September 15, 2025
By Ashley Tucker, OD, FAAO, FSLS, ABO Diplomate
If diversified segmental defocus optimization (DSDO) spectacle lenses—with or without atropine—are helpful in slowing down myopia progression in myopic children, might these strategies also work as a preventive approach?
Researchers at the Department of Ophthalmology at Peking University People’s Hospital set out to find out. A one-year, randomized, placebo-controlled, clinical double-masked trial followed children aged 5 to 12. Their spherical equivalent refraction was plano to 1.00D after cycloplegia. Study subjects had no ocular or systemic diseases and no previous use of optical or pharmaceutical myopia control methods.
The researchers created three equal groups of 150 children each:
- DSDO spectacles and placebo eye drops (DSDO group);
- DSDO spectacles and 0.01% atropine (DSDOA group);
- Single vision spectacles and placebo eye drops (control group).
After the 12-month study period, 370 participants completed the study. There were 121 in the DSDO group, 125 in the DSDOA group and 124 in the control group.
The lenses used in this trial were from Zhuahi FITLENS Medical Technology Co. The lenses incorporate a central optical zone (9.5 mm in diameter) and eight rings, each with 32 microlenses in the peripheral field. The plus power in these lenses gradually transition from 4.00D inside out toward 3.00D.
Myopia Incidence (1 year):
- Control group: 15.3% developed myopia
- DSDO group: 5.8% (significantly lower vs control, P = .02)
- DSDOA group: 4.8% (significantly lower vs control, P = .006)
- No significant difference between DSDO and DSDOA groups (P = .73).
Fast Myopic Shift (1 year):
- Control group: 42.7%
- DSDO group: 15.7% (27% lower than control, P < .001)
- DSDOA group: 9.6% (33% lower than control, P < .001)
- No significant difference between DSDO and DSDOA groups (P = .15).
Change in Spherical Equivalent Refraction (SER, 1 year):
- Control group: −0.30D
- DSDO group: −0.11D
- DSDOA group: −0.01D
- Both treatment groups showed significantly less myopic progression than controls (P < .001).
The study showed that the spectacle lenses were so effective that adding 0.01% atropine did not substantially increase their efficacy. Researchers looked at the primary outcomes of myopia incidence and participants with fast myopic shift over one year. Secondary outcomes looked at changes in spherical equivalent, axial length and subfoveal choroidal thickness. Both interventions slowed myopic progression and axial elongation compared with control. DSDOA showed a slight advantage in preserving choroidal thickness, but otherwise the two interventions performed similarly.
The researchers concluded that the findings support daily use of DSDO spectacles without atropine to delay myopia as a preventive method. However, there is also a need for longer follow-up and replication.
ABSTRACT
Diversified Segmental Defocus Optimization Lenses With and Without Atropine for Myopia Prevention: A Randomized Clinical Trial
Yuchang Lu, MD; Xue Yang, MBBS; Jingwei Zhou, MBBS; Sitong Chen, MD; Xuewei Li, PhD; Yuanqi Deng, MD; Yixuan Zhang, MD; Yan Li, MS; KaiWang, PhD
Importance
With growing myopia prevalence worldwide, effective strategies to prevent early-onset myopia are needed.
Objective
To evaluate the efficacy of diversified segmental defocus optimization (DSDO) spectacle lenses with or without 0.01% atropine for myopia prevention.
Design, Setting, and Participants
This was 1-year randomized placebo-controlled double-masked clinical trial conducted in the Department of Ophthalmology at Peking University People’s Hospital from November 2023 to December 2024. Children aged 5 to 12 years with spherical equivalent refraction (SER) of 0.00 to 1.00 diopters (D) after cycloplegia were included, excluding those with ocular diseases, systemic diseases, or previous use of optical or pharmaceutical myopia control methods.
Interventions
Participants were randomly assigned in a 1:1:1 ratio to receive DSDO spectacles with placebo eye drops (DSDO group), DSDO spectacles with 0.01% atropine eye drops (DSDOA group), or single-vision spectacles with placebo eye drops (control group).
Main Outcomes and Measures
The primary outcomes were the cumulative incidence rate of myopia (defined as SER ≤−0.50 D) and the percentage of participants with fast myopic shift (defined as a spherical equivalent myopic shift ≥0.50 D) over 1 year. Secondary outcomes included changes in SER, axial length, and subfoveal choroidal thickness.
Results
Of the 450 children initially randomized (DSDO group: mean [SD] age, 7.05 [0.12] years; 77 [51.3%] male; DSDOA group: mean [SD] age, 7.02 [0.14] years; 73 [48.7%] male; control group: mean [SD] age, 7.01 [0.11] years; 78 [52.0%] male), 370 (82.2%) completed the study, including 121 in the DSDO group, 125 in the DSDOA group, and 124 in the control group. The 1-year cumulative incidence rates of myopia in the DSDO, DSDOA, and control groups were 5.8% (7/121), 4.8% (6/125), and 15.3% (19/124), respectively, and the percentages of participants with fast myopic shift after 1 year were 15.7% (19/121), 9.6% (12/125), and 42.7% (53/124). Both DSDO and DSDOA groups showed significantly lower 1-year cumulative myopia incidence (DSDO: difference, 9.5%; 95% CI, 1.9-17.5; P = .02; DSDOA: difference, 10.5%; 95% CI, 3.3-18.4; P = .006) and the percentage of patients with fast myopic shift (DSDO: difference, 27.0%; 95% CI, 16.1-37.3; P < .001; DSDOA: difference, 33.1%; 95% CI, 23.1-42.8; P < .001) vs control. No significant differences were observed between DSDO and DSDOA groups.
Conclusions and Relevance
These data suggest that daily use of DSDO spectacles delays the onset of myopia among children without myopia, supporting DSDO spectacles without atropine as an alternative preventive method for children without myopia if supported with longer follow-up and replication by others.
Trial Registration Chinese Clinical Trial Registry: ChiCTR2300077307
