New and emerging myopia management: Spectacles

Due to their limited efficacy, many practitioners in the US disregard spectacles as a viable option for myopia control and lean on more successful options such as dual focus/multi-focal contact lenses, orthokeratology, and atropine. (Adobe Stock/Asada)

Likely, the most anticipated addition to our myopia management toolbox is a variety of US Federal Drug Administration (FDA) approved myopia control spectacles or for those of us in the US­­—just one option would phenomenal!

Although the notion of wearing spectacles for myopia control is not novel, the most traditional options—bifocals and rogressive addition lenses (PALS)—are only marginally effective. Thus, most studies concluded the minimal effect did not warrant use of them over single vision lenses.^1-3 The one exception to this is the executive bifocal with base-in prism, which has been proven most effective in children with low lags of accommodation.³

Due to their limited efficacy, many practitioners in the US disregard spectacles as a viable option for myopia control and lean on more successful options such as dual focus/multi-focal contact lenses, orthokeratology, and atropine.

Related: New and emerging myopia management: Low dose atropine

Although one of these will typically suffice for most patients, there are still a significant number of children who are gravely contact lens or drop averse. Having efficacious spectacles would truly provide an option for every child.

Currently, there are several novel spectacle designs available across the world. Unfortunately, none of them are currently available in the US.

MiyoSmart by Hoya

This spectacle lensutilizes defocus incorporated multiple segments (DIMS) and is considered a dual focus design. The lens consists of a central optical zone for distance correction with approximately 400 plus powered (+3.50) lenslets equally distributed in a honeycomb pattern throughout the midperipheral zone.

This design provides clear distance vision while simultaneously creating myopic defocus on the peripheral retina. It has been shown to slow myopia progression by 52% and axial elongation by 62% when compared to single vision lenses over a 2-year period.⁴ Recently, this lens also became available in photochromics for the additional benefit of UV protection while wearing the lenses outdoors.

Stellest by Essilor

This spectacle lens incorporates highly aspherical lenslet target (HALT) technology. The lens consists of a single vision optical zone surrounded by 11 rings of aspherical lenslets of varying powers to create a volume of myopic defocus. Over a 1-year period, it has been shown to slow myopia progression and axial elongation by approximately 63% and 64%, respectively when compared to single vision.⁵

SightGlass

This spectacle lens uses diffusion optics technology (DOT) to reduce contrast. This lens is based on the theory that high levels of contrast on the retina cause axial elongation, whereas low level contrast slows elongation. The lens consists of a clear central aperture surrounded by thousands of dots reducing peripheral retina contrast by at least 30% when compared to central contrast. Initial results of 2 test lenses with varying dot density showed 59% and 74% reduction in myopia progression and 33% and 50% reduction in axial elongation over a 2-year period when compared to single vision.⁶

Closing thoughts

Although these exciting spectacle options aren’t available to all practitioners, we can all look forward to a day when every child—no matter their age or needs—will have a myopia control option that perfectly suits them.

References

1. Gwiazda J, Hyman L, Hussein M, Everett D, Norton TT, Kurtz D, et al. A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression of myopia in children. Invest Ophthalmol Vis Sci. 2003; 44:1492-500.
2. Hasebe S, Ohtsuki H, Nonaka T, Nakatsuka C, Miyata M, Hamasaki I, et al. Effect of progressive addition lenses on myopia progression in Japanese children: a prospective, randomized, double-masked, crossover trial. Invest Ophthalmol Vis Sci. 2008; 49:2781-9.
3. 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;132(3):258–264.
4. Lam C.S.Y., Tang WC, Tse DY, Lee R.P.K., Chun R.K.M., Hasegawa K, et al. Defocus Incorporated Multiple Segments (DIMS) spectacle lenses slow myopia progression: a 2-year randomised clinical trial. Br J Ophthalmol. 2019.
5. Black K. Essilor’s Reveals Results of “Game-changing” Stellest Lens for Myopia https://www.mivision.com.au/2020/09/essilors-reveals-results-of-game-changing-stellest-lens-for-myopia/. mivision; 2020.
6. Rappon J, Chung C, Young G, et al Control of myopia using diffusion optics spectacle lenses: 12-month results of a randomised controlled, efficacy and safety study (CYPRESS) British Journal of Ophthalmology Published Online First: 01 September 2022.