Comparative effectiveness of myopia-control spectacle lenses: clincial setting performance from a retrospective cohort study

Purpose To compare the clincial setting effectiveness of three myopia control spectacle lenses, defocus incorporated multiple segments (DIMS), highly aspherical lenslet target (HALT), and cylindrical annular refractive elements (CARE), versus single-vision lenses (SVLs) in attenuating axial elongation and myopic refractive shift in children. Design A single-center, retrospective cohort study. Participants A total of 899 subjects (1780 eyes) aged 6–16 years with cycloplegic spherical equivalent (SE) between –0.50 D and –9.00 D. Subjects were divided into four groups based on prescribed eyewear: SVL (n = 446 eyes), DIMS (n = 523 eyes), HALT (n = 295 eyes), and CARE (n = 516 eyes). Methods Data were extracted from electronic medical records. Longitudinal changes in axial length (AL) and SE refraction were analyzed using linear mixed-effects models to compare progression rates among the lens types, adjusting for baseline age, sex, parental myopia, and the baseline value of the respective outcome variable. Main Outcome Measures Annualized rate of progression in AL (mm/year) and SE (D/year). Results The mean age of our cohort was 12.18 ± 2.73 years, and the mean follow-up time was 12.49 ± 5.71 months. All myopia control lenses significantly slowed AL elongation compared to the SVL group (0.193 mm/year). The adjusted annual AL progression was 0.098 mm/year for DIMS, 0.088 mm/year for CARE, and 0.054 mm/year for HALT (P < 0.001 for all vs. SVL). Highly aspherical lenslet target lenses demonstrated significantly greater efficacy in slowing AL elongation compared to both DIMS (P < 0.001) and CARE (P value < 0.001). All myopia control lenses also significantly reduced myopic SE progression (–0.370 D/year for SVL) with rates of –0.107 D/year for DIMS, –0.106 D/year for CARE, and –0.073 D/year for HALT. However, pairwise comparisons among the three myopia control lens types for SE progression did not reach statistical significance (P > 0.13). Conclusions Highly aspherical lenslet target, DIMS, and CARE effectively slowed progression versus SVL, with HALT showing the greatest AL control. While the retrospective design warrants cautious interpretation, results support the use of all three lenses. Future prospective head-to-head studies are needed to clarify durability and optimal combination strategies.