This study investigated the relationship between relative peripheral refraction (RPR), retinal choroidal vessel, and the growth rate of axial length (AL) in children with myopia wearing multifocal soft contact lenses (MiSight CLs).Forty-four eyes of 44 children with myopia wearing MiSight CLs were included in the study. RPRs and retinal choroidal vessel were measured at baseline, 3 months, 6 months, and 1 year using multispectral refraction topography (MRT) and optical coherence tomography angiograghy (OCTA). MRT presented RPR at different fields of view and OCTA presented retinal choroidal vessel characteristics centered on the macula. The correlation between the changes of RPR (ΔRPRs) and the growth rate of AL was analyzed.The baseline AL, spherical equivalent, age, and average growth rate of AL of children are 24.76 ± 0.95 mm,  - 3.22 ± 1.77 D, 11.25 ± 2.42 years, and 0.22 ± 0.17 mm/year. At 3 months, TRPR (RPR of the circular visual field of 53° centered on macular fovea) (p = 0.0007), RPR-15 (p = 0.0042), RPR-30 (p = 0.0012), RPR-45 (p = 0.0031), and RPR-I (p = 0.0082) of children with myopia wearing MiSight CLs were significantly lower than baseline. The ΔRPR was negatively correlated with the growth rate of AL (ΔTRPR, r = - 0.43, p = 0.003; ΔRPR-45, r = - 0.43, p = 0.004; ΔRPR-I, r = - 0.35, p = 0.02; ΔRPR-N, r = - 0.32, p = 0.04). At 1 year, there was a significant difference in the retina vessel volume index compared to baseline (p = 0.0002).RPR showed significant changes at 3 months after wearing multifocal soft contact lenses, but noticeable changes in retinal vessel volume index occurred only at 1 year. MRT demonstrates a higher efficacy in the early detection of the effectiveness of myopia control measures.© 2025. The Author(s).