The use of soft contact lenses with multi-focus optics to slow myopia progression has seen enormous progress in recent times, from the first case report published in 20081 and first clinical trial published in 2013,2 both utilizing commercially available designs originally for presbyopia. Since then, a variety of soft contact lens designs specifically for myopia have emerged and been tested in randomized controlled trials. These include defocus-incorporated,3 dual-focus concentric,4 and extended-depth-of-focus5 designs.
The newest evolution of myopia controlling soft contact lenses involved extensive preclinical testing to develop prototype designs incorporating concentric annular zones with noncoaxial relative plus power.6 Termed RingBoost™ technology, it was developed by Johnson and Johnson Vision with the aim to increase the relative plus power or ‘Add’ power for increased treatment efficacy while minimizing the impact on vision.6 This article will explore the RingBoost™ technology design and efficacy to slow myopia progression in children.
What is RingBoost technology?
Dual-focus contact lenses3 incorporate an annular ‘Add’ power in the lens optics which provides the presumed mechanism for slowing myopia. This Add power brings light to focus at a single point in front of the retina. In the RingBoost™ technology soft contact lenses, relative plus power is incorporated to create myopic defocus as well; however, these plus power zones do not create a point focus. Instead, a ring focus is formed in front of the retina, forming off the central axis of vision.6
Animal models indicate that the amount of peripheral defocus induced by an optical treatment influences the amount of eye growth that occurs.7,8 The Bifocal Lenses in Nearsighted Kids (BLINK) study showed that a high add power (+2.50D) in center-distance multifocal soft contact lenses had a myopia control effect, where a medium add power (+1.50D) did not.9 You can read more about the dose-response in soft contact lenses in our article Is There A Dose Response In Myopia Control?
Following from this theory, increasing Add power is thought to provide more myopic defocus and so a greater myopia control effect.6-8 In multifocal or multi-zone soft contact lenses, the impact of increasing Add powers on vision is a limiting factor: due to the singular point focus at the line of sight, visual acuity and contrast sensitivity is impacted up to +2.00D or +3.00D add powers and haloes typically experienced.10 In RingBoost™ technology, Add powers are introduced into the contact lens as torus shapes rather than in a spherical shape, which creates a ring-focus in a noncoaxial position, around the line of sight.6,10
How well does RingBoost technology slow myopia?
In the multisite randomized clinical trial of the RingBoost™ soft contact lenses, 200 children aged 7- to 12-years old with spherical equivalent refractive error (SER) between -0.75D to -4.50D were recruited. Four types of soft contact lens designs were compared:
- EE: EE is prototype 1 of the RingBoost™ technology and was designed to “enhance efficacy” – it has 2 concentric, annular treatment zones of +7.00D non-coaxial plus power. In this EE prototype, the plus power is positioned closer to centration. It also features a +10.00 D co-axial treatment zone for greater efficacy.
- EV: EV is prototype 2 of the RingBoost™ technology and was designed to “enhance vision” – it also has 2 concentric, annular treatment zones of +7.00D non-coaxial plus power. However, in this EV prototype the plus power is positioned further away from centration.
- DF: Dual-focus contact lenses
- SV: Single vision contact lenses
Data at 6 months revealed that the EE lenses provided the most myopia control effect out of all the designs investigated as measured by axial length and spherical equivalent autorefraction (SECAR) – see the graph below. The EV lenses were comparable to the dual-focus lens design in terms of myopia control efficacy.6
Figure 2 from open access paper Randomized Trial of Soft Contact Lenses with Novel Ring Focus for Controlling Myopia Progression6 with the following caption: “Unadjusted mean (standard error) change in (A) axial length (AL) and (B) spherical equivalent cycloplegic autorefraction (SECAR) by lens type across time. The 2 measures of AL at 26 weeks represent noncycloplegic (dark gray) and postcycloplegic measures (black). D = diopter; EE = enhanced efficacy lens group; EV = enhanced vision lens group; DF = dual-focus lens group; SV = single-vision lens group.”
At this stage, only 6-month data is available. As we know, treatment effect is not constant over time: but a good indicator of long-term efficacy is early strong myopia control performance. Myopia control treatments typically demonstrate this in the first 6 to 12 months of use.11 Read more about this in our article Can We Predict Long-Term Efficacy From Short-Term Outcomes?
Does RingBoost technology affect vision and visual function?
At all study visits, in all the contact lens designs (EE, EV, DF and SV) participants achieved a visual acuity of 0.00 logMAR (6/6 or 20/20 equivalent). 90% of participants expressed a high level of satisfaction with their visual experience; however, both the EE and DF groups experienced a higher incidence of haloes and other visual disruptions. At the 1-week mark, approximately 12% of participants reported experiencing haloes, which decreased to 5-7% after 26 weeks. The EE group had a lower occurrence of ghosting (2%) compared to the DF group (14%) after 26 weeks.6
Subjective visual experience may be age-dependent. A recent cross-over study investigated the visual differences between different soft contact lens designs for myopia control. Participants aged 7- to 17-years old were given single vision contact lenses to wear for 1 week. Over a 6 week period, they were then given either the RingBoost™ prototype EE, the RingBoost™ prototype EV or dual-focus soft contact lenses and switched every 2 weeks. It was found that teenagers were more judgemental with regards to vision quality than children, with this age group being more critical about their visual experience with the EE and dual-focus lenses.12
In a study evaluating the effect on accommodation, the RingBoost™ lenses were compared to dual-focus concentric, center-distance multifocal and single vision soft contact lenses, as well as standard spectacle lenses. It was found that the accommodative responses from the RingBoost™ wearers were statistically equivalent to single vision contact lenses, where dual-focus lenses showed either a smaller or larger accommodative response compared to single vision depending on measurement type. Center-distance multifocal contact lens accommodative responses were reduced compared to single vision.13
Final Thoughts
The RingBoost™ design offers a soft contact lens myopia control option that provides a high level of myopic defocus while still maintaining good vision and visual function.6,10,12,13 While continued research is underway to reveal how the RingBoost™ technology performs over longer time periods, early data indicates promising potential as a robust myopia control treatment.
About Jeanne
Jeanne Saw is a clinical optometrist based in Sydney, Australia. She has worked as a research assistant with leading vision scientists, and has a keen interest in myopia control and professional education.
This content is brought to you thanks to an unrestricted educational grant from
References:
- Aller TA, Wildsoet C. Bifocal soft contact lenses as a possible myopia control treatment: a case report involving identical twins. Clin Exp Optom. 2008 Jul;91(4):394-9.
- Walline JJ, Greiner KL, McVey ME, Jones-Jordan LA. Multifocal contact lens myopia control. Optom Vis Sci. 2013 Nov;90(11):1207-14.
- Lam CS, Tang WC, Tse DY, Tang YY, To CH. Defocus Incorporated Soft Contact (DISC) lens slows myopia progression in Hong Kong Chinese schoolchildren: a 2-year randomised clinical trial. Br J Ophthalmol. 2014 Jan;98(1):40-5.
- Chamberlain P, Peixoto-de-Matos SC, Logan NS, Ngo C, Jones D, Young G. A 3-year Randomized Clinical Trial of MiSight Lenses for Myopia Control. Optom Vis Sci. 2019 Aug;96(8):556-567.
- Sankaridurg P, Bakaraju RC, Naduvilath T, Chen X, Weng R, Tilia D, Xu P, Li W, Conrad F, Smith EL 3rd, Ehrmann K. Myopia control with novel central and peripheral plus contact lenses and extended depth of focus contact lenses: 2 year results from a randomised clinical trial. Ophthalmic Physiol Opt. 2019 Jul;39(4):294-307.
- Cheng X, Xu J, Brennan NA. Randomized Trial of Soft Contact Lenses with Novel Ring Focus for Controlling Myopia Progression. Ophthalmol Sci. 2022 Oct 18;3(1):100232.
- Smith EL 3rd, Arumugam B, Hung LF, She Z, Beach K, Sankaridurg P. Eccentricity-dependent effects of simultaneous competing defocus on emmetropization in infant rhesus monkeys. Vision Res. 2020 Dec;177:32-40. (link)
- Troilo D, Smith EL 3rd, Nickla DL, Ashby R, Tkatchenko AV, Ostrin LA, Gawne TJ, Pardue MT, Summers JA, Kee CS, Schroedl F, Wahl S, Jones L. IMI - Report on Experimental Models of Emmetropization and Myopia. Invest Ophthalmol Vis Sci. 2019 Feb 28;60(3):M31-M88. (link)
