Modern spectacle lenses may halve childhood myopia progression

A review published July 31, 2026, in Ophthalmic and Physiological Optics concluded that contemporary myopia-control spectacle lenses are safe, clinically useful options that reduce short-term childhood myopia progression by approximately 50% relative to single-vision lenses.¹

However, study authors David A. Atchison, DSc, The Centre for Vision and Eye Research, Queensland University of Technology, Kelvin Grove, Brisbane, in Queensland, Australia; and W. Neil Charman, of The School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, in Manchester, United Kingdom; cautioned that efficacy varies across designs and studies, long-term durability remains uncertain, and the biological mechanisms underlying treatment are not fully established. These considerations are clinically relevant as an expanding range of lenslet, annular, progressive-addition, and contrast-modulating designs enters optometric practice.

“The last decade and a half have seen exciting progress in the development of optical methods for myopia control, so that some methods have now become safe, valuable tools well suited for integration into routine optometric practice,” Atchison and Charman stated. “Although some myopia-control spectacles (and contact lenses) were originally designed on the basis of different hypothetical control mechanisms, evidence is mounting that reduced modulation transfer at medium and high spatial frequencies of images in the peripheral retina may be a common factor in their action. Further development should help to clarify the exact nature of the mechanisms of action of the different lenses and improve their efficacy.”

Review overview

The narrative review evaluated developments in spectacle-based myopia control over approximately the past 15 years. It described the theoretical basis, optical characteristics, clinical performance, and potential mechanisms of progressive-addition lenses, multisegment lenses, annular cylinder lenses, diffusion optics technology, and concentric bifocals.¹

Because this was not an epidemiologic systematic review or meta-analysis, there was no defined patient sample, clinical setting, or pooled primary end point. The authors instead synthesized published clinical trials and optical modeling studies, focusing principally on changes in spherical refractive error and axial length compared with single-vision spectacle lenses.

The review also placed spectacle lenses alongside soft contact lenses, orthokeratology, red-light therapy, atropine, and environmental interventions. Comparisons across modalities should be interpreted cautiously because protocols, participant characteristics, follow-up periods, and efficacy calculations differed among trials.

Key findings

Based on recent reviews, the authors estimated that, over approximately 12 months, myopia-control spectacles reduce both axial elongation and refractive progression by about 50% relative to single-vision lenses. Estimated short-term efficacy was approximately 50% for contact lenses, 60% for orthokeratology, and 80% or more for red-light therapy.¹ Red-light therapy was associated with safety concerns and rebound after cessation, whereas evidence has not indicated rebound with spectacle or soft contact lens treatment.³

One representative 2-year randomized trial of defocus incorporated multiple segments lenses in Chinese children aged 8 to 13 years reported approximately 50% efficacy for axial length and 60% efficacy for myopia progression relative to single-vision lenses.² More recent designs have increased lenslet power, asphericity, or treatment-zone size, with early studies suggesting that some enhanced designs may further reduce axial elongation.

Visual effects generally appeared limited. According to the review, multisegment and diffusion optics lenses produced relatively small changes in visual function compared with single-vision lenses, supporting adaptation and adherence. Spectacle lenses also avoid risks associated with contact lens wear and are considered inherently safe when manufactured from impact-resistant materials such as polycarbonate.¹

Clinical interpretation

Many current lenses were developed around the hypothesis that peripheral myopic defocus inhibits axial growth. However, the review highlighted findings that challenge a simple defocus-based explanation. Positive and negative lenslet arrays have demonstrated similar myopia-control effects, and off-axis optical modeling suggests that several designs substantially reduce medium- and high-spatial-frequency information in peripheral retinal images.

The authors proposed that contrast reduction may therefore represent a shared mechanism across lenslet and diffusion optics designs. This possibility remains unconfirmed but may help explain why optically different lenses produce comparable clinical outcomes.

For clinicians, the findings support myopia-control spectacles as a noninvasive option that can be incorporated into routine care, particularly when contact lenses, pharmacologic treatment, or light-based interventions are unsuitable. Lens selection should nevertheless account for age, refractive progression, visual demands, tolerance, adherence, cost, and the evidence supporting the specific design.

Limitations and future research

The review did not systematically assess trial quality or perform a quantitative synthesis. Comparative efficacy estimates may be affected by heterogeneous study populations, protocols, control groups, and reporting methods. Evidence beyond 2 years remains inconsistent: a 2025 meta-analysis found short-term benefit but no significant control effect after 24 months, whereas other reports have described sustained effects with selected lens designs.⁴

Further randomized trials should directly compare designs, report absolute as well as relative treatment effects, and evaluate long-term efficacy, cessation effects, adherence, and visual performance. Laboratory studies are also needed to clarify whether peripheral defocus, contrast modulation, or another retinal signal primarily mediates treatment.

Clearly, more work is required to clarify these issues if the true mechanisms of myopia control are to be properly understood,” the study authors stated. “One problem in modelling lens optical performance is the limited information released by manufacturers on the details of their designs, eg, manufacturing techniques used, lenslet asphericities and the nature and effects of any hard or other coatings applied to multisegment lenses, as well as details of the fill factor and angular light-scattering characteristics of the elements of DOT lenses. Further laboratory work on the optical details of many of these lenses is required if their actions are to be fully understood. It may be that the use of instrumentation allowing experimental simulation of the images produced by simultaneous (dual-focus) vision lenses will be helpful.”

References

1. Atchison DA, Charman WN. Spectacle lenses for control of myopia progression in children. Ophthalmic Physiol Opt. Published July 31, 2026. https://doi.org/10.1007/s44402-026-00149-6

2. Lam CSY, Tang WC, Tse DY, et al. Defocus incorporated multiple segments spectacle lenses slow myopia progression: a 2-year randomised clinical trial. Br J Ophthalmol. 2020;104:363-368. https://doi.org/10.1136/bjophthalmol-2018-313739

3. Bullimore MA, Brennan NA. Efficacy in myopia control—the impact of rebound. Ophthalmic Physiol Opt. 2025;45:100-110. https://doi.org/10.1111/opo.13403

4. Perea-Romero J, Signes-Soler I, Badenes-Ribera L, Tauste A. Efficacy of spectacle lenses specifically designed for myopia control: systematic review and meta-analysis. Graefes Arch Clin Exp Ophthalmol. 2025;263:909-924. https://doi.org/10.1007/s00417-024-06706-4