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Spectacle Lenses: Where Are We Now?

Durgasri Jaisankar, PhD, BOptom

BHVI

The global prevalence of myopia is rising, leading to higher rates of visual impairment associated with its progression.1 Myopia progression has a complex aetiology influenced by various known genetic and environmental factors,2,3 as well as many unknown factors that researchers worldwide are actively investigating. Myopia-control spectacles and contact lenses are designed to slow or halt myopia progression in children and young adults.

Myopia-control spectacle lenses fall into three main design categories: 1) progressive addition lenses (PALs) e.g. Myokids and MyoVision, (Carl Zeiss, Germany); 2) lenses with multiple optical defocus zones e.g., Stellest, (Hoya, Japan), Miyosmart (Essilor, France) and Myocare/Myocare S (Carl Zeiss, Germany); and 3) lenses with microdot zones that scatter light to reduce peripheral visual contrast e.g., DOT lenses (SightGlass Vision Inc.).4 These lenses are reported to be efficacious in controlling the myopia progression to a certain extent.5-7

The scientific understanding around myopia progression interventions continues to evolve as new information emerges. Early theory suggested that the lag of accommodation seen in myopia leads to hyperopic defocus on the retina, which may drive myopia progression.8,9 Myopia control PALs were designed to address this. The lenses provide distance power centrally with addition power in the surrounding periphery to counteract the accommodation lag. However, clinical trials have shown that PALs produce only minimal or clinically insignificant effects on slowing myopia progression.10,11

The limited effectiveness of PALs may be due to their tendency to induce myopic defocus rather than addressing accommodation lag. This led to designing lenses with multiple optical zones to create simultaneous peripheral myopic defocus with positive lenslets or rings to act as a signal to stop axial elongation while maintaining a sharp image through the centre of the lens. These lenses have demonstrated efficacy of about 52% – 67% when compared to controls (usually single vision spectacle lenses).12-15 They are becoming increasingly popular as an alternative to atropine or other invasive myopia-control treatments or as a combined therapy.16

Although the most popular hypothesis of myopia control is to induce peripheral myopia defocus, recently, negative optical defocus components which induce hyperopic defocus in the periphery have shown promising results.17 Papadaogiannis et al.18 assessed the peripheral refraction and peripheral visual functions of three myopia control spectacle lenses with peripheral positive optical defocus. They found that the lenses only had a small effect on the peripheral refraction but had significant effect on the retinal contrast. This indicated that the mechanism of myopia control with multiple optical defocus zones may be because of reduced contrast information through the lenslet instead of peripheral hyperopia correction.

High contrast visual information activates retinal photoreceptors, triggering signals that promote eye elongation. The lenses are designed with a clear central zone and multiple small scattering peripheral zones that reduce the image contrast and help in slowing myopia progression. A 4-year clinical study19 with Diffusion Optics Technology (DOT) spectacle lenses investigated two DOT lenses. Test 1 (DOT 0.2) had 0.365 mm spacing of the diffusers and test 2 (DOT 0.4) had 0.240 mm spacing to create a higher fill factor. After the first year, test 2 lenses had significant dropouts due to their denser optical pattern and in the fourth year, test 2 lenses were swapped to test 1 lenses. Children wearing the DOT lenses at least 13 hours per day had a myopia control effect of 0.52 D and 0.21 mm with test 1 lenses after 4 years, with most benefit occurring in the first year.

To conclude, current evidence indicates that traditional single vision spectacle lenses will be replaced by more efficient myopia control lens options. Clinicians are encouraged to adopt evidence-based approaches for myopia management and should remain informed about the evolving lens design and their underlying mechanisms.

  1. Holden BA, Fricke TR, Wilson DA, et al. Global prevalence of myopia and high myopia and temporal trends from 2000 through 2050. Ophthalmology. 2016 May 1;123(5):1036-42.
  2. Martínez-Albert N, Bueno-Gimeno I, Gené-Sampedro A. Risk factors for myopia: a review. Journal of clinical medicine. 2023;12(18):6062.
  3. Morgan IG, Wu P-C, Ostrin LA, & et al. IMI Risk Factors for Myopia. Investigative ophthalmology & visual science. 2021; 62, 3-3.
  4. Atchison DA, Charman WN. Optics of spectacle lenses intended to treat myopia progression. Optometry and Vision Science. 2024;101(5):238-49.
  5. Lam CS, Tang WC, Zhang HY, et al. Long-term myopia control effect and safety in children wearing DIMS spectacle lenses for 6 years. Scientific reports. 2023;13(1):5475.
  6. Li X, Huang Y, Yin Z, et al. Myopia control efficacy of spectacle lenses with aspherical lenslets: results of a 3-year follow-up study. The American Journal of Ophthalmology 2023; 253: 160-168.
  7. Liu X, Wang P, Xie Z, et al. One‐year myopia control efficacy of cylindrical annular refractive element spectacle lenses. Acta Ophthalmologica 2023; 101: 651-657.
  8. Charman WN. The eye in focus: accommodation and presbyopia. Clinical and experimental optometry. 2008;91(3):207-25.
  9. Gwiazda J, Thorn F, Bauer J, et al. Myopic children show insufficient accommodative response to blur. Investigative ophthalmology & visual science. 1993;34(3):690-4.
  10. Hasebe S, Jun J, Varnas SR. Myopia control with positively aspherized progressive addition lenses: a 2-year, multicenter, randomized, controlled trial. Investigative ophthalmology & visual science. 2014;55(11):7177-88.
  11. Kanda H, Oshika T, Hiraoka T, et al. Effect of spectacle lenses designed to reduce relative peripheral hyperopia on myopia progression in Japanese children: a 2-year multicenter randomized controlled trial. Japanese journal of ophthalmology. 2018;62(5):537-43.
  12. Lam CS, Tang WC, Tse DY, et al. Defocus Incorporated Multiple Segments (DIMS) spectacle lenses slow myopia progression: a 2-year randomised clinical trial. British Journal of Ophthalmology. 2020 Mar 1;104(3):363-8.
  13. Bao J, Huang Y, Li X, et al. Spectacle lenses with aspherical lenslets for myopia control vs single-vision spectacle lenses: a randomized clinical trial. JAMA ophthalmology. 2022 May 1;140(5):472-8.
  14. Chen X, Wu M, Yu C, et al. Slowing myopia progression with cylindrical annular refractive elements (CARE) spectacle lenses—year 1 results from a 2‐year prospective, multi‐centre trial. Acta Ophthalmologica. 2025 Dec;103(8):929-38.
  15. Chen X, Wu M, Yu C, Ohlendorf A, Li W, Liu N, Yang Y, Li L, Sankaridurg P. Efficacy of cylindrical annular refractive elements (CARE) spectacle lenses in slowing myopia progression over 2 years. American Journal of Ophthalmology. 2025 Jun 13.
  16. Nucci P, Lembo A, Schiavetti I, Shah R, Edgar DF, Evans BJ. A comparison of myopia control in European children and adolescents with defocus incorporated multiple segments (DIMS) spectacles, atropine, and combined DIMS/atropine. PLoS One. 2023;18(2):e0281816.
  17. Su B, Cho P, Vincent SJ, et al. Novel lenslet-array-integrated spectacle lenses for myopia control: A 1-year randomized, double-masked, controlled trial. Ophthalmology. 2024 Dec 1;131(12):1389-97.
  18. Papadogiannis P, Börjeson C, Lundström L. Comparison of optical myopia control interventions: effect on peripheral image quality and vision. Biomedical Optics Express. 2023;14(7):3125-37.
  19. Laughton D, Hill JS, McParland M, Tasso V, Woods J, Zhu X, Young G, Craven R, Hunt C, Neitz J, Neitz M. Control of myopia using diffusion optics spectacle lenses: 4-year results of a multicentre randomised controlled, efficacy and safety study (CYPRESS). BMJ Open Ophthalmology. 2024;9(1).

Dr Durgasri Jaisankar is a postdoctoral researcher at the Brien Holden Vision Institute Limited (BHVI), in addition to a conjoint lecturer appointment at the School of Optometry and Vision Science, UNSW. At BHVI, Durgasri specializes in ophthalmic lens product development for the correction and treatment of refractive errors. She obtained her PhD in Optometry and Vision Science from the Queensland University of Technology in 2021. Her PhD work focused on the evaluation of peripheral ocular optics and visual performance.

Durgasri completed her bachelor’s degree in optometry at Elite School of Optometry in India in 2014. Following this, she worked as a clinical optometrist and research fellow in the department of vitreoretinal diseases at the Medical Research Foundation, Sankara Nethralaya, Chennai, India. Throughout her academic and professional career, Durgasri has published over 20 peer-reviewed articles.

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