Eye glasses for myopia control in young adults

• Eye glasses are also known as spectacles, made up of the spectacle frame and spectacle lenses.
• Most young adults with myopia will wear spectacles or contact lenses, or both.
• Myopia typically progresses or worsens until the late teenage years and in some into the early 20s.
• New spectacle lenses for myopia control have been shown to slow myopia progression in kids up to age 16 years.
• Myopia control spectacles could be an option for progressing myopia in young adults, but no studies have yet been undertaken.

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

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

Wearing the correctly powered glasses is important for academic and work performance, social participation and ability to complete daily activities. 

The lenses in a pair of spectacles serve as the window through which we view the world and the environment clearly. Depending on your individual needs, your optometrist or eye doctor will recommend specific lens designs, materials, and lens treatments. Examples can include the following.

1. High-index materials: 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. You may also be conscious of how the lenses make your eyes appear smaller than they are (called minification). For those with high myopia, it is generally recommended to select high-index lens materials or consider contact lenses to reduce these unwanted effects, or to consider wearing contact lenses.
2. Anti-reflective coatings are a great choice for those who spend time in bright environments, such as working with digital screens, under artificial down lighting, or driving, as they provide sharper vision with less glare and ghost images. They also make your spectacles more attractive by making the lenses appear nearly invisible.
3. Blue-light blocking coatings can reduce eye strain for some people, when spending a lot of time looking at back-lit screens. There is a small amount of evidence that they can improve sleep quality in people with self-reported insomnia, but may not have an effect in those with normal sleep patterns. Claims about these coatings protecting the health of the retina have not been supported by evidence.^3,4 The best advice is to pick this type of coating if you feel more comfortable looking through it at a screen.

An ideal spectacle frame choice should meet three key requirements: 

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

When selecting an appropriate spectacle frame, consider your head size and facial features, and not just the colour and style. 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 for you to 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 people, it is likely that the frames will require manual adjustment to achieve a comfortable fitting.

Plastic is a popular frame material for 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.

Myopia in young adults firstly requires the blurred vision to be corrected with spectacles or contact lenses. Special types of spectacles or contact lenses can correct blurred vision and also control myopia progression, although there is limited evidence for effectiveness of myopia control past age 16. Some adults can suffer progression, or worsening of their myopia in their 20s or even experience the onset of myopia after having no vision problems as a child.⁵

Most of the evidence for myopia control treatments so far has been collected for children and teenagers, who are most likely to experience faster myopia progression.⁶ You can read more about these treatment options and the evidence for particular age groups in Which is the best option for myopia control?

There are very few studies which investigate the effectiveness of these treatments past the age of 16, partly because half of teenagers with myopia will show stability of their myopia by age 16.⁶ The other half of teenagers with myopia will experience myopia progression into late teenage years and into their 20s. Myopia can also onset in early adulthood, after a childhood of normal vision. A large study which examined adults at age 20 and again at age 28 found that 14% developed myopia over that time.⁵

These statistics highlight that there is a need for myopia control for young adults, but there is simply not much data available for suitable treatments. Despite this, experts recommend that myopia control treatments which are commenced in childhood should ideally continue as long as possible,² and into early adulthood to have the best overall impact on slowing myopia progression.

If you are considering wearing myopia control spectacle lens designs, there are options available with evidence for effect in kids and teenagers up to age 16. They may have an effect for myopia control in older teens and young adults, but this just hasn't been studied yet.

The most effective spectacle lenses with evidence for slowing myopia progression in teenagers are new types incorporating ‘lenslets': multiple, strong powered, extremely small lenses dotted across the larger spectacle lens. These are the Hoya MiYOSMART⁹ and the Essilor Stellest¹⁰ spectacle lenses. Both have published data for two-year clinical trials, and three-year data which includes kids up to 16 years of age.

There is another myopia control lens called SightGlass DOT spectacle lens uses microscopic 'diffusers', which are different to the lenslets. It has been studied in children aged 6 to 11 years and has published data for a one-year clinical trial,¹¹ so has not been tested yet in teenagers.

1. Logan NS, Wolffsohn JS. Role of un-correction, under-correction and over-correction of myopia as a strategy for slowing myopic progression. Clin Exp Optom. 2020 Mar;103(2):133-137.
2. Gifford KL, Richdale K, Kang P, Aller TA, Lam CS, Liu YM, Michaud L, Mulder J, Orr JB, Rose KA, Saunders KJ, Seidel D, Tideman JWL, Sankaridurg P. IMI - Clinical Management Guidelines Report. Invest Ophthalmol Vis Sci. 2019 Feb 28;60(3):M184-M203.
3. Downie LE. Blue-light filtering ophthalmic lenses: to prescribe, or not to prescribe? Ophthalmic Physiol Opt. 2017 Nov;37(6):640-643.
4. Lawrenson JG, Hull CC, Downie LE. The effect of blue-light blocking spectacle lenses on visual performance, macular health and the sleep-wake cycle: a systematic review of the literature. Ophthalmic Physiol Opt. 2017 Nov;37(6):644-654.
5. Lee SS, Lingham G, Sanfilippo PG, Hammond CJ, Saw SM, Guggenheim JA, Yazar S, Mackey DA. Incidence and Progression of Myopia in Early Adulthood. JAMA Ophthalmol. 2022 Feb 1;140(2):162-169. doi: 10.1001/jamaophthalmol.2021.5067. 
6. 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.
7. Gifford KL, Gifford P, Hendicott PL, Schmid KL. Zone of Clear Single Binocular Vision in Myopic Orthokeratology. Eye Contact Lens. 2020 Mar;46(2):82-90.
8. González-Méijome JM, Carracedo G, Lopes-Ferreira D, Faria-Ribeiro MA, Peixoto-de-Matos SC, Queirós A. Stabilization in early adult-onset myopia with corneal refractive therapy. Cont Lens Anterior Eye. 2016 Feb;39(1):72-7. 
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;104:363-368.
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. Rappon J, Chung C, Young G, Hunt C, Neitz J, Neitz M, Chalberg T. Control of myopia using diffusion optics spectacle lenses: 12-month results of a randomised controlled, efficacy and safety study (CYPRESS). Br J Ophthalmol. 2022 Sep 1:bjophthalmol-2021-321005.