Mastering MiSight 1 day

The MiSight^® 1 day is a daily disposable contact lens specifically designed for myopia control. It is a centre distance dual focus concentric ring design with alternating distance vision correction zones (two) and treatment zones with +2.00D of defocus (two). It is NOT a multifocal contact lens in the traditional sense of those prescribed for presbyopia. Instead, MiSight 1 day is a dual-focus lens which is designed to create simultaneous defocus on the retina for both distance and near viewing¹ - with an image falling on the retina to correct myopia and the +2.00D of defocus falling in front of the retina to create myopic defocus as a 'slow-down' signal for childhood eye growth.

MiSight 1 day was the first soft contact lens to be approved by the United States FDA for slowing the progression of myopia in children (see FDA indication footnote below).

Above is an image of MiSight^® 1 day from CooperVision.com. The lens design features:

• Two treatment zones create myopic defocus with image focus in front of the retina, rather than behind it to slow axial elongation
• Two correction zones correct myopia in all gaze positions

MiSight 1 day is a soft, daily disposable contact lens designed specifically for myopic children and was the first myopia control intervention to be granted a CE indication. In 2019, MiSight 1 day became the world's first myopia management intervention to be FDA approved in the USA.

This wide central distance zone provides excellent visual acuityand subjective vision outcomes, no different to an equivalent single vision contact lens,² and simple first fitting based on the spherical equivalent refraction at the contact lens plane. A recent conference abstract³ presenting data from the MiSight 1 day three year clinical trial showed that almost 70% of MiSight 1 day fits require no over-refraction adjustment from their best-vision sphere starting power for trial lens fitting. The MiSight 1 day fitting guide suggests only adding extra minus if it improves distance vision.

The MiSight 1 day three year clinical trial found that best corrected acuity with MiSight 1 day was within one letter for the dual focus lens and the control (single vision) lens at distance and near, with a mean of around 0.00 logMAR (6/6 or 20/20) or better in both lens types.²

Some children may require an adaptation period to the dual-focus optical design of MiSight 1 day, when compared to a single vision contact lens. The MiSight 1 day fitting guide mentions that "under certain circumstances (such as low light levels), this optical design may cause reduced image contrast, symptoms of ghost images, and/or glare or halos around bright lights."

Typically, these symptoms should be mild and should resolve within the first week or so of wear. It is best to explain to a child that their vision might feel 'different' rather than 'blurred' and that it should improve with time.

The answer is no - think of MiSight 1 day as functioning like a single vision contact lens in terms of its fitting and visual acuity outcomes, and in terms of binocular vision too. Because it is NOT a multifocal contact lens, it does NOT provide a near add as multifocal contact lenses do for presbyopes. Studies have shown that MiSight 1 day does not alter binocular vision function when compared to single vision spectacles4 or contact lenses.^5,6

The MiSight 1 day lens should prove a well-fitting lens for the majority of children. In the MiSight 1 day clinical study, only 6 out of 144 children showed unacceptable lens fit and did not proceed – three wearing MiSight 1 day and three wearing the control single vision lens.²

A survey undertaken on 8- to 12-year-old children who were new to CL wear found that after 1 week, 57% reported handling as ‘kind of easy’ or ‘really easy’. This increased to 85% at one month and 97% from 6 months through to the end of the 36 month study. Comfort was also reported highly, with over 95% reporting they ‘sometimes’ or ‘don’t notice’ the feeling of CLs on their eyes.⁷

Randomized controlled trials indicate that children aged 8-12 years with -0.75 to -4.00D of myopia and no more than 0.75D of astigmatism, who wear MiSight 1 day contact lenses, are less likely to have rapid myopia progression, and are more likely to show refractive stability than their peers wearing single vision lenses.^2,8 

The MiSight 1 day three year clinical trial found that after 3 years, children wearing MiSight were 0.73D less myopic on average than children wearing the single vision contact lens.²

Further data indicates that children fit at age 11-15 years may also benefit from a reduction in their myopia progression over three years, and that continued MiSight wear of up to six years appears to be beneficial for slowing myopia progression.⁹

On follow up, best-corrected acuity should be 6/6 or 20/20 in the lenses at distance and near.² MiSight also doesn't influence accommodative or binocular vision function compared to single vision spectacles, or over time.³

Children report very high levels of satisfaction when wearing MiSight, with almost all giving a rating of seeing 'really well' or 'kind of well' for school. In the three year clinical trial, only 10% of MiSight 1 day wearers reported 'slightly annoying' visual disturbances like ghosting, halos or glare, compared to 5% of single vision Proclear® 1 day wearers, although this did not affect wearing time or continuation of wear throughout the study.⁷

As mentioned above, lens fit and comfort are normally without complication in children.2,7  Six years of MiSight and/or Proclear 1 day contact lens wear has been shown to have no significant impact on ocular health, with biomicroscopy signs being no different to pre-contact lens wear and no serious adverse events occurring.¹⁰

In evaluating safety in the community eye care setting, data from seven US eye care clinics was reviewed alongside that from randomized, controlled clinical trials (Ruiz-Pomeda et al 2018⁸ and Chamberlain et al 2019² MiSight 1 day studies) for children aged 8-12 years at soft contact lens fitting. The rate of microbial keratitis was 7.4 per 10,000 years-of-wear and corneal inflammatory events 0.66% per year. This fills an important gap in understanding safety in young wearers, with rates no higher than that in adults wearing SCLs.¹¹

The MiSight 1 day dual focus contact lens has been demonstrated in two randomized clinical trials to be safe,^2,8,10,11 effective^2,8,9 and well accepted^3,7 by myopic children. It has the longest dataset available of any myopia controlling soft contact lens, with results available to six years.⁹

Read more about the FDA indication in the footnote below - this is of crucial importance in the United States and is an important mark of efficacy and quality which is globally recognized. A daily disposable is the safest modality of myopia controlling contact lenses. Read more about Contact Lens Safety in Kids via the link.

FDA Indications for use (US only): 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.

• Optimizing distance vision with MiSight 1 day

• Enhancing near vision with MiSight 1 day

• Why MiSight 1 day is not a multifocal contact lens

• Product Information: MiSight 1 day

• Science review: MiSight 3-Year Data Analysis

• Science review: Myopia control efficacy of MiSight 1 day over six years

• ARVO 2021 update: Long term myopia control efficacy of MiSight 1 Day