Essilor Stellest lenses: 5-year results

Paper title: Myopia control efficacy of spectacle lenses with highly aspherical lenslets: results of a 5-year follow-up study

Authors: Li X (1), Huang Y (1), Liu C (1), Chang X (1), Cui Z (1), Yang Q (1), Drobe B (2), Bullimore MA (3), Chen H (4), Bao J (5)

1. National Clinical Research Center for Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, 270 Xueyuan Road, Wenzhou, 325027, Zhejiang, China
2. R&D, EssilorLuxottica, Singapore, Singapore
3. College of Optometry, University of Houston, Houston, TX, USA
4. National Clinical Research Center for Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, 270 Xueyuan Road, Wenzhou, 325027, Zhejiang, China
5. National Clinical Research Center for Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, 270 Xueyuan Road, Wenzhou, 325027, Zhejiang, China

Date: Published online March 5, 2025

Reference: Li X, Huang Y, Liu C, Chang X, Cui Z, Yang Q, Drobe B, Bullimore MA, Chen H, Bao J. Myopia control efficacy of spectacle lenses with highly aspherical lenslets: results of a 5-year follow-up study. Eye Vis (Lond). 2025 Mar 5.

[Link to open access paper]

Research on novel interventions for myopia control have produced promising short-term results. For example, spectacle lenses with highly aspherical lenslets (HAL) have already demonstrated significant slowing of myopia progression and axial length elongation in a three-year study.¹ However, a longer study duration is ideal to confirm long-term myopia control efficacy, and provide data  related to prolonged treatment such as safety. This study aimed to determine the efficacy of HAL lenses in slowing myopia progression over a 5-year term.

This study was a randomized, double-masked extended trial in China involving myopic children aged 8 to 13 years (mean age 10.4 years) who were originally allocated to wear HAL lenses for a 2-year randomized controlled trial.  Participants from the original HAL group continued wearing HAL lenses for further 3 years (n=43), representing a total of 5 years of continuous treatment. 5-year myopia control efficacy was evaluated by comparing the myopia progression and axial elongation (AL) of the HAL group with an extrapolated single vision spectacle (ESVL) lenses group.

Key findings were as follows.

• Mean myopia progression over 5 years was -1.27 D for HAL, and -3.03 D for ESVL, a difference of 1.75 D.
• Mean AL elongation over 5 years was 0.67 mm for HAL, and 1.40 mm for ESVL, a difference of 0.72 mm.
• 28% of the HAL group had an AL greater than 26 mm after 5 years, compared with an estimated 54% in the ESVL group. 
• The incidence of high myopia after 5 years (>-6.00D) was 9% in the HAL group, and 38% in the ESVL group.
• No significant treatment-related complications were reported during the extended 5-year study period.

These findings confirm that HAL lenses offer sustained benefits in slowing the progression of myopia and axial elongation. 

The 5-year HAL data strengthens the long-term evidence base for myopia control, with other interventions also having 5 or more years of continuous study evidence including low-concentration atropine,² dual-focus soft contact lenses,³ defocus incorporated multiple segments (DIMS) spectacle lenses,⁴ and overnight orthokeratology.⁵ For eye care practitioners, this supports HAL lenses as a safe and effective first-line strategy for myopia management as well as a viable long-term solution.

Minimizing the final level of myopia in adulthood and mitigating the associated risk of pathological complications is an underlying goal of myopia management. Results from this study indicate that long-term use of HAL lenses decreases both the incidence of high myopia, and the risk of progressing to AL greater than 26 mm. 

Achieving and maximizing these outcomes relies on multiple factors. In terms of HAL spectacle lenses, these include early intervention (i.e. pre-myopia),⁶ consistent wearing time (at least 12 hours per day)⁷, and continued treatment until myopia stabilization – typically in the late teenage years.

This study provides valuable long-term data on HAL spectacle lenses, but certain limitations remain. 

Firstly, the authors relied on an extrapolated single-vision group rather than continuing a fully monitored parallel group, which may limit the precision of comparisons. Daily wearing time was not tracked in the final phase, and assumed to be consistent with the first 3 years of the study – raising the question of whether usage patterns changed over the final 2 years. External factors, such as school closures and increased screen time during COVID-19 lockdowns, may have further influenced progression rates. 

While the findings are promising for myopia management, future studies would ideally incorporate robust, continuously observed control groups, although there are ethical challenges in achieving this given the widespread recognition of effective myopia control treatments. Further information on more diverse patient populations would be useful, along with closely monitored compliance to ensure accurate long-term efficacy. Such data will help optometrists and ophthalmologists better understand the broader clinical applicability of these lenses.

Purpose: To evaluate myopia control efficacy in myopic children wearing spectacle lenses with highly aspherical lenslets (HAL) for 5 years.

Methods: This is a randomized, double-masked extended trial. Myopic children aged 8 to 13 years who were originally allocated to the HAL group in the 2-year clinical trial. The HAL group underwent a 5-year assessment for myopia progression using cycloplegic spherical equivalent refraction (SER) and axial length (AL). An extrapolated single-vision spectacle lenses (ESVL) group was used as a control group. The 5-year myopia progression and axial elongation of the ESVL group was calculated based on the 2-year data from the single-vision spectacle lenses group in the same clinical trial, and the data for the following 3 years was estimated by assuming an annual reduction in SER by 9.7% and in AL by 15%. A generalized linear model approach was used to evaluate the treatment efficacy. The validity of the ESVL group was evaluated by comparing myopia progression in the first year of the 3-year estimates with a single-vision spectacle lenses (SVL2) group from a 1-year extended study of the same clinical trial.

Results: Forty-three participants from the original HAL group completed the 5-year visit (74%). Five-year myopia progression [mean ± standard error (SE)] in the HAL group was - 1.27 ± 0.14 D. Compared with the ESVL (- 3.03 ± 0.18 D), myopia progression was - 1.75 ± 0.24 D less for the HAL group (P < 0.001). The mean AL elongation over 5 years was 0.67 ± 0.06 mm for the HAL group compared with 1.40 mm in the ESVL group (P < 0.001), AL elongation was slower by 0.72 ± 0.10 mm for the HAL group (P < 0.001). No significant differences were found for myopia (- 0.58 ± 0.04 D vs. - 0.56 ± 0.05 D) or AL elongation (0.28 ± 0.02 mm vs. 0.28 ± 0.02 mm) between the ESVL group and SVL2 group (PSER = 0.83; PAL = 0.93) in year 3.

Conclusions: In this 5-year study, HAL spectacles reduced the rate of myopia progression and axial elongation, preventing the equivalent of 3 years of myopia progression and axial elongation. Long-term use of HAL spectacles also decreased the incidence of high myopia. Extrapolated control groups are valid for evaluating myopia progression in long-term studies.

[Link to open access paper]