Multifocal spectacles delay myopia onset in pre-myopic children

Paper title: Efficacy of Multifocal Spectacles for Myopia Control in Pre-myopic Children: A Multicentre Real-world Study

Authors: Jing Rao (1,2), Qizhi Zhou (1,3,4), Yongchuan He (1,5), Jianhua Li (1), Zhiquan Wang (6), Xiao Chen (1,3), Qin Wang (6), Yi Kuang (3), Yuanyuan Tang (3), Quanlan Li (6), Shenghui Feng (7), Jiwen Yang (8,9)

1. Aier Eye Hospital, Jinan University, Guangzhou, China.
2. Aier Eye Research Institute, Jiangbei District, Chongqing, China.
3. Chongqing Eye and Vision Care Hospital, Aier Eye Hospital Group, Chongqing, China.
4. Aier Academy of Ophthalmology, Central South University, Changsha, China.
5. Chongqing Aier Children's Eye Hospital, Aier Eye Hospital Group, Chongqing, China.
6. Chongqing Aier Eye Hospital, Chongqing, China.
7. Chongqing Aier-Mega Eye Hospital, Aier Eye Hospital Group, Chongqing, China.
8. Aier Eye Hospital, Jinan University, Guangzhou, China.
9. Liaoning Aier Eye Hospital, Shenyang, China. 

Date: April 2026

References: Rao J, Zhou Q, He Y, Li J, Wang Z, Chen X, Wang Q, Kuang Y, Tang Y, Li Q, Feng S, Yang J. Efficacy of Multifocal Spectacles for Myopia Control in Pre-myopic Children: A Multicentre Real-world Study. Ophthalmic Physiol Opt. 2026 Apr 9

 [Link to open access paper]

Pre-myopia is recognized as a high-risk refractive state in children, with a significant likelihood of progressing to established myopia. This stage represents a critical window of opportunity to recognize and monitor even small shifts that can signal accelerated ocular growth. While multifocal lenses have demonstrated efficacy in myopic children, evidence for their use in pre-myopia has been limited.

This retrospective cohort study evaluated whether multifocal spectacle lenses (including Defocus Incorporated Multiple Segments (DIMS), Diverse Segmented Defocus Optics (DSDO), and Highly Aspherical Lenslet (HAL) lens designs) can delay myopia onset and control progression in pre-myopic children.pre-myopic children.

Electronic health records from 1,501 pre-myopic children aged 4–14 years, classified as pre-myopic according to study eligibility criteria, across six clinical centers in China between January 2022 and December 2024 were analysed. The study compared 835 children prescribed multifocal spectacle lenses with 666 children prescribed single-vision lenses. Propensity score matching balanced baseline covariates including age, sex, baseline refraction, and axial length. Primary outcomes included changes in spherical equivalent refraction and axial length at 6-month and 12-month follow-up, with myopia onset defined as cycloplegic spherical equivalent of –0.50 D or more myopic.

Key findings

• At 12 months, multifocal spectacles reduced spherical equivalent progression by 0.35 D and axial elongation by 0.23 mm versus single-vision spectacles.
• One-year myopia incidence was 42.6% in the multifocal group compared with 65.6% in the single-vision group.
• Rapid myopia progression (>0.50D per year) occurred in 20.8% of the children wearing multifocal spectacles, compared with 45.1% in the single-vision group.
• Rapid axial elongation (>0.2 mm per year) occurred in 34.2% of the multifocal group versus 73.5% of the single-vision group.
• No significant differences in myopia progression or axial elongation control efficacy were observed among the four multifocal lens designs.

These findings suggest that microlens spectacle lenses may be a viable option for eyecare practitioners managing pre-myopic children, particularly if a spectacle-based treatment is preferred. The study found that different microlens designs achieved comparable efficacy in slowing axial elongation and refractive progression over 12 months, with no statistically significant differences between designs. This may simplify clinical decision-making, as lens selection can be based on individual patient preference, rather than anticipated differences in efficacy.

The observed reduction in rapid axial elongation and myopia progression may be clinically meaningful when monitoring children considered at higher risk of developing myopia. 

The study could not determine optimal timing for intervention and whether starting microlens spectacles earlier in the pre-myopic stage offers increased benefit rather than waiting until children approach the myopic threshold. As a result, although the study suggests there is an association between microlens spectacle wear and slower myopia development, a direct causal relationship cannot be confirmed.

Although the study findings are encouraging, there are some limitations that affect their interpretation in clinical practice. The retrospective study design means that potentially confounding factors, such as outdoor time, near-work activity and parental myopia, were not measured or controlled. Spectacle wearing time was also not objectively monitored, so variation in compliance may have influenced outcomes.

The one-year follow-up period limits application to longer-term outcomes, including whether the observed effects continue beyond the first year. 

While the study found no significant differences among the various microlens spectacle lens designs tested, the relatively small sample sizes for individual lens types may have limited the ability to detect meaningful differences if they exist. The study population was entirely Asian and conducted in China, where myopia progression rates tend to be higher than in other populations. Whether these findings apply equally to children of other ethnicities or in different geographic regions remains uncertain.

Purpose: To evaluate the efficacy of multifocal (MF) spectacles, compared with single-vision (SV) spectacles, in controlling myopia progression and delaying myopia onset amongst Chinese children with pre-myopia (spherical equivalent [SE] ≤ +0.75 and >-0.50 D).

Methods: A multicentre retrospective case-control study was conducted, with baseline characteristics balanced using propensity score matching (PSM). The participants underwent spherical equivalent refraction (SE) and axial length (AL) measurements. Primary outcomes included SE and AL progression at 6 and 12 months, as well as the 1-year cumulative incidence of myopia (SE ≤ -0.50 D).

Results: A total of 1501 participants (mean age: 8.60 ± 2.26 years; mean SE: 0.00 ± 0.37 D) were included in the analysis, comprising 835 in the MF group and 666 in the SV group. After 12 months, MF spectacles slowed SE progression (difference: -0.35 ± 0.63 D; p < 0.001) and AL elongation (difference: 0.23 ± 0.27 mm; p < 0.001) significantly, compared with the SV group. The proportion of children with rapid myopia progression was significantly lower in the MF group (SE progression > 0.50 D: 20.8% vs. 45.1%, χ² = 78.15, p < 0.001; AL elongation > 0.2 mm: 34.2% vs. 73.5%, χ² = 165.9, p < 0.001). Kaplan-Meier analysis showed a significantly lower 1-year cumulative incidence of myopia in the MF group than in the SV group (42.6% vs. 65.6%; log-rank p < 0.001).

Conclusion: This large-scale, multicentre study demonstrated that MF spectacles effectively slow SE progression and AL elongation and delay myopia onset in pre-myopic children. Despite the inherent limitations of retrospective designs relative to randomised controlled trials, the findings provide strong real-world evidence supporting the potential of MF spectacles as an effective, non-pharmacologic intervention for pre-emptive myopia control.

 [Link to open access paper]