Essilor Stellest lenses effective for pre-myopia with adequate wear

Paper title: Effectiveness of spectacle lenses with highly aspherical lenslets in slowing axial elongation among non-myopic children

Authors: Wang L (1), Wong YL (2), Drobe B (2), Wang X (1)

1. Children's Ophthalmology and Optometry Clinic, Wellem Medical Group, Shanghai, China
2. Research and Development Centre, EssilorLuxottica, Singapore, Singapore

Date: Published online May 22, 2025

Reference: Wang L, Wong YL, Drobe B, Wang X. Effectiveness of spectacle lenses with highly aspherical lenslets in slowing axial elongation among non-myopic children. Clin Exp Optom. 2025 May 22:1-7.

[Link to open access paper]

Spectacle lenses with highly aspheric lenslets (HAL), commercially known as Essilor Stellest, are an established intervention for controlling myopia progression in myopic children. In terms of preventing myopia onset in at-risk non-myopic children, the effectiveness of HAL lenses is still being examined. 

A prior randomized controlled trial1 which investigated plano HAL spectacle lenses in low-hyperopic Chinese children suggested there was a benefit with children who wore their lenses for at least 30 hours per week. To further explore this observation, this study aimed to examine the effectiveness of plano HAL lenses in slowing axial elongation and refractive change among non-myopic Chinese children aged 4–9 years.

In this retrospective study, medical records of 105 non-myopic children (mean age 6.8 years, mean SER +0.22 D, mean axial length 23.1 mm) from Shanghai, China, were reviewed. Children were instructed to wear plano HAL spectacle lenses for at least 3 hours per day, especially during near work. Annualised rates of axial elongation and spherical equivalent refraction (SER) before and after starting plano HAL lenses were compared, with pre-treatment rates serving as control.

Key findings were as follows.

• HAL spectacle lenses slowed axial elongation by 0.31 mm/year – from an annualised pre-treatment axial length change of +0.44mm/year to +0.13mm/year post-treatment.
• SER progression slowed by 0.42 D/year, from a myopic annualised pre-treatment SER change (−0.28D/year) to a hyperopic post-treatment SER change (+0.14D/year).
• Longer daily wearing time (>6 hours per day) was associated with greater reduction in axial elongation.
• A small proportion of children (4.8%) exhibited axial shortening, and one-third showed clinically meaningful SER regression after treatment.

Plano HAL spectacle lenses appear to be a viable intervention for children with pre-myopia. In the study, this was defined by non-myopic refraction combined with either fast axial elongation (≥0.2 mm over 6 months) or low hyperopia reserve (non-cycloplegic SER ≤ +0.50 D).

The effectiveness of plano HAL lenses in reducing axial elongation and SER progression in pre-myopic children was conditional upon at least 6 hours per day of wear daily. The dose-response relationship observed in this study aligns with previous randomized trials involving low-hyperopic children1 as well as myopic children.2 

This reinforces the importance of educating patients about meeting the recommended daily wearing time, in order to maximize treatment efficacy.

There were several limitations to this study. 

Treatment effects could have been overestimated due to selection bias from a higher-risk sample. There was also differential loss to follow-up to account for, as children with less favourable outcomes might have discontinued treatment early. Cycloplegia was not performed either, limiting the accuracy of SER measurements and assessing the progression of SER over time.

Lens wearing time was self-reported by parents (rather than objectively measured), which is prone to recall bias and may not reflect actual wear. Treatment effect was compared against pre-treatment data instead of a historical control group, which limits the usefulness of these results.

Clinical relevance: Spectacle lenses with aspherical lenslets are effective in controlling axial elongation and slowing myopia progression in children with myopia, and its effectiveness may extend to children at risk of developing myopia.

Background: This study aims to examine the effectiveness of plano highly aspherical lenslets (HAL) spectacle lenses in slowing down axial elongation and spherical equivalent refraction (SER) progression among non-myopic children, using retrospective data records.

Methods: This retrospective study included data from medical records from an eye hospital network (Wellem Group) in Shanghai, China. Non-myopic children (non-cycloplegic SER between >-0.50 and ≤+0.75 D) aged 4–9 years, prescribed plano HAL lenses, were reviewed (N = 147). With available data prior to intervention, annualised changes in axial length and SER before and after wearing plano HAL lenses were computed. Effectiveness was evaluated with pre-treatment rates acting as controls, and differences in changes over time were calculated.

Results: A total of 105 non-myopic children were prescribed plano HAL lenses and had both pre-treatment and post-treatment visits (≥6 months). The mean ±SD age, SER, and axial length was 6.8 ± 1.3 years, 0.22 ± 0.29 D, and 23.1 ± 0.7 mm, respectively. The mean ±SE axial length and SER pre-treatment change was +0.44 ± 0.01 mm/year and −0.28 ± 0.03 D/year, respectively. After treatment, the mean axial length and SER change were +0.13 ± 0.01 mm/year and +0.14 ± 0.03 D/year, respectively. The mean difference in axial length and SER change over time was significantly different at −0.31 ± 0.02 mm/year and 0.42 ± 0.06 D/year, respectively (both p < 0.001). Lens wearing time was significantly associated with difference in axial length change over time (R² = 0.19, p < 0.001).

Conclusion: Plano HAL lenses are effective in slowing axial elongation and SER progression among non-myopic children aged 4–9 years, which can potentially help in delaying myopia onset. 

[Link to open access paper]