Spectacle lenses for myopia control Part 2: Back ups and dispensing

Originally posted August 12, 2019
Updated July 29, 2025

Children using atropine as a first line treatment should be monitored for needing an add - while research has described a minimal effect on amplitude of accommodation in lower concentrations,^1,2 we are yet to understand how atropine affects more detailed measures of binocular vision.  Consider also any light sensitivity from mydriasis - photochromatic lenses may be indicated.

Children wearing orthokeratology (ortho-k) may have minimal uncorrected time so may be suitable for single vision distance back up glasses, primarily to manage costs. In practice I find that these back-up spectacles are rarely used by ortho-k wearing children - only to save them taking their lenses on overnight school trips or on occasions where they may be unwell.

Children wearing myopia control soft contact lenses, by comparison, may need a myopia control spectacle lens option depending on their frequency of intended wear of both. I would take this on a case-by-case basis - these children ideally should be wearing their contact lenses full time for best outcomes, which means around 13 hours a day, 6 to 6.5 days per week.³ If they instead would like to wear both spectacles and contact lenses part-time, alternating between them (called dual-wear), then a myopia control treatment in both modalities will be ideal. Read more about dual-wear considerations in our article Should kids wear both myopia control glasses and contact lenses?

If you are prescribing progressive addition spectacle lenses for a patient who needs a near add - for example to manage atropine side effects or for binocular vision function - lenses should be selected which have a shorter corridor, to allow the child to access the full add as soon as possible when in downgaze. The immediate accessibility of the full bifocal add in downgaze is appealing, as long as the frame doesn't slip down and render the add too low! The segment height should be set on the lower lid for maximum utility, while frame fit and adjustments are crucial.

Cosmesis and lens type availability may also factor into the prescribing decision. If you don't have an E-segment bifocal lens available, will a standard D-segment or curved top do the same job? It will in terms of binocular vision, but it's hard to say from the myopia control perspective, given what has and hasn't been studied in research. From a practical perspective, I would suggest that we should be cautious in generalising the research results of one spectacle lens design to all similar designs - the same as for multifocal contact lenses - but that any design of bifocal is better than nothing if the prescribing criteria are met as per Part 1 of this article series on progressives, bifocals and binocular vision.

New spectacle lens technology for myopia control has arrived and outclassed progressive addition and bifocal spectacle lens designs for myopia control efficacy, and function essentially like single vision lenses in terms of ease of fit and influence on binocular vision.^4-6 Read more about these designs in The next generation - DIMS, H.A.L.T., DOT and CARE spectacle lenses for myopia control.

If your patient has normal binocular vision function, and you have these new myopia control lenses available, they will provide the best option for myopia correction and control. If your patient needs a near add, then these new designs will not provide it - in this case, progressive addition or bifocal spectacle lenses would be the better choice to manage binocular vision. Note, though, that they are unlikely to also be the best option for managing myopia - in these cases, atropine 0.025% or 0.05% could be added, ensuring that both binocular vision function and myopia progression are appropriately treated.