Myopia is no longer viewed merely as a refractive condition but as a progressive ocular disease with lifelong implications. High myopia significantly increases the risk of irreversible vision-threatening complications such as myopic maculopathy, retinal detachment, and glaucoma.1
As the global prevalence of myopia continues to rise, especially among children, proactive myopia management has become a clinical imperative. In this article, we focus specifically on optical myopia management strategies, including contemporary spectacle lens designs such as Defocus Incorporated Multiple Segments (DIMS) lenses and highly aspherical lenslet designs, as well as contact lens-based interventions.
With multiple evidence-based optical strategies now available, clinicians are increasingly faced with a practical question: Should I recommend glasses or contact lenses for this child? The answer lies in understanding both the science and the patient.
The science behind myopia control spectacles and contact lenses
Mechanism of action
The cornerstone of modern optical myopia control is the concept of peripheral myopic defocus. Experimental and clinical studies demonstrate that when the peripheral retina receives hyperopic defocus, axial elongation is stimulated, whereas sustained peripheral myopic defocus inhibits excessive eye growth through choroidal thickening and scleral remodeling mechanisms.2
This biological principle underpins virtually all contemporary myopia control optics:
- Myopia-control spectacle designs such as DIMS and lenslet technology create multiple zones of peripheral myopic defocus while maintaining clear central vision.3,4
- The Essilor Stellest spectacle lens represents a recent advancement in spectacle-based myopia control. The lens incorporates highly aspherical lenslet (HAL) technology arranged in a constellation pattern designed to generate peripheral myopic defocus while maintaining clear central vision.5
- Clinical studies have demonstrated significant slowing of myopia progression and axial elongation in children wearing Stellest lenses compared with single-vision spectacle lenses.6 In September 2025, the Stellest lens design received FDA approval in the United States for myopia management, making it the first spectacle lens design to receive this regulatory recognition.5
- Dual-focus and extended-depth-of-focus soft contact lenses achieve the same optical effect using concentric treatment zones.6
- Orthokeratology reshapes the corneal surface overnight, creating a corneal profile that induces continuous peripheral myopic defocus during waking hours.6
In contrast, single-vision spectacles and standard soft contact lenses correct central refractive error only and may inadvertently leave relative peripheral hyperopia, potentially allowing continued axial elongation.2,3
Benefits and limitations of spectacles and contact lenses
Each modality offers a range of pros and cons, which we will explore further in this section.
Spectacles
Myopia-control spectacles are widely regarded as the safest entry point into myopia management. They require no handling skill, carry no infection risk, and are easily incorporated into daily routines—making them especially suitable for younger children.3,4
Modern myopia-control spectacle lenses, including DIMS and highly aspherical lenslet designs, demonstrate clinically meaningful efficacy, with studies reporting myopia-progression slowing of approximately 50% or greater—comparable to that reported with orthokeratology and dual-focus soft contact lenses.6,7 Their principal limitation is that, while effective, the magnitude of control is generally lower than that achieved with contact-lens-based interventions.3
Contact lenses
Soft dual-focus contact lenses provide clinically meaningful myopia control while offering functional advantages over spectacles, particularly for active children who participate in sports or require unobstructed peripheral vision.8,9 However, these lenses modulate accommodation.
Studies demonstrate increased accommodative lag and reduced accommodative facility at near compared with single-vision lenses, particularly in early wear.4 Certain EDOF lens designs may also influence reading eye movements and regressions during adaptation.5
Ortho-k
Orthokeratology provides both therapeutic and functional advantages. By eliminating the need for daytime correction, it is ideal for athletic children while also delivering among the strongest axial length control effects.7,10 Toric orthokeratology extends myopia control benefits to children with astigmatism.
While some studies report slightly reduced high-contrast visual acuity compared with soft multifocal contact lenses, overall patient preference and functional satisfaction often favor orthokeratology.6 The main limitations of orthokeratology remain higher cost, technical complexity, and an increased risk of microbial keratitis requiring stringent hygiene protocols.8
To learn how optometrists can integrate orthokeratology into their practices, check out: A Clinical Guide to Implementing Ortho-K in Your Practice!
Efficacy based on recent studies
The 2023 Cochrane Review and the Health Technology Wales Evidence Appraisal conclude that myopia-control spectacle lenses, dual-focus soft contact lenses, and orthokeratology are effective in slowing myopia progression and axial elongation compared with single-vision correction.6,7 Orthokeratology commonly achieves 40 to 60% axial length reduction compared with single-vision correction.9
Across contemporary optical strategies, reported reductions in myopia progression and axial elongation generally range from approximately 30 to 60% compared with single-vision correction, with overlapping efficacy across spectacles, dual-focus contact lenses, and orthokeratology.3,7,8
Long-term sustainability of spectacle-based therapy has now been clearly demonstrated. A 6-year follow-up study of children wearing DIMS lenses showed continued suppression of progression, no rebound effect after discontinuation, and preserved visual function.4 This establishes spectacle-based therapy as a long-term disease-modifying strategy rather than a short-term intervention.
Importantly, children who switched from spectacles to standard single-vision soft contact lenses experienced slightly faster myopia progression than those who remained in spectacles, emphasizing that contact lens wear alone is not myopia control unless the lens design is therapeutic.10
Brief focus on FDA-approved options
Among contact lenses, daily disposable dual-focus designs remain the only FDA-approved optical therapy for myopia control. Their approval provides additional medico-legal reassurance and enhances parental confidence.
Orthokeratology remains off-label for myopia control but is supported by global clinical guidelines and national health technology bodies when prescribed appropriately.8,12 Myopia-control spectacle lenses function as optical medical devices rather than regulated drug-device therapeutics. As mentioned earlier, the Essilor Stellest spectacle lens design received FDA approval in the United States in September 2025 for myopia management.5
Clinical decision-making
Choosing between glasses and contact lenses requires balancing clinical risk factors with behavioral and environmental realities. Myopia progression velocity, age of onset, family history, axial length trends, lifestyle demands, and family readiness all guide the final modality.
Table 1: Comparison of myopia control interventions for clinical selection.7,13
| Clinical Factor | Myopia-Control Spectacles | Dual-Focus Soft Contact Lenses | Orthokeratology |
|---|---|---|---|
| Typical Age | 4 to 10 years | 8 to 16 years | 8 to 18+ years |
| Axial Length Control | Clinically meaningful reduction (~30 to 60% vs. single vision) | Clinically meaningful reduction (~30 to 60% vs. single vision) | Clinically meaningful reduction (~30 to 60% vs. single vision) |
| Astigmatism Handling | Up to −4.00D (lens- and frame-dependent | Moderate | Good (toric designs available) |
| Dry Eye / Allergy | Generally well-tolerated | May exacerbate symptoms in some patients | Often suitable with careful ocular surface management |
| Sports Suitability | Low | High | Excellent |
| Hygiene Requirement | Minimal | Moderate | High |
| Infection Risk | None | Low | Higher, manageable with strict hygiene and monitoring |
| Daytime Freedom | No | No | Yes |
| FDA Approval | FDA-approved (Stellest lens design, US) | FDA-approved | Off-label for myopia control |
| Cost | Practice-dependent; often comparable across modalities | Practice-dependent | Practice-dependent |
Considerations: Age, severity, co-morbidities
Meaningful selection requires understanding whether the child can reliably perform lens hygiene, whether parents can supervise daily use, how demanding the child’s academic and sports schedule is, and whether the family understands that myopia management is a long-term preventive investment rather than just prescription updating.
Typically, children under 7 years of age are best managed with spectacle-based interventions. For patients aged 8 to 12 years old, contact lenses and orthokeratology may be introduced under active parental supervision. High myopes and fast progressors benefit most from contact-lens-based therapy.
Ocular surface disease, allergic conjunctivitis, poor lid hygiene, and significant dry eye favor spectacle therapy. Toric orthokeratology allows management of astigmatism but requires careful centration and monitoring.7 Binocular vision disorders may reduce early tolerance to multifocal optics.
Lifestyle and behavioral factors
Participation in sports, swimming, screen-intensive education, outdoor activity exposure, and family supervision capacity all influence treatment success. Dual-wear strategies—using myopia-control spectacles for weekdays and contact lenses for sports—can improve adherence and treatment exposure.9
Combining clinical findings with behavioral factors
Combination therapy may be considered for aggressive progressors; however, a 3-year comparative study found that 0.01% atropine combined with dual-focus contact lenses did not significantly outperform atropine alone.13 Thus, escalation should be based on documented progression rather than routine stacking of therapies.
While combining 0.01% atropine with dual-focus soft contact lenses did not significantly outperform atropine monotherapy,13 a systematic review and network meta-analysis demonstrated that combined atropine and orthokeratology may provide greater myopia control than either treatment alone, particularly in fast-progressing children.14
Current IMI guidelines emphasize long-term monitoring of axial length, not refractive error alone, as the primary marker of success.15
How to discuss treatment options and costs
Parents are more likely to accept myopia management when it is framed as lifelong disease prevention rather than short-term vision correction. Transparent discussion of costs should emphasize that today’s intervention reduces tomorrow’s pathological risks.
Trust-centered communication has been shown to improve long-term adherence and engagement in myopia management programs.16 Structured myopia programs also improve practice sustainability when implemented ethically and transparently.7,17
Sample conversations on myopia interventions
- For myopia-control spectacles: “These glasses actively slow your child’s eye growth. They are very safe, easy to manage, and ideal for young children.”
- For dual-focus soft contact lenses: “These daily disposable lenses slow myopia while giving your child freedom during sports and activities. They require good hygiene and regular review.”
- For orthokeratology: “These lenses are worn only at night, so your child sees clearly during the day without glasses. It’s one of our strongest options but requires strict cleaning and follow-up.”
Key takeaways
- Axial length should be prioritized over refractive change alone when monitoring treatment response, as structural progression may continue despite stable refraction.12
- Wear time consistency remains one of the strongest predictors of success across all optical modalities.3,4,8
- Earlier intervention, particularly before 8 years of age, is associated with stronger long-term control.4
- Dual-focus and EDOF contact lenses may cause short-term near-vision adaptation issues due to accommodative changes, so anticipatory counseling is essential.4,6
- Orthokeratology remains highly effective for fast progressors but requires strict hygiene and close monitoring.6,7
- Importantly, standard single-vision soft contact lenses should not be used as substitutes for myopia control.17
- Combination therapy should be reserved for selected high-risk progressors.
