ASPECT trial finds 0.025% atropine and DIMS lenses slow axial length

Paper title: Atropine and Spectacle lens Combination Treatment (ASPECT): 12-month results of a randomised controlled trial for myopia control using a combination of Defocus Incorporated Multiple Segments (DIMS) lenses and 0.025% atropine

Authors: Guemes-Villahoz N (1,2), Talavero González P (3), Porras-Ángel P (2,4), Bella-Gala R (4), Ruiz-Pomeda A (4), Martin-Garcia B (4), Hernandez-Garcia E (3,2), Gomez de Liaño N (4), Shah R (5,6), Garcia-Feijoo J (2,7), Gomez-de-Liaño R (2,7)

1. Opthalmology Service, Hospital Clínico Universitario San Carlos, Madrid, Spain
2. Ophthalmology, The Health Research Institute of the Hospital Clínico San Carlos, Madrid, Spain
3. Opthalmology Service, Hospital Clínico Universitario San Carlos, Madrid, Spain
4. Optometry and Vision, Complutense University of Madrid, Madrid, Spain
5. Department of Optometry and Visual Sciences, City St George's, University of London, London, UK
6. HOYA Vision Care, Amsterdam, Netherlands
7. Ophthalmology, Hospital Clinico, Instituto de Investigaciones Ramon Castroviejo, Universidad Complutense, Madrid, Spain

Date: Published online August 20, 2025

Reference: Guemes-Villahoz N, Talavero González P, Porras-Ángel P, et al. Atropine and Spectacle lens Combination Treatment (ASPECT): 12-month results of a randomised controlled trial for myopia control using a combination of Defocus Incorporated Multiple Segments (DIMS) lenses and 0.025% atropine. Br J Ophthalmol. 2025 Aug 20;109(9):1074-1080.

[Link to open access paper]

This study was conducted to address the limited evidence on whether combining two established myopia control interventions, Defocus Incorporated Multiple Segments (DIMS) spectacle lenses and low-dose atropine, can offer enhanced treatment effects compared to monotherapy. Both DIMS lenses and 0.025% atropine have individually shown efficacy in slowing myopia progression, but their combined use has not been evaluated in a randomised controlled trial until now.

The Atropine and Spectacle lens Combination Treatment (ASPECT) study aimed to determine whether the combination of 0.025% atropine and DIMS lenses could slow axial elongation and refractive progression more effectively than 0.025% atropine paired with single vision (SV) lenses. Children aged 4–16 years with myopia between -1.00 and -6.00D were randomly allocated to use 0.025% atropine with either single vision spectacles (Group A) or with DIMS spectacle lenses (Group B).

Key points were as follows:

• Over 12 months, mean axial elongation was 0.18 mm in the atropine+SV group and 0.07 mm in the atropine+DIMS group.
• 39.6% of children in the combination group had no axial elongation, compared to 12.2% in the atropine+SV group.
• Spherical equivalent refraction (SER) changes were −0.19 D and −0.09 D, respectively, but differences were not statistically significant.
• The study population was ethnically diverse, and combination therapy appeared effective across ethnic groups.
• Pupil size (photopic and mesopic) was not associated with axil length or  SER outcomes.

The ASPECT study provides strong evidence that combining 0.025% atropine with DIMS spectacle lenses can further slow axial elongation in myopic children compared to 0.025% atropine with single vision lenses. The reduction in axial length growth (0.07 mm vs 0.18 mm over 12 months) is clinically meaningful and suggests a potential additive effect between DIMS spectacle lenses and atropine. Notably, nearly 40% of children in the combination group had no axial elongation over the study period, which aligns with expected growth patterns in emmetropic children.

While changes in spherical equivalent refraction were modest and not statistically significant, axial elongation was clearly reduced in the combination group. Axial length is increasingly regarded as a more reliable marker of long-term myopia risk, due to a close association with structural changes. The near-emmetropic levels of axial growth observed may support the use of combination treatment in younger children or those with faster progression, where early and effective intervention is particularly valuable.

For children already responding to monotherapy, the combination approach may offer further benefit. Additionally, the absence of a relationship between pupil size and treatment efficacy suggests the mechanism of action may not be dependent on atropine-induced pupil dilation, helping to clarify expectations.

This study reports 12-month outcomes from an ongoing 24-month trial, so it remains unclear whether the treatment effect is sustained, increases, or plateaus over time. The design compared atropine plus DIMS lenses to atropine with single vision lenses, but did not include a DIMS-only group. This limits interpretation of how much benefit is gained by adding atropine to DIMS, or vice versa.

While axial elongation differences were clear, refractive error changes were modest and not statistically significant. Larger samples or longer follow-up may be needed to clarify this relationship. Additionally, although compliance was monitored and similar across groups, consistent drop use and spectacle wear remain real-world challenges.

The study used 0.025% atropine, but the optimal concentration for combination therapy is still unknown. A separate randomised trial in China found similar outcomes using 0.01%, 0.025%, and 0.05% atropine with DIMS lenses, suggesting a potential ceiling effect. A European randomised trial observed additive benefit with 0.01% atropine plus DIMS in a European cohort. Future research could compare atropine concentrations, monotherapy vs combination, and outcomes across different age and progression profiles.

Aim: To evaluate and compare the efficacy of combination treatment using 0.025% atropine and Defocus Incorporated Multiple Segments (DIMS) spectacle lenses to 0.025% atropine and single vision (SV) spectacle lenses in slowing myopia progression in children with myopia.

Methods: Randomised controlled trial conducted on children aged 4–16 years with myopia between −1.00 D and −6.00 D and astigmatism ≤2.00 D. Children were randomly allocated into two groups: 0.025% atropine and SV spectacle lenses treatment group (group A), and 0.025% atropine and DIMS spectacle lenses treatment group (group B). Cycloplegic spherical equivalent refraction (SER) and axial length were measured at baseline, 6 and 12 months.

Results: 102 patients completed the 12-month follow-up: n=49 in group A, mean age 9.50±2.78 years and n=53 in group B, mean age 9.90±2.47 years. At 12 months, the mean AL±SD change was 0.18±0.16 mm in group A and 0.07±0.16 mm in group B (mean difference: 0.11, 95% CI: 0.05 to 0.17; p≤0.001). Mean SER±SD progression at 12 months was −0.19±0.42 D and −0.09±0.35 D in groups A and B, respectively (p=0.13). 39.6% of children in group B had no axial elongation over 12 months compared with 12.2% of the children in group A (p=0.002).

Conclusions: Combination treatment with 0.025% atropine and DIMS spectacle lenses is more effective in controlling axial elongation than 0.025% atropine with SV lenses. Although not significant, SER differences between groups were lower in group B. These findings support a potential additive effect of the two treatments.

[Link to open access paper]