patient-wearing years. Read more about this in Contact Lens Safety in Kids.

1. When a myopic child wishes to wear contact lenses part-time, it's important to investigate how often this means. Optical myopia control strategies should be worn full time, or as per the indication to align with scientific data and maximize the best chance for efficacy. Single vision CLs may be acceptable if worn very occasionally.
2. Daily disposable CLs are ideal for occasional and part-time wear, and have the highest safety profile.

MiSight® 1 day (omafilcon A) soft (hydrophilic) contact lenses for daily wear are indicated 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 ≤ 0.75 diopters of astigmatism. The lens is to be discarded after each removal.