Special Cases with Essilor® Stellest® lenses

Spectacle lenses with highly aspherical lenslets (HAL, Essilor® Stellest® lenses) generate a volume of non-focused light in front of the retina and following its shape, to slow the progression of myopia and axial length (AL) growth. 

Essilor® Stellest® lenses are a widely used intervention for myopia control, and have established a robust evidence base through randomized control trials. 

A 2-year randomized controlled clinical trial1 in Wenzhou, China, found that children wearing HAL spectacle lenses reduced myopia progression by 0.80D (55%) and axial elongation by by 0.35mm (51%) compared with those wearing single vision lenses (SVL). In addition, the results demonstrated that wearing the lenses full-time (defined as ≥12 hours per day) every day for two consecutive years, increased this efficacy to 0.99D (or 67%) and 0.41mm (or 60%) in axial elongation, on average, compared with single vision lenses.

Long-term studies demonstrate sustained efficacy over 5 years, preventing 3 years of myopia progression and axial elongation on average.2 Six-year clinical data was recently announced at the 2025 China Optometry & Ophthalmology Conference (COOC) and presented at British Contact Lens Association (BCLA) Clinical Conference 2025, with the abstract pending publication.

In addition to their use in children with low-to-moderate myopia, Essilor® Stellest® lenses have been evaluated for myopia control in diverse clinical scenarios, including pre-myopia,3,4 unilateral myopic anisometropia,5 intermittent exotropia,6 and myopia of prematurity.

This article reviews the current evidence for these special cases. 

It is known that a low hyperopic reserve (having a lower amount of hyperopia than expected for a child’s age) is the primary risk factor for myopia development.7 Delaying the onset of myopia has profound implications for those at risk of developing myopia (pre-myopia), by lowering an individual’s ultimate level of myopia,8 and the associated risks of eye disease and visual impairment.9

Until recently, preventive measures against myopia onset have predominantly involved increased outdoor time11 and low-concentration atropine.12

One of the first studies to explore the use of optical interventions for pre-myopia was conducted using Essilor® Stellest® lenses (plano pair) in 2024.3 In their randomized trial, Zhang et al investigated the effectiveness of HAL spectacle lenses for slowing axial elongation and myopia development in children with low hyperopic reserve. Wearing HAL spectacle lenses for at least 30 hours/week reduced axial length change to 0.11mm over one year, compared to 0.27mm in SVL wearers. This revealed a clear relationship between higher wearing times and smaller changes in AL and spherical equivalent refraction (SER). 

Building on these findings, Wang et al4 found that wearing plano HAL lenses significantly slowed AL growth (0.31mm/year) and myopic shift (0.42D/year) in pre-myopic children; but more importantly, reproduced a dose-response relationship between wearing time and efficacy. Wearing HAL lenses for at least 6 hours/day was associated with a greater reduction in AL elongation. 

A separate study provided insights into the short-term impacts of HAL lens wear in pre-myopic children. In a real-world study, Sun et al.13 examined the short-term effectiveness of plano HAL lenses by instituting follow-up examinations at 3, 6, and 12 months. While the 1-year efficacy was consistent with previous studies, the most significant reduction in AL elongation was found to occur within the first 3 months of wear.

Unilateral myopic anisometropia (UMA) is a refractive condition wherein a myopic eye is paired with a low hyperopic or emmetropic eye.5

There has been some confusion surrounding refractive progression rates in the myopic and fellow eye. Pointer and Gilmartin14 suggested that the myopic eye will progress similarly to bilateral myopia, whereas the initially emmetropic eye will undergo less myopia progression – leading to a reduction in anisometropia over time.15

Later studies showed not only that the magnitude of anisometropia increases over time,16 but that the initially non-myopic eye is also at risk of myopia development.17 However, there is a shortage of evidence on optical interventions for delaying myopia onset in the non-myopic eye of UMA.

New evidence has emerged that wearing Essilor® Stellest® spectacle lenses binocularly confers protective benefits to both eyes of children with UMA. 

Zhai et al compared the effects of monocular orthokeratology (OK) with binocular HAL lenses over 12 months, in Chinese children with UMA aged 8-14 years.5 Those treated with HAL lenses wore full correction in the myopic eye, and plano lenses in the non-myopic eye. In the non-myopic eye, binocular HAL lenses reduced axial elongation by 0.29mm (71%), myopia incidence by 33%, and rapid myopic shift by 50%, compared to the OK group (with an uncorrected non-myopic eye) over 12 months. Wearing binocular HAL lenses led to slow and similar post-treatment AL changes in both eyes (0.10mm in the myopic eye, and 0.12mm in the non-myopic eye, at 12 months). 

Intermittent exotropia (IXT) is the most common form of strabismus, seen in approximately 3% of preschool children in China.18 A previous US-based population study19 of children with IXT showed a significant association with incident myopia, predicting more than 90% to develop myopia by 20 years of age. Binocular vision is also relevant to myopia control as some interventions may affect visual function. For example, after wearing OK lenses, distance and near exophoric shifts along with improvements in accommodative function can occur.20

No significant differences in visual acuity, accommodative lag, amplitude, phoria, or stereoacuity have been found in healthy myopic children after 1 year wearing of HAL lenses, compared to SVLs.21 Other lenslet-based spectacle designs have also reported minimal impacts on visual function in healthy children.22 However, small effects on binocular vision can be more critical for children with IXT, as loss of fusion could result in manifest exotropia. 

Recently, Zhou et al.6 assessed the short-term influence of HAL spectacle lenses on binocular vision and accommodation in myopic children with IXT. Compared to SVLs, HAL lenses did not significantly affect binocular vision or accommodation – including stereoacuity, phoria, accommodative response, or vergence facility. The only difference observed was a small increase in accommodative microfluctuation (AMF), which was not significantly different from visually normal children wearing HALs. 

Retinopathy of prematurity (ROP) is a developmental retinal disorder that occurs in prematurely born infants, characterised by abnormal retinal vascular development.23 In addition to increased retinal complications, the development of the ocular components may be adversely affected, predisposing infants to myopic refractive error.24,25

Myopia of prematurity (MOP) refers to myopia associated with ROP, and is considered a distinct entity from pathologic or school-age myopia. MOP is characterised by an abnormal anterior segment and disproportionally short axial length, as the primary source of myopia is lenticular as opposed to axial myopia.26 As most clinical trials evaluating myopia control treatments exclude participants with ocular abnormalities, the role of myopia control in special populations has not been thoroughly explored. 

An abstract presented at the ARVO 2025 Annual Meeting shed light on the potential application of Essilor® Stellest® lenses in children who developed myopia following ROP.Parrozzani et al. evaluated whether HAL spectacle lenses could reduce myopia progression in children with MOP. In comparison with SVLs, wearing HAL spectacle lenses reduced myopia progression by 0.61D (66%) over 12 months. Interestingly, the achieved efficacy was similar to the 1-year results27 of the original HAL randomized trial (0.53D/67%).

1. Essilor® Stellest® lenses can be used effectively in pre-myopic children, provided they are worn for at least 6 hours per day.
2. In unilateral myopic anisometropia, Essilor® Stellest® lenses slow progression in the myopic eye and help delay onset in the fellow eye.
3. Essilor® Stellest® lenses do not adversely affect binocular vision or accommodation in children with intermittent exotropia, apart from minor AMF changes
4. In children with myopia of prematurity, Essilor® Stellest® lenses reduce myopia progression to a similar degree as children without pre-existing ocular conditions.
5. Essilor® Stellest® lenses are an established first-line intervention for myopia management, with sufficient wearing time being crucial for optimal outcomes. Children are recommended to wear Essilor® Stellest® glasses during all waking hours, at least 12 hours per day, every day.

Essilor® Stellest® lenses are not currently FDA approved and are not commercially available for sale in all countries, including the U.S.