PurposeTo compare peripheral defocus, higher-order aberrations (HOAs), and contrast visual acuity (CVA) in myopic children wearing orthokeratology (OK) lenses and multifocal soft contact lenses (MSCLs) designed with highly addition.MethodsThis is a prospective, nonrandomized, controlled study. Subjects at 8 to 13 years of age with spherical equivalent refraction from − 1.00 to − 5.00 dioptres (D) were included in the OK group (n = 30) and MSCL group (n = 23). Relative peripheral corneal defocus (RPCD) and relative peripheral refraction (RPR) were measured before and after wearing lenses. HOAs including spherical aberration (SA), coma, trefoil, and total HOAs, and high (100%) and low (10%) CVA were compared between the groups. Axial length (AL) was measured before and after wearing the lenses for 1 year.ResultsAfter wearing the lenses, subjects in the MSCL group had RPCD and RPR values similar to the OK group at the paracentral (within 2 mm of the cornea or 20° of the retina, all p > 0.05) but larger than the OK group at the periphery (all p < 0.05). All HOAs increased after wearing the lenses except the trefoil in the MSCL group (all p < 0.05). HOAs increased more in the OK group (all p < 0.05). The 100% and 10% CVAs were worse in the MSCL group (p = 0.02 and p = 0.004). After 1 year, AL elongation was 0.37 mm (SD = 0.16) in the MSCL group and 0.28 mm (0.16) in the OK group (p = 0.06).ConclusionMSCL produced larger myopic defocus at the periphery, increased less HOAs and had worse CVA than OK lens. The high addition of this MSCL did not result in better myopia control efficacyTrial registrationChinese Clinical Trial Registry: ChiCTR1800018564. Registered 25 September 2018; retrospectively registered, http://www.chictr.org.cn/showproj.aspx?proj=31376