New clinical evidence on MiYOSMART: Long-term outcomes over 8 to 10 years, pre-myopia, combination treatment and 3-year outcomes in UK children

Since the first clinical studies evaluated the efficacy of MiYOSMART spectacle lenses for slowing myopia progression, research has continued to explore new ways Defocus Incorporated Multiple Segments (D.I.M.S.) Technology may be used in clinical practice. More recent research is exploring how MiYOSMART may be applied in different clinical scenarios. This article reviews the new evidence investigating MiYOSMART’s long-term outcomes over 8 to 10 years, its potential role in pre-myopia management, combination treatment with atropine, and 3-year outcomes in UK children.

Paper title: Long-term axial elongation in myopic children wearing DIMS spectacle lenses: an 8-to-10-year observational study

 Authors:  Tsz Wing Leung, Han Yu Zhang, Kin Ho Chan, Paul H Lee, Kenneth Ka King Liu, Yee Mui Kwok, Ka Mei To, Natalia Vlasak, and Carly Siu-yin Lam

As one of the first spectacle lens designs developed specifically for myopia control, MiYOSMART has demonstrated robust efficacy in its landmark two-year randomised controlled trial, with data showing sustained myopia control efficacy across three years and six years. However, myopia progression can continue beyond childhood and adolescence into young adulthood; therefore, understanding whether the treatment effect is maintained over longer periods and what occurs after treatment cessation is clinically important. 

 This observational study followed 60 participants from the original randomised controlled trial for an average of 9.4 years, from a baseline age of 8–13 years into late adolescence and young adulthood (17–23 years). Participants demonstrated varied spectacle-wear histories over the follow-up period, including continuous MiYOSMART spectacle lens wear, discontinuation to single-vision (SV) spectacle lenses, and switching between the two. Given the heterogeneity in wear patterns and follow-up intervals, linear mixed-effects model (LMM) was applied to the observed visit-to-visit data to characterise the relationship between age, spectacle-wear status, and rates of change in axial length (AL) and cycloplegic spherical equivalent refraction (cSER). This model was subsequently used to generate projected outcomes for two hypothetical scenarios: continuous MiYOSMART spectacle lens wear and continuous single vision (SV) spectacle lens wear. Findings are as follows.

• Axial elongation: DIMS spectacle lens wear was associated with a statistically significant reduction in the rate of axial elongation relative to SV spectacle lens wear, with the effect most pronounced before age 18. The model projected a cumulative axial elongation of 0.44mm for continuous DIMS wear versus 1.27mm for continuous SV wear over 9.4 years, corresponding to a 65% reduction. When benchmarked against external normative data for untreated Asian children (projected elongation of 1.85mm over the same period), continuous DIMS spectacle lens wear corresponded to a 76% reduction.
• Refractive error: In contrast, no statistically significant treatment effect was identified for SER progression at the level of individual visit intervals, despite the model projecting a clinically meaningful cumulative difference (–0.57D for continuous DIMS spectacle lens wear versus –2.17D for continuous SV spectacle lens wear). This may be due to the inherent variability of autorefraction relative to the small annual refractive signal and the fact that the SV wear periods were not truly untreated, as prior DIMS spectacle lens exposure may have produced a residual carryover effect that reduced the apparent difference between lens types.

Paper title: Stepwise DIMS Spectacle Wear for Myopia Prevention in Pre-myopic Preschoolers: A 1.5-Year Prospective Study

 Authors: Hsin-Yu Yang, Der-Chong Tsai, Yu-Chieh Yang, Chiao-Yu Wang

This 1.5-year prospective pilot study evaluated the feasibility and effectiveness of stepwise DIMS photochromic plano spectacle wear in pre-myopic preschool children (n=23, mean age 5.4 years). Children in Taiwan wore DIMS lenses part-time (when doing near work) before starting school, and full-time after starting school. The intervention was well tolerated, with 20/20 equivalent near acuity with DIMS, 91.3% adherence and only mild early visual complaints. After 1.5 years, SER remained relatively stable (mean SER change −0.14 D) while axial length increased by 0.35 mm (largely considered physiological growth). Only two children out of the group developed myopia. The stepwise approach could be a practical way to introduce optical interventions in pre-myopic children. By starting with part-time wear during near work before school entry and transitioning to full-time wear later, this method allows for gradual adaptation to the spectacles. If validated in larger studies, stepwise DIMS spectacle use could become a valuable tool in pre-myopia management.

Paper title: Atropine and Spectacle Lens Combination Treatment (ASPECT): 24-Month Interim Results of a Randomised Controlled Trial for Myopia Control

 Authors: Noemi Guemes-Villahoz, Paula Talavero-Gonzalez, Elena Hernandez Garcia, Paloma Porras-Angel, Rafael Bella-Gala, Blanca Alonso-Abad, Alicia Ruiz-Pomeda, Beatriz Martin-Garcia, Nunila Gomez De Liaño, Elena Montolio-Marzo, Julian Garcia-Feijoo, Rosario Gomez-De-Liano

This randomised controlled trial evaluated whether combining 0.025% atropine with DIMS spectacle lenses improved myopia control compared to 0.025% atropine with SV lenses over 24 months in European children aged 4–16 years. Among the 71 participants who completed follow-up, the combination therapy group showed less axial elongation than the atropine + SV group (0.22 mm vs 0.36 mm at 24 months), indicating better control of eye growth. SER progression at 12 and 24 months was -0.16D and -0.37D in the SV group, and -0.17D and -0.19D in the DIMS group and were not statistically significant. This study demonstrates that combining 0.025% atropine with DIMS spectacle lenses is more effective in controlling axial elongation compared to 0.025% atropine with SV lenses over 24 months. The additive effect of the two treatments is particularly evident in the first year.

Abstract Title: Multi-Site Interventional Study of Defocus Incorporated Multiple Segments (DIMS) spectacle lenses in UK children: 3-year results

 Authors: Jane Fulton, Kathryn Saunders, Sara McCullough, Holly Barr, Susie Jones, Nicola S. Logan, Shahina Pardhan, Patrick Richardson, Yasmin Whayeb, Peter Williamson, Natalia Vlasak

While much of the evidence supporting DIMS spectacle lenses has been generated in Asian populations, a three-year multi-site study explored their effectiveness in 116 UK children aged 5 to 15 years from predominantly non-asian ethnic backgrounds. Participants wore DIMS spectacle lenses and attended six monthly follow up visits over three years. Researchers compared axial elongation outcomes with age and ethnicity matched estimates of eye growth expected in untreated myopic children.

 Over the three-year period, children wearing DIMS lenses demonstrated average axial elongation of 0.17 mm in the first year, 0.12 mm in the second year and 0.12 mm in the third year. Corresponding refractive progression was -0.32 D, -0.23 D and -0.19 D per year. Overall, DIMS wearers exhibited 0.36 mm less axial elongation over 36 months than would be expected in untreated myopic children of similar age and ethnicity (virtual controls). Importantly, 92% of participants showed slower eye growth than predicted for untreated myopes, indicating that the treatment effect was maintained for most children throughout the study period. Younger age at enrolment was associated with greater axial elongation, consistent with the known pattern of faster myopia progression in younger children. 

Research on MiYOSMART continues to evolve beyond the original efficacy studies, exploring how DIMS technology may be applied across a wider range of clinical scenarios. From investigating stepwise use in children with pre-myopia, to combination treatment with atropine and long-term outcomes in non-Asian populations, these studies continue to build on the existing evidence base. Together, they highlight the growing versatility of MiYOSMART as an evidence-based spectacle lens option for myopia management.