Eye glasses for myopia control in children

• Eye glasses are also known as spectacles, made up of the spectacle frame and spectacle lenses.
• Good compliance with spectacle wear maximises the effectiveness of the spectacles, to provide clear vision and also the myopia control treatment effect.
• New spectacle lenses for myopia control have the ability to slow myopia progression in children, with evidence in kids from age 6 to 16 years. There is the most evidence for kids aged 8 to 13 years.
• Frame and lens selection should incorporate the clinical needs of your child’s eyesight with their individual lifestyle and expectations.

Myopia, also known as short-sightedness or near-sightedness, causes vision to become blurred in the long distance, and the need for glasses or contact lenses to bring the eye back into focus.

In most cases, myopia starts in childhood, and then progressively increases typically up until early adulthood when it stabilizes.¹ Myopia is a lifelong condition and increases risk of potentially sight threatening conditions in later life, leading the World Health Organization to classify myopia as a global health concern.²

'Myopia control' has become the increasingly adopted term to describe the use of treatments aimed to slow progression of myopia. These treatments can include spectacles, contact lenses or atropine eye drops. Myopia control is particularly important in children, because this is the stage in life when myopia is most likely to progress or worsen quickly. Taking action to control progression of myopia in children during this fast progression stage in their life will therefore likely achieve the most gains.³

Spectacles are a simple and non-invasive way to correct your child’s blurred eyesight. The term 'glasses' is used commonly to describe the combination of spectacle frames and spectacle lenses. This article describes important information about both.

Spectacle frames are the physical holder for corrective lenses, which must fit comfortably and accurately on a child's nose and ears to give them good vision.

Spectacle lenses are the key component of glasses which correct vision.

Poor compliance with spectacle wear (not correctly and consistently wearing glasses as prescribed) limits their ability to be useful. Uncorrected vision (not wearing glasses) can lead to poorer academic performance,³ reduced participation in social activities,⁴ and difficulty completing day-to-day tasks.⁵ Common reasons for poor compliance include broken glasses, forgetfulness to wear glasses, and negative perception of appearance.⁶

Wearing the correctly powered glasses is important for your child’s academic performance, social participation and ability to complete daily activities. Balancing the right choice of spectacle frames and spectacle lenses with your child’s needs can overcome many of these barriers to successful spectacle wear and in turn, maintain good vision.

Spectacle lenses which correct a large amount of myopia tend to be thicker on the edges and heavier, leading to the finished spectacles being less comfortable to wear. For children with high myopia, it is generally recommended to select high-index lens materials to reduce the thickness and overall weight of the lens.

Foremost, children with myopia need their blurred vision corrected with spectacles or contact lenses. Standard types of spectacles and contact lenses, called single vision, can correct this blurred vision but they do not control progression of myopia.

Progressive addition lenses have a gradual change in power from the top of the lens (for far vision) down to the bottom of the lens (for reading vision). They have been studied extensively but shown to be ineffective for slowing myopia progression in children.⁸

Bifocal spectacle lenses have been shown to slow myopia progression by about one-third (about 33%) in children aged 8 to 13 years at the start of treatment. The evidence includes a three-year study, so includes children up to age 16.⁹

There are three types of specific myopia control spectacle lens designs that have been shown effective at slowing progression of myopia by at least half (at least 50%). Two use a special 'lenslet' design - think of this as tiny, 1mm diameter mini-lenses distributed across the lens surface, helping to send a specific type of slow-down growth signal to the myopic eye.

These 'lenslet' designs are the Hoya MiYOSMART and the Essilor Stellest spectacle lenses. Both have been studies in children aged 8 to 13 years at the start of treatment.^10,11 Both are now reporting three year data, indicating effectiveness and tolerance in children up to 16 years of age.

The SightGlass DOT lens uses microscopic 'diffusers', which are different to the lenslets. It has been studied in children aged 6 to 10 years at the start of treatment, with only one-year data currently available, indicating effectiveness up to 11 years of age.¹²

There is one type of 'peripheral defocus' spectacle lens called Zeiss MyoVision, which showed no impact on slowing eye growth in children.¹³

While a bifocal spectacle lens features the obvious line in the lens, in all three of these special myopia control spectacle lens designs, they look like normal glasses when worn. The special 'lenslets' or 'diffusers' are typically seen when the glasses are taken off and the lenses are held up to the light.

The research studies of children wearing the Hoya MiYOSMART, the Essilor Stellest or the SightGlass DOT spectacle lenses all show very positive outcomes where children wearing them experience clear vision for far and close-up vision and adapt quickly to lens wear.^10-12

First and foremost, your optometrist or eye doctor is best placed to advise on which spectacle (glasses) lens is the best solution, specific to your child’s age, vision requirements and what will likely suit them best. Also, not all spectacle lenses are available in all countries at this stage.

When it comes to myopia control effectiveness, the specialized myopia control designs with lenslets or diffusers are most effective. These have been shown to slow down myopia progression in children by at least half, compared to children wearing standard single vision spectacle lenses. They are similarly effective for myopia control as ortho-k, dual focus soft contact lenses and atropine 0.05% eye drops.

There are no myopia control treatments that can promise to stop myopia progression, but they can help to slow it down.¹⁴ Myopia control glasses treatment will be working, firstly, if your child can see clearly with their spectacles or contact lenses and are tolerating the treatment well with minimal side effects.¹⁴

Myopia progression can be measured either by measuring change to refraction prescription or change in the axial length of the eye, and compared to research data to determine success of a myopia control treatment.

Selecting the right spectacle frame for glasses is especially important for myopia control, because to be effective, the myopia control lens designs need to be accurately aligned with the eye and remain in a stable position throughout wear. The frame should also be comfortable enough for the child to be able to wear them full-time.

An ideal spectacle frame choice should meet three key requirements: 

1. Fits well and comfortable to wear
2. Suitable for your child’s vision and lifestyle needs
3. Attractive to the wearer

When selecting an appropriate spectacle frame for your child, consider their head size and facial features. The image below shows four key areas where frame fits can be evaluated for suitability.

Each of these frame fitting areas is important for the following reasons.

1. Width of frame on face: A frame that is too narrow or too wide may place excessive pressure on the ears or side of the head, leading to discomfort and headaches.
2. Eyepiece size: should be just large enough that your child can view comfortably in all directions through the lenses.
3. Nose bridge: this distributes the weight of the glasses on the nose, and should be wide enough to sit comfortably and securely on the nose with a large and even area of contact.
4. Temple length: the frame temples also distribute the weight of the glasses, onto the ears, and should be long enough to allow a straight path from temple to ear.

As there is great variation in head size and facial features amongst children, it is likely that the frames will require manual adjustment to achieve a comfortable fitting.

The choice of frame material should factor in a child’s predisposition to high-energy movements. Plastic is a popular frame material for children’s glasses, as its low weight, smooth surface, and thicker temple arms allows for a forgiving and comfortable fit. Metal-based frames are also an excellent choice for their durability and flexibility, and often contain adjustable nose pads to ensure a secure fit.

Your child’s personality and interests can also play a role in frame styling. Kids frames often incorporate designs of popular cartoon characters or trendy colors, so that they may choose a frame they like. For kids who participate in sport, an elastic strap attached to the temple tips can ensure that the frames sit securely during rapid movement, or contact lenses can also be considered.

1. Hou W, Norton TT, Hyman L, Gwiazda J; COMET Group. Axial Elongation in Myopic Children and its Association With Myopia Progression in the Correction of Myopia Evaluation Trial. Eye Contact Lens. 2018 Jul;44(4):248-259. (link)
2. The impact of myopia and high myopia. Report of the Joint World Health Organization-Brien Holden Vision Institute Global Scientific Meeting on Myopia. 2015 (link)
3. Hopkins S, Narayanasamy S, Vincent SJ, Sampson GP, Wood JM. Do reduced visual acuity and refractive error affect classroom performance? Clin Exp Optom. 2020 May;103(3):278-289. 
4. Naidoo K, Govender P, Holden B. The uncorrected refractive error challenge. Community Eye Health. 2014;27(88):74-5. 
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9. Lam CSY, Tang WC, Tse DY, Lee RPK, Chun RKM, Hasegawa K, Qi H, Hatanaka T, To CH. Defocus Incorporated Multiple Segments (DIMS) spectacle lenses slow myopia progression: a 2-year randomised clinical trial. Br J Ophthalmol. 2020 Mar;104(3):363-368. 
10. Bao J, Huang Y, Li X, Yang A, Zhou F, Wu J, Wang C, Li Y, Lim EW, Spiegel DP, Drobe B, Chen H. Spectacle Lenses With Aspherical Lenslets for Myopia Control vs Single-Vision Spectacle Lenses: A Randomized Clinical Trial. JAMA Ophthalmol. 2022 May 1;140(5):472-478.
11. Cheng D, Woo GC, Drobe B, Schmid KL. Effect of bifocal and prismatic bifocal spectacles on myopia progression in children: three-year results of a randomized clinical trial. JAMA Ophthalmol. 2014 Mar;132(3):258-64. 
12. Rappon J, Neitz J, Neitz M, Chung C, Chalberg TW. Two-year effectiveness of a novel myopia management spectacle lens with full-time wearers. Invest Ophthalmol Vis Sci. 2022;63(7):408.
13. Sankaridurg P, Donovan L, Varnas S, Ho A, Chen X, Martinez A, Fisher S, Lin Z, Smith EL 3rd, Ge J, Holden B. Spectacle lenses designed to reduce progression of myopia: 12-month results. Optom Vis Sci. 2010 Sep;87(9):631-41.
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