Eye glasses for myopia control in teenagers

• 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 kids up to age 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.

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.

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,¹ reduced participation in social activities,² and difficulty completing day-to-day tasks.³ Common reasons for poor compliance include broken glasses, forgetfulness to wear glasses, and negative perception of appearance.⁴ 

The lenses in a pair of spectacles serve as the window through which your teenager can view their world clearly. Wearing the correctly powered glasses is important for academic performance, social participation and ability to complete daily activities. 

Balancing the right choice of frames and lenses with your teenager’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. Your teenager may also be conscious of how the lenses make their eyes appear smaller than they are. For those with high myopia, it is generally recommended to select high-index lens materials for spectacles to reduce these unwanted effects, or to consider contact lenses.

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.⁶ 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.⁷

'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. Although myopia tends to progress fastest before the teenager years, teens are still susceptible to myopia progression and likely to benefit from myopia control.³

Foremost, teenagers 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.⁸

There are specific types of spectacle lenses which can slow down the progression, or worsening, of myopia in teenagers.

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.⁹

Bifocal spectacle lenses have been shown to slow myopia progression by about one-third (about 33%) with evidence including children up to age 16.¹⁰ The visible line in a bifocal spectacle lens is not cosmetically ideal for teenagers.

Research has shown that the most effective spectacle lens options for myopia control are new types incorporating ‘lenslets': multiple, strong powered, extremely small lenses dotted across the larger spectacle lens. Two types of these new lenses are Hoya MiYOSMART¹¹ and the Essilor Stellest¹² spectacle lenses. Both have published data for two-year clinical trials, and three-year data which includes kids up to 16 years of age.

The newest design 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,¹³ so has not been tested yet in teenagers.

There is one type of 'peripheral defocus' spectacle lens called Zeiss MyoVision, which showed no impact on slowing eye growth in children and teens.¹⁴

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.^11-13

The special 'lenslets' or 'diffusers' are typically not easy to see when the glasses are being worn, but are visible when the glasses are taken off and the lenses are held up to the light. This means that these special myopia control glasses can look just like normal spectacles.

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, (at leaset 50%) compared to teenagers 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.⁸ 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.⁸

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.

When selecting an appropriate spectacle frame with your teenager, it's important to consider their head size and facial features and not just the colour or look of the frame. 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 teenager 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 teenagers, 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.

A teenager’s personality and interests can also play a role in frame styling. They may be interested in trendy colors or have strong ideas about their own sense of style. For teenagers who participate in sports, an elastic strap attached to the temple tips can ensure that the frames sit securely, or contact lenses can also be considered.

Your optometrist will provide you advice on this specific to your teenager’s vision and what will likely suit them best. Also, be aware that not all myopia control spectacle designs are available in all countries at this stage as the technology is relatively new.

There is currently limited evidence overall for treatments to slow myopia progression in those older than 16 years. This is partly because around half of teenagers with myopia show stability of their myopia by age 16, while the other half will continue to progress into later teenage years and early adulthood.⁶ Therefore, the best recommendation is to initiate myopia control therapy as early as possible, with the most effective treatment available, and to continue the treatment well into the teenage years or beyond.⁸

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2. Naidoo K, Govender P, Holden B. The uncorrected refractive error challenge. Community Eye Health. 2014;27(88):74-5.      
3. Vu HT, Keeffe JE, McCarty CA, Taylor HR. Impact of unilateral and bilateral vision loss on quality of life. Br J Ophthalmol. 200589(3): 360–363.
4. Dhirar N, Dudeja S, Duggal M, Gupta PC, Jaiswal N, Singh M, Ram J. Compliance to spectacle use in children with refractive errors- a systematic review and meta-analysis. BMC Ophthalmol. 2020 Feb 24;20(1):71.      
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7. 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)
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9. Gwiazda J, Hyman L, Hussein M, Everett D, Norton TT, Kurtz D, Leske MC, Manny R, Marsh-Tootle W, Scheiman M. A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression of myopia in children. Invest Ophthalmol Vis Sci. 2003 Apr;44(4):1492-500. (link)
10. 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. (link)
11. 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. 
12. 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.
13. 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.
14. 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.