Myopia control using spectacle lenses with highly aspherical lenslets

A study published in JAMA Ophthalmology¹ reported that spectacle lenses with highly aspherical lenslets (HAL) are safe and effective for reducing myopia progression in US children. The investigators, led by Jason Shen, PhD, are from Essilor International, Dallas, and Visioncare Research, Farnham, UK.

They explained the importance of this study (NCT05174780) in light of the recognition of the increasing prevalence of myopia in the US. “While most individuals who develop myopia currently do not develop pathologic myopia in their lifetimes, increasing myopia severity correlates with increasing risk of pathologic myopia²; therefore, interventions that slow myopia in children may have additional importance if they also reduce the risk of pathologic myopia into adulthood.”

HAL spectacle lenses are potential treatment that directs light to an envelope of caustics to create a volume of myopic defocus in front of the retina to slow the progression of myopia,³ they explained.

Other treatments include antimuscarinic eye drops, orthokeratology, and specially designed soft contact lenses or spectacle lenses,4 the last of which includes HAL.

HAL study design

Shen and colleagues conducted a double-masked randomized clinical trial that compared the safety of effectiveness of HAL spectacle lenses compared with single-vision spectacle lenses at 24 months in children with myopia.

The study was conducted at nine US sites. A total of 159 children 6 to 12 years of age were randomized 1:1 to the study lenses or single-vision lenses. Children who were eligible for the study had a manifest spherical equivalent refraction (SER) of -0.75 to -4.5 diopters (D). The primary outcome was the change at 24 months in the cycloplegic SER and axial length.

Takeaways from the data analysis

The investigators reported that 135 of the 159 children completed the 24-month visit. The baseline mean ± standard deviation cycloplegic SER was −2.21 ± 1.07 D in the HAL group and −2.05 ± 1.22) D in the SVL group. At the final evaluation, the adjusted mean myopia progression was −0.25 ± 0.05) D in the HAL group and −0.90 ± 0.05) D in the SVL group, a relative reduction of 71% that reached significance (P < 0.001).

The axial length behaved in like manner. The respective baseline mean axial lengths were 24.26 ± 0.92 mm and 24.32 ± 0.83 mm. The respective adjusted mean axial elongation values were 0.21 ± 0.02 mm and 0.45 ± 0.02 mm, a 53% relative reduction that also reached significance (P < 0.001).

The best-corrected visual acuities did not differ significantly between the two groups (P = 0.23). Ocular adverse events, none serious or related to the lenses, developed in nine patients randomized to HAL spectacle lenses and in 12 of those with the single-vision lenses.

Shen and colleagues commented on their results. “The findings of this randomized clinical trial support the hypothesis that the progression of myopia is reduced with HAL spectacle lenses compared with single-vision lenses. After adjusting for age, sex, and baseline refraction, the average protective effect of HAL lenses over 2 years was a difference of 0.64 D of cycloplegic SER and a difference of 0.24 mm axial length.”

They advised that the impact of the treatment, ie, decreased progression the SER and axial length through adulthood is unknown and that further follow-up is needed to determine if these differences result in longer term reduction of the risk for myopia-related ocular pathologies.4

References
1. Shen J, Hung C, Young G, Drobe B. Spectacle lenses with highly aspherical lenslets for myopia control. A randomized clinical trial. JAMA Ophthalmol. 2026;144:889-96. doi:10.1001/jamaophthalmol.2026.3288
2. Bullimore MA, Brennan NA. Myopia control: why each diopter matters. Optom Vis Sci. 2019;96:463-5. doi: 10.1097/OPX.0000000000001367
3. Radhakrishnan H, Lam CSY, Charman WN. Multiple segment spectacle lenses for myopia control. Part 1: optics. Ophthalmic Physiol Opt. 2023;43:1125-36. doi:10.1111/opo.13191
4. Gifford KL, Richdale K, Kang P, et al. IMI—Clinical Management Guidelines report. Invest Ophthalmol Vis Sci. 2019;60:M184-M203. doi:10.1167/iovs.18-25977