Learning more about the Essilor® Stellest® lens

Essilor® Stellest® lens is part of the newest generation of myopia controlling spectacle lens technologies and has become a robust choice for correcting and controlling myopia. There's a lot we already know about the lenses - you can read about it in our article Understanding The New Essilor Stellest Spectacle Lens - but what are we still learning? This article will go through the newest research coming out regarding the Essilor® Stellest® lenses.

The Essilor® Stellest® lens is made up of 11 rings of 1021 contiguous aspherical lenslets that surround a central clear zone of 9mm.^1,2 While they do not appear to have any impact on visual acuity¹ and accommodation³ and minimal impacts on contrast sensitivity and glare sensitivity,⁴ the potential impact on visual field sensitivity has only recently been studied.

In November 2022, Gao et al published findings regarding the impacts of spectacles with highly aspherical lenslets on visual sensitivity using automated static perimetry. The study included 21 adults aged 26 to 61 years old with spherical equivalent refractive error (SER) ranging from +0.88D to -8.75D. Participants were asked to complete visual fielding testing using a Goldmann perimeter, and targets were presented within 30°eccentricity. The visual field sensitivity was obtained through one lens with highly aspherical lenslets (HAL), and one single vision lens and compared.

It was found that there was no significant difference between visual field sensitivity as measured through single vision lenses and HAL lenses, indicating that there is no measurable impact on visual field sensitivity, after accounting for age and SER.⁵

A cross-over clinical trial is a research method where individuals undergo a series of treatments, rather than being assigned into a control group or treatment group. This way, participants in a cross-over clinical trial act as their own comparison group. This trial design allows researchers to assess and compare the effects of different treatments within each participant and is valuable for studying long-lasting conditions or interventions with sustained impacts.⁶

The Brien Holden Vision Institute (BHVI) conducted a cross-over trial comparing HAL lenses and single vision lenses.⁷ Stage 1 of the trial involved 119 Vietnamese children aged 7 to 13 years old with SER range of -0.75 to -4.75D who were given HAL or single vision lenses to be worn for 6 months. In stage 2, these lenses were switched from HAL to single vision and vice versa and again worn for another 6 months. After stage 2, all children were switched to HAL lenses. 

Results indicate that HAL lenses slowed myopia compared to single vision lenses, and that this was evident between groups wearing different lenses, and at the individual level when lenses were switched to HAL lenses. The research further indicates that there is no rebound effect when switching from HAL to single vision lenses.⁷

The one-year and two-year randomized control trial data established the Essilor® Stellest® lens as an efficacious myopia control treatment option on par with the current 'best' interventions of orthokeratology, dual-focus soft contact lenses and 0.05% atropine.^1-2,8

The 3-year data is a continuation of the original randomized control trial.⁹ The study participants were separated into groups:

• HAL1 group: 52 children who have been wearing HAL lenses for 2 years continue to wear HAL lenses
• HAL2 and HAL3 groups: children who had been wearing single vision lenses (n=48) or slightly aspherical lenslets (SAL) lenses (n=51) are switched to HAL lenses.
• nSVL group: 56 children with no prior history of myopia control were newly recruited at the start of the 3 year trial extension date and were given single vision lenses only. These children were matched for age, sex, cycloplegic SER and axial length to the HAL3 group.

It was found that the HAL1 group benefited from less myopia progression and axial elongation compared to single vision over 3 years. In the HAL2 and HAL3 groups, they also benefited from slowed myopia progression and axial elongation after switching to HAL lenses after 2 years of wearing single vision lenses or SAL lenses. In fact, No differences among the three HAL treatment groups were found in this third extension year. The nSVL group was compared as a control against the third year changes of the HAL groups, and it was found that there was significantly more axial elongation and SER progression in the nSVL group compared to all 3 HAL groups.⁹

Early reports from the 4-year clinical trial data indicate positive results. 43 children completed the 4th year follow-up and were now 11- to 16-year-olds with an average SER of -3.70±1.22 D and AL of 25.28±0.84 mm. Data was compared to single vision lens models based on data from the first 2 years of the clinical trial: it was found that myopia progression and axial elongation was slower in children wearing HAL than in the modeled single vision control group even in the fourth year of wear.¹⁰

The current research further indicates that the Essilor® Stellest® lens is not only highly effective in slowing the progression of myopia, but does not impact visual function even when it comes to visual field sensitivity. It remains a worthy weapon in the myopia management armory, as long as compliance to full-time wear is emphasized.