Myopia Profile

Clinical

A successful spectacle lens fitting for myopia

 Posted on November 14th 2022 by Connie Gan

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In this article:

The advancements in spectacle lens options for myopia management give practitioners a wide range of options for their patients.

Spectacle lens options for myopia management have evolved from progressive and bifocal lens options to the next generation of technology involving lenslets. These new technologies are showing myopia control efficacy at least equivalent with our best contact lens options and atropine concentrations, based on current data.1,2 Here, PC shared a case whereby his patient's myopia is well controlled by one of these new technology spectacle lenses: the Highly Aspherical Lenslet Target or H.A.L.T. Technology lens, available as the Essilor® Stellest™ lens.

PC It’s always exciting to see something new. And fantastic that a child comes in already wearing myopia control glasses and not SV! First time I’ve come across the Essilor Stellest lenses in real life. This 10 year old boy got them in China 6 months ago (R -1.00 L -1.75) as his first glasses and today R -1.00 L -2.00. Getting him fitted with MiSight for the days when he prefers not to wear glasses.

Comments from the Myopia Profile community

JG Love seeing these amazing results with stellest Lena. It's such a great Lena for myopia management!VM You won't come across myopic kids from mainland China wearing SVDPC That’s the way it should be! Myopia management as standard of care!

The global trends in myopia management attitudes and strategies in clinical practice show that fewer practitioners are prescribing single vision lenses and there is an increase in pharmaceutical and multifocal soft lens prescriptions. More practitioners are also now aware that under correction is not an effective method for myopia control.3

Question from the commenters

1. Should we stop myopia treatment at the age of 12?

SK … A small question, is the 12y old a cut off point for trying to halt myopia with these lenses? Is there any scientific support for or against carrying on even over this age ?PC … No, I don’t believe there should be an age cut-off for using myopia control interventions - just because the studies didn’t include older kids it does not mean the treatments don’t work or any less effective. About half of myopes continue to progress beyond age 15 and a small percentage into their 20s. Treatments should be initiated based on the individual’s progression and risk profile.

The randomized controlled trial which investigated the Essilor Stellest spectacle lens recruited children aged 8-13 years at baseline, who after two years would have been 10-15 years: hence the evidence base covers children across this age range.1

At 12 years old, growth in children can be accelerating, with the most obvious example being their height. A study has shown axial length growth is correlated with body height. In addition, axial length growth accelerates faster in myopes compared to emmetropes.4

The COMET (progressive addition spectacle lens) study showed that 77% of myopes show refractive stability by the age of 18, whilst 90% of myopes stabilized by the age of 21.5 Hence, ceasing myopia management at 12 years old can be slightly too early. Read When To Stop Myopia Control Treatments to find out more.

2. Does a 0.25D change warrant a lens update?

SK … As a comment , 0,25 shouldn't be considered as a change even if it's the same examiner ,same examination room , same procedure all along . Even a child's mood might change for a 0.25D…PC …  generally use both axial length and refraction to determine progression, ensuring they correlate; in this case I don’t have previous AXL data but I agree -0.25 is within the margin of error of subjective refraction…KFS it’s interesting to see different perspectives. I am new to myopic prevention so the thought of a general rule that -0.25 is insignificant is a new concept for me.PC Depends on the time frame of the -0.25 change though. If it’s -0.25 over 3 months that’s -1.00 per year and that’s significant. Also more meaningful if that -0.25 change is supported by an axial length change of about 0.1mm.HT Did you update his glasses to reflect the extra -0.25 change?PC No, I would generally update glasses when -0.50 or more progression.HT  I had a similar progression today and didn't update either. no functional benefit but just wondered what others did.

From the comments, the general consensus is that a -0.25D change does not warrant a lens update as this most likely does not significantly affect vision or function. It is important to check this change with the patient and also perform the most accurate refraction possible to assess for change.

PC also makes an important point that axial length measurement changes can affirm whether or not a -0.25D change is true progression, or merely a factor of the margin of error with subjective refraction.

Take home messages

  1. Always start myopia intervention as early as possible to achieve the best outcomes.
  2. Myopia management strategies are generally best to be continued throughout childhood and into early adulthood until progression has plateaued, which is likely to be around or after age 21 in most people.
  3. A -0.25D change in subjective refraction may not warrant a spectacle lens update, dependent on the patient's experience of their vision. It is also useful to monitor the correlation between refractive error and axial length changes, to determine true progression of myopia compared to variability in refraction.

Further reading

Meet the Authors:

About Connie Gan

Connie is a clinical optometrist from Kedah, Malaysia, who provides comprehensive vision care for children and runs the myopia management service in her clinical practice.

Read Connie's work in many of the case studies published on MyopiaProfile.com. Connie also manages our Myopia Profile and My Kids Vision Instagram and My Kids Vision Facebook platforms.

About Kimberley Ngu

Kimberley is a clinical optometrist from Perth, Australia, with experience in patient education programs, having practiced in both Australia and Singapore.

Read Kimberley's work in many of the case studies published on MyopiaProfile.com. Kimberley also manages our Myopia Profile and My Kids Vision Instagram and My Kids Vision Facebook platforms.

This content is brought to you thanks to unrestricted educational grant from

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