All we’ve learnt in a year about the SightGlass Vision Diffusion Optics Technology™ spectacle lens

The SightGlass Vision Diffusion Optics Technology™ (DOT™) spectacle lens has gained significant attention in myopia management as an innovative intervention with a unique mechanism of action. Over 2024, a wealth of new evidence has emerged from 5 new peer-reviewed publications and 14 conference abstracts, offering deeper insights into its efficacy, underlying mechanisms, and impacts on vision and visual function. This article delves into key findings from the CYPRESS study, newly published four-year data, and additional real-world and clinical studies from China and Canada, presented at major conferences in 2024 including the Association for Research in Vision and Ophthalmology (ARVO) meeting and the International Myopia Conference (IMC).

The DOT™ spectacle lens has newly presented research suggesting it is a highly effective intervention for managing myopia progression. Several clinical trials and real-world studies provided compelling evidence of its consistent efficacy:

• The CYPRESS study, a 4-year multicenter randomized controlled trial (RCT) undertaken in North America, demonstrated the efficacy and safety of DOT™ spectacle lenses in slowing myopia progression in children aged 6–10 years. Similarly to other studies undertaken during the COVID-19 pandemic,^1-3 study results were impacted by public health restrictions. Despite the significant COVID-19 related disruption, DOT™  lenses reduced axial elongation by 0.20 mm and refractive error progression by 0.52 D compared to control lenses over four years. The most significant treatment benefits were observed in the first year (pre-COVID): a 50% reduction in axial elongation and a 74% reduction in refractive error progression.⁴  In year 4, DOT™  lens wearer eye growth was similar to physiological eye growth observed in age-matched emmetropic eyes.^5,6 
• Early results from a 2-year RCT involving 186 children aged 6-13 years in China showed DOT™ spectacle lenses significantly slowed myopia progression after 6 months. Mean axial elongation in the DOT™ lens group was only 0.01 mm (vs. 0.19 mm in the control group) and refractive error progression was 0.04 D (vs. -0.35 D in the control group).⁷ AL growth was halted in 49% of the DOT™ group (n=63, mean AL change: -0.11 mm).⁸
• Real-world data from a retrospective study in China evaluating DOT™ lens wearers aged 5-16 years indicated minimal progression in refractive error (-0.04 D) and AL (0.04 mm) over 12 months.⁹ 
• A Canadian clinical practice retrospective study compared DOT™ spectacle lenses to a defocus-based lens and reported DOT™ lenses were 45% more effective in slowing myopia progression (-0.32 D vs. -0.58 D) and 41% more effective in limiting AL elongation (0.19 mm vs. 0.32 mm) compared to a defocus-based lens in children aged 6-8 years.¹⁰  

These findings collectively affirm the robust myopia control efficacy of DOT™ spectacle lenses in real-world and clinical trial settings across diverse populations. In a study looking at the rebound effect after discontinuation of DOT™ spectacle lenses wear, it was also found that these effects were maintained even after discontinuation. Six months after swapping from DOT™ lenses to standard single vision lenses, myopia progression and axial elongation were similar between the former DOT™ group (-0.12 D, 0.11 mm) and the control group (-0.16 D, 0.08 mm), suggesting the benefits of DOT™ lenses are retained post-treatment.¹¹

Near work, such as reading and screen use, has long been considered a risk factor for myopia.^12,13 The contrast theory proposes that retinal contrast levels drive eye growth, with high (artificial) contrast stimuli (e.g. books, tablets, urban environments) promoting axial elongation and lower, more natural contrast environments (e.g. outdoor sports field) slowing it. Research suggests that high-contrast images from near work (eg. black text on a white background) overstimulate peripheral midget bipolar cells (contrast detecting retinal cells), signalling eye elongation.^14,15 DOT™ spectacle lenses are designed to reduce this overstimulation by diffusing light to mimic more natural contrast., At the same time, they maintain a clinically equivalent visual experience to standard single vision lenses, while effectively slowing myopia progression.¹² You can read more about the contrast theory in our article The contrast theory in myopia: Q&A with Prof. Earl Smith, Marcella McParland and Jill Woods.

New research also suggests that DOT™ spectacle lenses influence eye growth at the choroidal level. Initial choroidal thickening when commencing myopia management treatment is thought to indicate that a treatment is likely to be effective at slowing myopia progression longer-term with continuous wear. Short-term studies have shown that DOT™ lenses can induce significant choroidal thickening in central and parafoveal regions of emmetropic children aged 8-14 years in as little as 30 minutes.¹⁶ In a study looking at the effect in myopic children aged 6-12 years, they found that after 1 week of DOT™ spectacle lens wear there was significant sub-foveal choroidal thickening present.¹⁷ 

Emerging research is challenging traditional assumptions about how optical interventions slow myopia progression. A study by Su et al. found that children wearing spectacle lenses with negatively powered lenslets (NLARI lenses) experienced similar myopia control effects as those with positively powered lenslets, despite the expectation that mid-peripheral hyperopic defocus would accelerate myopia progression.¹⁸ This raises the possibility that defocus-based optical interventions may also operate via contrast management, though further research is needed to clarify its role across different lens designs.¹⁹

The DOT™ spectacle lenses have been shown to preserve key aspects of vision and visual function, offering a visual experience comparable to standard single-vision (SV) lenses across various conditions, with new research showing the following:

• Central and Peripheral Visual Acuity: The DOT™ spectacle lenses maintained central distance visual acuity (VA) for high-contrast letters comparable to SV lenses. Unlike DIMS and HAL lenses, which exhibited reductions in VA in the peripheral treatment zones, the DOT™ spectacle lenses showed no significant impact on peripheral high-contrast VA. This highlights the DOT™ spectacle lenses advantage in preserving all-round clarity of vision, particularly as the eyes move.¹⁸
• Dynamic Vision and Reading Performance: Dynamic vision through DOT™ spectacle lenses performed similarly to SV lenses, with no significant differences in error scores or task durations. Furthermore, DOT™ spectacle lenses did not exhibit the reduced reading performance observed with DIMS lenses in the peripheral zone, highlighting their suitability for patients with diverse visual demands.¹⁹
• Contrast Sensitivity and Glare: Under glare and low luminance conditions, DOT™ spectacle lenses maintained contrast sensitivity comparable to standard SV lenses in the peripheral zone and outperformed HAL and DIMS lenses in low light conditions. This suggests that DOT™ spectacle lenses offer enhanced visual performance in challenging lighting environments.²⁰
• Long-Term Visual Performance: Over three years, DOT™ spectacle lenses demonstrated high- and low-contrast visual acuity, reading speed, and stereopsis similar to standard SV lenses in children aged 6-10 years at baseline. Minor differences in glare-related metrics were clinically insignificant, reinforcing that DOT™ spectacle lenses provide excellent visual performance while effectively controlling myopia.²¹
• Adaptation and Patient Satisfaction: In a study of Chinese children aged 6-13 years, 97% adapted well to DOT™ spectacle lenses within a few days, reporting clarity of vision at distance and near, as well as comfort and satisfaction levels similar to standard single-vision lens wearers,²² demonstrating DOT™ lenses are as easy to adapt to as standard single vision lenses.  

Over the past year, new insights have further solidified the DOT™ spectacle lenses’ position as a highly effective intervention, offering significant reductions in myopia progression and axial elongation. Beyond its efficacy, the DOT™ spectacle lenses provide a visual experience comparable to single-vision lenses, ensuring that critical aspects of vision and visual function are preserved. As research continues to expand, the DOT™ spectacle lenses represent a promising advancement in addressing the global myopia epidemic, providing clinicians and patients with an effective and evidence-based solution for managing myopia.

DOT™ lenses are currently not available for sale in the US but are available in selected countries outside the US.