May 1, 2025
By Philip Cheng, B.Optom (Melb), GCOT, IACMM, FIAOMC
Photo courtesy of Dr. Cheng
When it comes to correcting and managing myopia, glasses immediately spring to mind. Most parents and children would also associate short-sightedness with wearing glasses to see clearer. Even with the increasing popularity of effective daytime contact lenses and orthokeratology night lenses, spectacles remain a mainstay in optometry for children with myopia.
Prior to the development of this generation of evidence-based spectacles, slowing myopia progression with glasses was limited to cosmetically-challenging bifocal or executive bifocal lenses. Progressive addition lenses have no clinically significant benefits for myopia management. With few spectacle lens treatment options available, the majority of patients opted for orthokeratology, soft contact lenses or atropine eye drops. Peripheral-defocus spectacle lenses have been a gamechanger in being able to start effective myopia management earlier and more easily in younger children with a safe, non-invasive treatment.
In accordance with best practice, our clinic’s position is that any myopic child choosing to wear spectacles should be dispensed with myopia management lenses. The perception among many practitioners is that single-vision lenses are now a thing of the past and inconsistent with the expected standard of care in 2025. In the past five years, we have successfully treated and managed hundreds of myopic children using spectacle lenses.
Early Adoption of Myopia Management Spectacles
Our practice in Melbourne, Australia, has prescribed effective myopia management spectacle lenses since mid-2020. As an industry key opinion leader, we were privileged to have early, pre-market access to the novel Hoya MiyoSmart lenses with Defocus Incorporated Multiple Segments (DIMS) technology.
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At the Shanghai International Optical Fair, Dr. Cheng saw the latest myopia management spectacle lens designs.
Clinical Findings on Myopia Management Spectacles
DIMS
DIMS lenses feature a 9.4mm clear central vision zone surrounded by a 33mm honeycomb-shaped treatment zone with +3.50D segments to induce myopic defocus in the peripheral retina.
The landmark two-year randomized controlled trial, published in 2020, showed DIMS lenses to slow the progression of myopia in children by 62%, in terms of axial elongation, compared to single-vision lenses. Six-year data of children wearing DIMS lenses has confirmed sustained myopia control effect without adverse outcomes and no evidence of rebound in children who discontinued treatment. DIMS lenses appear to slow eye growth due to the effects of choroidal thickening that is maintained over the long term of wearing these lenses.
Stellest
In 2022, Essilor released the Stellest spectacle lenses with Highly Aspherical Lenslet Target (HALT) technology. It features a constellation of 1,021 lenslets spread across 11 rings in the lens, creating a volume of defocus signals to modulate eye growth. A randomized controlled trial over two years involving 104 children showed this lens design to slow axial elongation by 60% versus single-vision lenses. The myopia control efficacy of Stellest lenses is now supported by six years of clinical research data.
SightGlass Vision DOT Spectacles
More recently, the CYPRESS study showed that lens designs based on modulation of retinal contrast could also be effective in slowing myopia progression. The study evaluated the efficacy of SightGlass Vision’s Diffusion Optics Technology (DOT) spectacle lenses in controlling myopia in children over a four-year period. Results indicated that DOT lenses significantly reduced myopia progression compared to standard lenses, with continued effectiveness observed in the fourth year. However, the COVID-19 pandemic negatively impacted treatment efficacy during the second and third years of the study.
A Global Spectacles Experience
In February, I had the opportunity to visit China for the Shanghai International Optical Fair. It is one of the largest optical exhibitions in Asia, showcasing Chinese and international spectacle frames, lenses, optical accessories and eye care instruments across 10 exhibition halls. With the high prevalence of myopia and high myopia in China, the Chinese optical industry is serious about promoting myopia management products. On show were an array of spectacle lenses marketed at slowing myopia progression. While I had anticipated seeing some locally developed lens designs, the 20-plus variations of defocus spectacle lenses by the large numbers of Chinese lens manufacturers were far beyond my expectations.
Photo courtesy of Dr. Cheng
These defocus lenses, with a peripheral array of plus-powered lenslets, appear to be inspired by the DIMS and HALT designs. However, they differ in their geometric patterns and power profiles of the treatment zones. There were defocus element patterns that resembled spider webs, soccer balls, shells and spirals. One design, marketed with the help of the Minions franchise, touted an efficacy of 73.82%. Several lenses also combined defocus lenslets with diffusion optics for a dual-treatment design aimed at further increasing efficacy. However, upon speaking with the lens representatives at the fair, we learned that most of these myopia management lens designs had only limited local research and testing, and some had no evidence base at all.
Awaiting FDA Approval for Spectacles
Due to the stringent approval process by the U.S. FDA, there are currently no available spectacle lenses indicated for myopia management. There are reports of U.S. patients crossing into neighboring cities in Canada, where such treatment lenses have been available for years, to have their glasses dispensed. Despite the robust RCT evidence of lens technologies incorporated in spectacle lenses for myopia management, there is still no release date for these products in the U.S. This means many thousands of children are potentially missing out on these effective interventions. Further large-scale studies are warranted to validate the applications for large groups of the population.
Not All Spectacles Are the Same
In other parts of the world that have more relaxed regulations for spectacle lenses, it is likely that practitioners will come across various lens designs marketed for myopia management. When recommending and prescribing spectacle lenses to manage a child with myopia, the most important aspect to consider is the efficacy of the lens design to slow myopia progression. After all, these are eye treatments, not just a lens product for vision correction. Just as practitioners should carefully consider the dose when prescribing low-dose atropine, and choosing an effective myopia management contact lens design, this also applies to spectacles. When incorporating spectacles with low-dose atropine, there is variability, as each spectacle design with different optics may interact variably for patients with or without atropine instillation.
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Photos courtesy of Dr. Cheng’s trip the Shanghai International Optical Fair
It may be easy to think that lenses that look similar will function in a similar way. It may also be tempting to consider cheaper alternatives for business reasons. However, one must look at the clinical evidence when deciding on a lens treatment for a child in your care. When we prescribe a myopia management solution, parents trust our expertise and invest in a treatment for their child. Our duty is to provide the highest standard of care. We must use evidence-based interventions that have the best chance of slowing or halting the child’s myopia progression.
Importance of Clinical Evidence on Spectacles
Going forward, as spectacle lenses become more commonplace globally, perhaps lens manufacturers should consider placing special identifier engravings on their lenses. Similar to identifier markings on progressive lenses, practitioners may more easily identify the lens design being worn. This would also give patients the peace of mind and confidence of using a genuine, evidence-based lens treatment.
It is certainly exciting that myopia control spectacle lenses are emerging as a first-line intervention for children with myopia. They’ve taken the place of single-vision lenses that optometrists have traditionally prescribed. But both practitioners and patients will need to exercise vigilance and caution when contemplating these spectacle lens treatments. We need to look past the allure of marketing claims and consider the strength of the clinical data of these lenses first and foremost.
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Philip Cheng graduated from University of Melbourne and is the founder of The Myopia Clinic Melbourne, a private practice focusing on children’s vision, myopia control, orthokeratology, and specialty contact lenses. Philip is internationally renowned as a leading practitioner in the myopia management space, and he has regularly presented and lectured on myopia in Australia and on the international stage. As a high myope himself, he is passionate about giving children the opportunity of better eyesight and eye health. He has attained the International Academy Certification in Myopia Management (IACMM). Philip is a Fellow of the International Academy of Orthokeratology and Myopia Control (FIAOMC).
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References
1 Cheng D, Woo GC, Drobe B, Schmid KL. Effect of bifocal and prismatic bifocal spectacles on myopia progression in children: three-year results of a randomized clinical trial. JAMA Ophthalmol. 2014 Mar;132(3):258-64
2 Gwiazda J, Hyman L, Hussein M, Everett D, Norton TT, Kurtz D, Leske MC, Manny R, Marsh-Tootle W, Scheiman M. A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression of myopia in children. Invest Ophthalmol Vis Sci. 2003 Apr;44(4):1492-500.
3 Lam CSY, Tang WC, Tse DY, Lee RPK, Chun RKM, Hasegawa K, Qi H, Hatanaka T, To CH. Defocus Incorporated Multiple Segments (DIMS) spectacle lenses slow myopia progression: a 2-year randomised clinical trial. Br J Ophthalmol. 2020 Mar;104(3):363-368.
4 Lam CSY, Tang WC, Zhang HY, Lee PH, Tse DYY, Qi H, Vlasak N, To CH. Long-term myopia control effect and safety in children wearing DIMS spectacle lenses for 6 years. Sci Rep. 2023 Apr 4;13(1):5475.
5 Chun RKM, Zhang H, Liu Z, Tse DYY, Zhou Y, Lam CSY, To CH. Defocus incorporated multiple segments (DIMS) spectacle lenses increase the choroidal thickness: a two-year randomized clinical trial. Eye Vis (Lond). 2023 Sep 15;10(1):39.
6 Bao J, Huang Y, Li X, Yang A, Zhou F, Wu J, Wang C, Li Y, Lim EW, Spiegel DP, Drobe B, Chen H. Spectacle Lenses With Aspherical Lenslets for Myopia Control vs Single-Vision Spectacle Lenses: A Randomized Clinical Trial. JAMA Ophthalmol. 2022 May 1;140(5):472-478.
7 EssilorLuxottica. Myopia control efficacy of spectacle lenses with highly aspherical lenslets: results of a 6-year follow-up study. 2025. Data on file.
8 Laughton D, Hill JS, McParland M, Tasso V, Woods J, Zhu X, Young G, Craven R, Hunt C, Neitz J, Neitz M, Chalberg TW, Jones D, Wolffsohn JS. Control of myopia using diffusion optics spectacle lenses: 4-year results of a multicentre randomised controlled, efficacy and safety study (CYPRESS). BMJ Open Ophthalmol. 2024 Oct 9;9(1):e001790.
