Age-stratified comparison of MiSight and Orthokeratology

Paper title: Age-Specific Efficacy of MiSight Dual-Focus Soft Contact Lenses and Orthokeratology Lenses for Myopia Control in Pediatric Patients: A Retrospective Comparative Study

Authors: Hye Jin Hong (1); Dong Wook Kim; Hui June Kim; Younghee Kim; Jiwon Jeong

1. Fatima Eye Clinic (H.J.H., H.J.K., J.J.), Fatima Eye Research (Y.K.), Changwon, Republic of Korea; Department of Information and Statistics, Department of Bio & Medical Big Data (D.W.K.), Research Institute of Natural Science, Gyeongsang National University, Jinju, Republic of Korea.

Date: Jun 2026

References: Hong HJ, Kim DW, Kim HJ, Kim Y, Jeong J. Age-Specific Efficacy of MiSight Dual-Focus Soft Contact Lenses and Orthokeratology Lenses for Myopia Control in Pediatric Patients: A Retrospective Comparative Study. Eye Contact Lens. 2026 Jun 4.

[Link to open access paper]

Evidence comparing MiSight and orthokeratology (ortho-K) across different pediatric age groups remains limited. Whether treatment response differs between younger and older children is not yet well understood.

This retrospective cohort study evaluated 239 eyes from 123 myopic children aged 8 to 18 years at a single clinic in South Korea. Patients received MiSight (137 eyes) or ortho-k (102 eyes) based on clinical judgment and parental preference. The primary outcome was axial length change measured at baseline, 6, 12, and 18 months. Patients were stratified by age using a 10 years of age cut-off. The MiSight group was older and had greater baseline myopia and axial length. Statistical analyses accounted for baseline differences in axial length and cylindrical power between the groups. 

Key study outcomes were as follows

• After accounting for baseline differences between the groups, annualized axial length elongation was 0.20mm / year with MiSight and 0.24 mm / year with ortho-k overall. 
• In older children (11-18 yrs), MiSight showed significantly lower axial elongation than ortho-k during months 6 to 12 (0.07mm versus 0.11mm), but rates converged during months 12 to 18 (0.10mm in both groups)
• In younger children (8-10 yrs), annualized axial elongation rates were comparable between MiSight and ortho-k (0.44mm / year versus 0.36mm / year), and overall progression in children 8-10 yrs of age was around twice that of children 11-18 yrs of age.
• MiSight showed minimal changes in cylindrical power throughout the study period
• Ortho-k produced an initial 1.55D improvement in spherical equivalent at 6 months and an increase in cylinder from baseline. 

Both MiSight dual-focus soft contact lenses and ortho-k were associated with annualized elongation rates of approximately 0.20mm / year and 0.24mm / year, respectively, after adjustment for baseline differences between the two groups. These rates are lower than those typically reported in untreated myopic children, suggesting both treatments may help slow eye growth. However, the clinical significance of the 0.04mm per year difference between modalities remains uncertain.

In children older than 10 years, MiSight demonstrated lower axial length progression during months 6 to 12, but this advantage was not maintained at 18 months. In younger children, progression rates were comparable between modalities throughout the study period. 

Substantial baseline imbalances existed between groups, with MiSight patients being older, more myopic, and having longer baseline axial length. Although statistical adjustment was performed, these differences may still have influenced the results. These also indicated that practitioners tended to fit younger children with ortho-k rather than MiSight, perhaps due to handling presumptions. Overall, both modalities remain viable options, with treatment selection likely guided more by individual patient factors than by expected differences in axial length control.

Patient compliance was not tracked, leaving uncertainty about whether children wore their lenses as prescribed, which could significantly affect observed differences in axial length control. 

The apparent advantage of MiSight in older children was limited to a single 6 to 12-month interval and was observed after accounting for substantial baseline differences between the groups. There was no difference between groups after 18 months. Future studies with better-matched participants are needed to confirm whether this represents a true differential treatment effect, and whether this persists over time. 

Objectives: To assess age-specific effectiveness of dual-focus soft contact lenses (MiSight) and orthokeratology (Ortho-K) in slowing myopia progression over 18 months in pediatric patients, emphasizing axial length (AL) changes.

Methods: Retrospective analysis of 239 eyes from 123 myopic pediatric patients (aged 8-18 years) (MiSight: 137 eyes; Ortho-K: 102 eyes), stratified by age (younger: ≤10 vs. older: >10 years). Primary outcome was AL elongation measured by IOL Master. Secondary outcomes included spherical equivalent (SE), keratometry, and cylinder power (CYL) through autorefraction. Orthokeratology measurements were taken during treatment without washout, limiting direct refractive comparisons. Linear mixed models were used for intragroup changes, and general linear model adjustment was applied for baseline imbalances in AL and CYL.

Results: Despite significant baseline imbalances (MiSight group had longer AL and more myopic SE), GLM-adjusted analysis showed modestly lower overall annualized AL elongation with MiSight (0.20 mm/year) compared with Ortho-K (0.24 mm/year). In older children (older than 10 years), MiSight was associated with lower AL progression, particularly between 6 to 12 months (0.07 vs. 0.11 mm/6-months, P=0.012). In younger children (10 years and younger), adjusted AL elongation rates were comparable between groups. MiSight maintained relatively stable refractive parameters, while Ortho-K induced corneal flattening but progressive worsening of CYL.

Conclusions: This age-stratified retrospective comparison demonstrated modestly lower axial elongation with MiSight after adjustment for baseline differences, particularly in older children (older than 10 years). These findings suggest potential age-dependent differences in treatment response between the two modalities and highlight the importance of individualized myopia management strategies.

 [Link to open access paper]