Should kids wear both myopia control glasses and contact lenses?

One of the first considerations when discussing treatment options is to decide what the child will wear to optically correct myopia, i.e. glasses or contact lenses. Considering that myopic children will require an optical correction as a bare minimum, a spectacle or contact lens-based intervention makes the most sense, to simultaneously provide clear vision and control myopia progression. 

Glasses and contact lenses offer a distinct set of practical benefits. Glasses are simple and familiar, while contact lenses are convenient for sports and other physical activities. Contact lenses require a learning curve, but can provide additional functional and psychological benefits for children and teens.1 With this in mind, both options have their merits and families do not necessarily need to be positioned to choose one or the other.

Dual-wear describes regularly use both spectacles and contact lenses on an alternating basis according to the wearer’s preference. For example, wearing myopia control contact lenses on some days (e.g. sport days / weekends) and myopia control spectacles on others (e.g. school days / weekdays).

While infrequently described, dual wear is not uncommon. A 2020 global survey commissioned by CooperVision estimated that 27% of people in the US who require vision correction use both spectacles and contact lenses. A separate 2023 survey commissioned by the Contact Lens Institute found a similar proportion of dual wearers (23.6%) in the US.

In practice, spectacle wearers enjoy using contact lenses in situations where glasses are impractical, such as for exercise or sport. Contact lens wearers generally do not rely solely on contact lenses and are encouraged to use their glasses when contact lenses are not necessary, such as when relaxing at home. 

In contrast, the current evidence-base and generally accepted approaches to managing childhood myopia focus on one optical treatment at a time. Even in combination therapy, an optical treatment is nearly always augmented by a non-optical treatment, such as atropine2  or repeated low-level red light therapy.

Due to the different advantages of spectacles and contact lenses, the benefits of access to both modalities are easily recognized, as the strengths of one modality overlap with the weaknesses of the other. By adapting which optical modality to use according to day-to-day requirements, a patient can align the benefits of each modality to their use-case. Therefore, exploring the risks and benefits of dual wear for myopia management is justified.

Dual-wear offers practical and lifestyle benefits that could make myopia management more achievable for some families. Although real-world evidence is lacking, these factors support the rationale that alternating therapy could maintain or even enhance long-term compliance, and may improve children’s quality of life compared to the usual paradigm of optical monotherapy.

Dual-wear provides a way for children to avoid blurred vision from uncorrected refractive error, no matter the circumstance. The ACHIEVE study – a three-year randomized trial of myopic children aged 8-11 years, showed that dual wearers wear vision correction significantly longer (97.5 hours/week) than those who are solely spectacle wearers (91.5 hours/week) or contact lens wearers (80.3 hours/week).3 Additionally, children with at least 2.00D of myopia were corrected for roughly 8 hours longer each week than those with less myopia, likely due to their poorer unaided distance vision.3

Dual-wear can help sustain (and potentially increase) a child’s exposure to the effects of a myopia control intervention, since stronger efficacy has been correlated with longer wearing times.4,5 Even when a child is wearing a treatment according to the product’s recommended minimum wearing time (generally at least 8-12 hours per day, 6+ days per week), this leaves a residual portion of the waking day when the treatment is not utilised (e.g. sports). In these instances, time spent undercorrected, uncorrected, or using single vision lenses could safely be replaced with an alternative that slows eye growth.

Dual-wear provides increased flexibility and reassurance for children with active lifestyles. Engagement in sports, swimming, or high-motion extracurricular activities renders glasses impractical to wear. Contact lenses provide functional vision and high satisfaction during sporting activities,1 while still providing an active myopia control effect.

Schoolwork, sports, and other recreational activities benefit from optimal vision. A child using both modalities can enjoy greater comfort and freedom across different environments. For instance, the flexibility to wear spectacles on school days and contact lenses on weekends, holidays, or special occasions can increase confidence and convenience.1

Having a backup myopia control modality ensures continuity of treatment as well as uninterrupted functional vision. A second modality provides recourse during travel, illness, eye infection, irritation, or lens loss – situations where rigid adherence to a single optical strategy is unrealistic. This minimizes the likelihood of wearing single vision lenses, or worse – remaining uncorrected; both of which pose a risk for myopia progression.6,7

Despite its apparent flexibility and being prevalent across single vision correction, dual-wear potentially introduces several challenges and limitations in myopia control.

There is no direct research evidence on myopia control efficacy for those dual-wearing myopia control treatments and it is unknown how dual-wear regimens compare with consistent single-modality therapy. As such, practitioners cannot predict whether combining modalities in this way will yield additive, neutral, or diminished outcomes compared to wearing one treatment for the full recommended duration.

Current optical strategies share similarities by including a central refractive correction and a more peripheral myopia control zone; however, each design inhibits axial elongation in a unique way. Many designs impose myopic defocus (e.g. MiYOSMART, Stellest, and MiSight lenses), but recent studies suggest other underlying optical mechanisms at play. For example, diffusion optics technology (DOT) spectacle lenses8  (which modulate retinal contrast), and lenslet-Array-integrated (LARI) spectacle lenses9  (positive or negative defocus) have also shown to inhibit axial elongation. 

Because these designs produce different retinal images,10  and may yield varying efficacy results11-14  for individual patients, no two products can be considered fully interchangeable. 

Many products specify a recommended wear schedule to achieve optimal benefits, as myopia treatments are more effective when worn full-time and every day.15  Examples of these include Stellest spectacle lenses which showed best results for children wearing them at least 12 hours per day, 7 days per week,5  and MiSight 1-day contact lenses which were worn for an average of 13+ hours per day, 6.5 days per week in the clinical study.16  Alternating between two products introduces the risk that neither product’s recommended wear time is consistently met. 

Monitoring compliance could become more challenging when managing two different treatment types. For soft contact lenses, compliance can be indirectly estimated by counting remaining blister packs or encouraging the use of calendars and diaries. Spectacle wear is usually reported anecdotally by parents. When two optical modalities are used interchangeably, it may become harder to measure wearing times for either modality, making compliance more difficult to verify.

Dual wearing myopia management lenses could also increase the financial burden for families compared to single wear, at least in the short-term. Spectacle lenses used in myopia management are usually more expensive to fit and manufacture than their single-vision counterparts and so involve greater upfront fees.17 However, these costs could be offset in the long-term, manifest as lower final myopia in adulthood and reduced risk of visual impairment as a result. Dual wear can be considered where the child is likely to benefit from access to both modalities, and where it is financially feasible for families to do so.

Regular reviews are recommended for children undergoing myopia management, to consider whether the treatment should be continued, modified, combined with an additional treatment, or stopped entirely.15 In the circumstance of dual wear, it becomes difficult to attribute success or failure to either modality, especially if the child’s wearing schedule cannot be tracked or recalled. In the absence of a consistent treatment baseline, clinical decisions become more speculative.

Alternating between myopia control spectacle lenses and myopia control soft contact lenses may introduce adaptation challenges. Although research has largely shown that the visual experience of myopia control spectacles and contact lenses is equivalent to single vision,4,12,16 it is unknown if there would be a challenge presented when shifting between optical designs.

There is no established consensus to support or discourage dual wear for myopia management. Eye care practitioners can apply clinical judgment and weigh potential risks and benefits on a case-by-case basis. 

A structured approach is suggested below to help eye care practitioners determine whether dual wear is appropriate.

1. Determine the primary treatment – Where possible, prescribe the optical treatment that the child will use consistently, suits their personal and lifestyle needs, is effective, and is likely to be tolerated well. Consider that ortho-k lenses may be more convenient than switching between spectacles and contact lenses, and are associated with high compliance and vision-related quality of life.15 
2. Identify potential barriers to full-time wear – Sporting activities, cosmesis, special or social occasions, and personal preferences may adversely affect wearing time, particularly if spectacles are preferred as the main treatment. This is a good opportunity to resolve parental concerns about vision or convenience, and determine the treatment which will encourage the best compliance.
3. Determine if a secondary correction is needed – All contact lens wearers should have a pair of glasses that allows them to achieve clear and comfortable vision as a precautionary measure. Spectacle wearers may be satisfied with their correction for the majority of activities, but can benefit from the convenience of contact lenses for other occasions. 
4. Determine whether the secondary correction should provide myopia control – A secondary treatment may be considered if it is required to supplement the wearing time of the primary treatment. For example, if a child wears dual focus soft contact lenses for 11 hours per day and sleeps for 8 hours per day, this implies roughly 5 hours per day where the child is not receiving myopia control treatment. This is a better value proposition for dual wear than if a spectacle wearer is out of their myopia control treatment for say, only 1 hour each day during waking hours (e.g. sport). Lifestyle, capacity for compliance, and the family’s budget can also factor into consideration.
5. Maintain routine reviews – The IMI recommends ongoing reviews every six months for young patients undergoing myopia management.16  Each review allows us to ensure the myopia treatment(s) are suitable for the patient and their family, and is meeting outcomes for their vision, eye health, and myopia control. This is even more important when different treatments are being used in combination.