Dr. Sandra Ganesh discusses the findings and implications of a recent retrospective cohort study evaluating spectacle lenses for myopia management.
August 17, 2026
In a recent publication in Ophthalmology Science, Dr. Sandra Ganesh and colleagues reported the findings of a retrospective cohort study conducted at Aravind Eye Hospital in India. The study1 evaluated myopia progression and axial elongation outcomes among children prescribed with one of three spectacle lens-based myopia management interventions in routine clinical practice. The findings contribute to the evidence base supporting spectacle lens interventions for myopia management and provide valuable real-world evidence on outcomes observed in routine clinical practice.
In this interview, Dr. Ganesh discusses the rationale behind the study, key findings, implications for myopia management and future directions for research in the field.
Study Rationale and Design
Q: What motivated you and your team to undertake this study?
Dr. Sandra Ganesh: This retrospective single-center cohort was motivated by a clinical need to compare real-world effectiveness of three commercially available spectacle lens designs developed for myopia control (DIMS, H.A.L.T.*, CARE) versus single-vision lenses for slowing axial elongation and refractive progression in children. Clinicians and families are increasingly choosing spectacle-based myopia management, yet head-to-head randomized data remain limited. We therefore sought to quantify the relative performance of these three widely used spectacle technologies in routine clinical practice to help inform selection and set realistic expectations.
Q: Can you briefly describe the study design and patient population included in your analysis?
Dr. Ganesh: We conducted a single‑center retrospective cohort involving 899 children (1,780 eyes) aged 6–16 years with cycloplegic spherical equivalent (SE) between −0.50D to −9.00D, who were naïve to myopia control spectacles and atropine. Participants were grouped according to the spectacle lens prescribed (SVL, DIMS, H.A.L.T.*, or CARE), and annualized axial length (AL) and spherical equivalent (SE) progression were analyzed using linear mixed‑effects models adjusted for baseline age, sex, parental myopia and baseline AL/SE to account for inter‑eye correlation and baseline imbalances.
Q: How do findings from studies conducted in routine clinical practice complement evidence generated through randomized clinical trials?
Dr. Ganesh: Real‑world cohorts reflect routine prescribing, compliance patterns, wider refractive ranges and the constraints clinicians actually face. They therefore complement randomized clinical trial (RCT) data by showing whether treatment effects translate into everyday clinical practice.
While RCTs provide stronger causal inference through strict inclusion criteria and controlled conditions, observational real‑world studies trade some causal certainty for broader generalizability and pragmatic insights, such as uptake of myopia management interventions, follow‑up adherence and age distributions that support clinical decision‑making.
Key Findings
Q: What were the key findings from the study, and were any of the results particularly noteworthy?
Dr. Ganesh:
Primary findings
The adjusted annual AL progression (mm/year) was 0.193 for SVL, 0.098 for DIMS, 0.088 for CARE and 0.054 for H.A.L.T.* spectacle lenses. All three spectacle lenses significantly reduced axial elongation compared with SVL. In this retrospective study, H.A.L.T.* spectacle lenses were significantly more effective than both DIMS and CARE for AL control (pairwise p < 0.001).
Refractive progression
Consistent with the axial length findings, SE progression was also reduced by all three designs compared with SVL. The adjusted annual progression was −0.370 D/year for SVL −0.107 D/year for DIMS; −0.106 D/year for CARE; −0.073 D/year for H.A.L.T.* spectacle lenses. However, pairwise differences among the three lenses for SE did not reach statistical significance.
Several findings were particularly noteworthy. First, the magnitude of AL suppression with H.A.L.T.* spectacle lenses was clinically meaningful, corresponding to an approximately 72% reduction compared with SVL in this cohort. Second, AL and SE outcomes did not always give identical results—H.A.L.T.* spectacle lenses led AL suppression most clearly in this study, while differences in SE progression across devices were smaller and not statistically significant. Third, benchmarking against an age-normative model2 showed that treated groups progressed substantially less than expected for untreated peers, providing additional support for the findings beyond the internal SVL comparison.
Q: One of the primary outcomes assessed was axial length progression. Why is axial length such an important measure in myopia management?
Dr. Ganesh: Axial length is the structural substrate of myopia and is considered the most objective metric of eye growth that can help predict the long-term risk of pathologic myopic complications (myopic maculopathy, retinal detachment, glaucoma) better than refractive error alone.3,4 Therefore, slowing axial elongation is the principal clinical target of controlling myopia progression.
Another practical advantage is that AL is less affected by accommodation, cycloplegia variability or spectacle vertex changes and is highly reproducible with modern biometers. As a result, it is the preferred endpoint for monitoring treatment response and supporting clinical decision-making, including when considering treatment escalation or combination therapy.
Clinical Implications
Q: What do these findings tell us about the role of spectacle lens interventions in contemporary myopia management?
Dr. Ganesh: The study supports the use of myopia control spectacle lenses as effective first-line options to slow axial growth in children, either alone or as part of a multifaceted management plan or combination therapy. In this study, H.A.L.T.* spectacle lenses demonstrated significantly lower axial elongation than DIMS and CARE.
These real-world estimates are directionally consistent with prior RCTs and cohort studies showing clinically meaningful myopia control from H.A.L.T.*, DIMS and CARE spectacle lenses, and they add comparative, pragmatic data from this study on axial length outcomes across the three spectacle lens designs (H.A.L.T.* > DIMS ≈ CARE) while acknowledging that refractive effects may be less differentiated.
Future Directions
Q: Based on your findings, what do you see as the most important priorities for future research in myopia management?
Dr. Ganesh: Prospective, randomized head-to-head trials with standardized adherence tracking and longer follow-up (≥ two to three years) are needed to confirm the hierarchy of AL control and the durability of treatment effects observed in real-world data. Future studies should also combine objective wear-time measurements with factors such as pupil size, binocular vision metrics and environmental exposures to identify effect modifiers and help personalise lens choice. Trials evaluating staged or combination therapy (spectacles + low-dose atropine) could determine whether additive or synergistic benefits can be achieved. Finally, mechanistic research linking AL changes with choroidal metrics and optical dose (lenslet density/defocus magnitude) may help refine future optical designs and inform prescription guidance, such as pupil coverage thresholds.
Closing
As the evidence base for myopia management continues to expand, studies conducted in routine clinical practice provide valuable insights into how interventions perform in real-world settings. Together with findings from RCTs, these data can help clinicians make informed decisions and continue advancing evidence-based care for children with progressive myopia.
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Dr. Sandra Chandramouli is a Consultant in the Department of Paediatric Ophthalmology and Strabismus at Aravind Eye Hospital, Coimbatore, India, where she also heads the Vision Rehabilitation Centre. With 20 years of experience at a high-volume tertiary eyecare institute and referral center, she has extensive clinical knowledge and surgical expertise in adult and paediatric cataract and complex strabismus. Her special interests include complex strabismus, topical and adjustable strabismus surgery, minimal-incision strabismus surgery, surgery for nystagmus, non-strabismic binocular vision disorders, myopia and cerebral visual impairment. She is actively involved in training fellows and postgraduate students and has presented papers, posters and instructional courses at national and international conferences. |
Notes
This communication is intended for scientific exchange only and does not constitute medical or therapeutic recommendations.
*H.A.L.T. is an acronym for Highly Aspherical Lenslet Target and does not imply a “halt” or “stop” of myopia progression.
Essilor® Stellest® lens regulatory status and product availability may vary by country. Data presented may be derived from one or more clinical studies. U.S. FDA authorization and indications for use are based solely on clinical trial data from the U.S.
References
- Ganesh SC, Armentano M, Rao SG, Sakthivel P, Elizabeth S, Sindhu A, Sivakumar PA, Alisi L, Narendran K. Comparative effectiveness of myopia-control spectacle lenses: Real-world performance from a retrospective cohort study. Ophthalmology Science. 2026 Feb 2:101103.
- Brennan NA, Shamp W, Maynes E, Cheng X, Bullimore MA. Influence of age and race on axial elongation in myopic children: a systematic review and meta-regression. Optometry and Vision Science. 2024 Aug 1;101(8):497-507.
- Wolffsohn JS, Kollbaum PS, Berntsen DA, Atchison DA, Benavente A, Bradley A, Buckhurst H, Collins M, Fujikado T, Hiraoka T, Hirota M. IMI–Clinical myopia control trials and instrumentation report. Investigative Ophthalmology & Visual Science. 2019 Feb 28;60(3):M132-60.
- Flitcroft DI, He M, Jonas JB, Jong M, Naidoo K, Ohno-Matsui K, Rahi J, Resnikoff S, Vitale S, Yannuzzi L. IMI–defining and classifying myopia: a proposed set of standards for clinical and epidemiologic studies. Investigative Ophthalmology & Visual Science. 2019 Feb 28;60(3):M20-30.
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This article is sponsored by EssilorLuxottica.
