The evidence supporting myopia management has expanded considerably over the past decade. While early research focused on efficacy, clinicians today have access to data spanning long-term outcomes, real-world effectiveness, visual performance, pre-myopia management, combination approaches, special patient populations, and the evolution of lens technologies.

WRITER Sephora Miao

More than 80 publications investigating Essilor Stellest lenses† or highly aspherical lenslets (HAL) spectacle lenses have contributed to the evidence base supporting myopia management with spectacle lenses. A recently released clinical summary infographic, developed in collaboration with Myopia Profile’s Dr Kate Gifford, highlighted seven key evidence areas underpinning Essilor Stellest lenses, including the potential for Essilor Stellest lenses to slow myopia progression, delay myopia onset, maintain visual performance while controlling myopia progression, and attain additional benefit when used in conjunction with atropine. The infographic is presented in an EssilorStellest leaflet included in this issue of mivision.

THE FOUNDATION: EFFICACY AND LONG-TERM OUTCOMES

Figure 1. Seven-year follow-up of participants from the original HAL spectacle lens clinical trial demonstrated cumulative slowing of myopia progression (2.30D) and axial elongation (0.92 mm) compared with extrapolated control group outcomes.

The foundation of the evidence supporting HAL spectacle lenses was established through a two-year randomised controlled clinical trial involving 157 myopic children in Wenzhou, China. Compared with single-vision lenses, children wearing HAL spectacle lenses experienced significantly slower myopia progression and axial elongation, establishing the efficacy of this spectacle lens approach for myopia management.1

Importantly, continued follow-up of children enrolled in the randomised clinical trial has provided valuable insight into the long-term performance of HAL spectacle lenses. Five-year findings demonstrated sustained treatment benefits,2 while seven-year follow-up data presented at the Association for Research in Vision and Ophthalmology (ARVO) 2026 meeting provided further evidence of long-term efficacy. The analysis included 40 participants who completed seven years of follow-up, representing approximately 71% retention from the original treatment group. Investigators reported cumulative slowing of myopia progression by 2.30D and axial elongation by 0.92 mm compared with extrapolated control group outcomes and this was observed in participants up to 19 years of age (Figure 1).3

More recently, findings from a prospective, randomised, double-masked, multicentre clinical trial, conducted across nine clinical sites in the United States, further expanded this body of evidence. Presented at ARVO 2026, the trial demonstrated slowing of myopia progression by 71% (0.64D) and axial elongation by 53% (0.24 mm) over two years compared with single-vision lenses.4

Efficacy was observed across age groups and baseline myopia levels, with stronger effects reported among younger children.5 Investigators also reported stable visual acuity, favourable safety outcomes, and high treatment compliance.6 Additional analyses indicated no impact on the rate of astigmatism change over two years compared to single vision lenses,7 confirming previously reported results in Chinese paediatric populations.8,9

Essilor Stellest lenses received United States Food and Drug Administration (US FDA) market authorisation in September 202510 and are currently the first and only spectacle lenses authorised in the US.

BRINGING CLINICAL TRIALS AND REAL-WORLD PRACTICE TOGETHER

Beyond individual clinical trials, clinicians increasingly rely on evidence generated across multiple study designs, including randomised controlled trials, long-term follow-up investigations, independent research, and real-world clinical practice.

A review of published evidence across 26 studies conducted in multiple patient populations, including 17 in China, showed consistent findings for HAL spectacle lenses.†11 Among the 10 studies that included a single vision lens control group, axial elongation in children wearing HAL spectacle lenses was consistently lower than in those wearing single vision lenses, regardless of study design or geographic location.11

Real-world evidence presented at ARVO 2026 and subsequently published in Ophthalmology Science (Figure 2) reported reductions in myopia progression in clinical practice, with HAL spectacle lenses incorporating highly aspherical lenslet target (HALT)* technology associated with the greatest reduction in axial length among the spectacle lens designs evaluated.12,13

Together, these findings highlight the robust body of evidence supporting HAL spectacle lenses across both controlled clinical studies and routine clinical practice.

Figure 2. ARVO 2026 poster evaluating published evidence across 26 studies on HAL spectacle lenses, prepared by Professor Mark Bullimore (USA) and Olga Prenat (EssilorLuxottica).

EARLIER INTERVENTION: PRE-MYOPIA MANAGEMENT

Research investigating plano HAL spectacle lenses has demonstrated reductions in axial elongation among children identified as being at risk of developing myopia compared with single vision lenses.14-16 These findings suggest that optical interventions may have a role before the onset of myopia.

A large school-based study in Shanghai, presented at ARVO 2026, demonstrated that integrated interventions, including HAL lens wear and increased outdoor time, may help reduce incident myopia and slow axial elongation in myopic and pre-myopic children.17 Notably, among children wearing HAL spectacle lenses for at least 12 hours per day, axial elongation was reduced by 90% in pre-myopic children and 75% in myopic children compared with the control group.17

Delaying myopia onset may be particularly important, as modelling studies suggest that delaying onset by just one year could provide benefits equivalent to 2–3 years of myopia management intervention after onset.18

PERSONALISING CARE THROUGH COMBINATION APPROACHES

Combination therapy has emerged as an area of increasing interest in myopia management, particularly for children who continue to progress despite monotherapy.

Several studies have evaluated HAL spectacle lenses in combination with low-dose atropine, with findings suggesting additional benefits compared with atropine monotherapy in selected patients.19-22

An independent study reported that combining HAL spectacle lenses with low-dose atropine (0.01–0.025%), in children who continued to progress despite atropine monotherapy, provided greater myopia progression control over 24 months compared with atropine alone.23

These findings suggest that combining optical and pharmacological interventions may provide an additional management option for selected children at risk of continued myopia progression.

DIVERSE PATIENT POPULATIONS

Researchers are increasingly investigating outcomes in patient populations traditionally underrepresented in myopia management studies.

Emerging evidence has demonstrated favourable outcomes in children with anisometropia, intermittent exotropia, and myopia of prematurity, including slowing of myopia progression and preservation of binocular visual function.24-26 These findings have been encouraging and suggest that evidence-based myopia management may have a role across a broader range of clinical scenarios.

PRESERVING VISUAL PERFORMANCE

Studies evaluating HAL spectacle lenses have consistently shown that distance and near visual acuity, accommodation, stereoacuity, and binocular vision remain comparable to single-vision lens wear.25,27,28 Children have also demonstrated fast adaptation to wearing HAL spectacle lenses, with all children adapting within one week of lens wear.28

Importantly, there is currently no evidence of rebound in myopia progression following cessation of treatment with HAL spectacle lenses.29 Analyses have shown that after the first and second year, the eye growth of 90% of children wearing HAL spectacle lenses full time was similar or slower than non-myopic children.30

Together, these findings support long-term wear of HAL spectacle lenses for myopia management.

CLINICAL EVIDENCE

Essilor Stellest 2.0 lenses (Figure 3) are powered by HALT Max technology, which incorporates aspherical lenslets with increased mean power and asphericity compared with Essilor Stellest lenses.31

Clinical evidence supporting HALT Max technology was generated through a

Figure 3. Essilor Stellest 2.0 lenses with HALT Max technology.

12-month prospective, randomised, double-masked contralateral crossover clinical trial involving 50 myopic children in Singapore.31 By allowing each participant to wear Essilor Stellest 2.0 lenses in one eye and Essilor Stellest lenses in the fellow eye, investigators were able to directly compare the two lens designs under identical real-world conditions.

The study found that eye growth was 1.88 times slower in eyes wearing Essilor Stellest 2.0 lenses compared with eyes wearing Essilor Stellest lenses.§31 A dose-response relationship was observed, with increased lenslet power and asphericity associated with greater slowing of axial elongation.31

These findings provide clinical evidence supporting HALT Max technology and demonstrate how refinements in spectacle lens design continue to be evaluated through clinical research.31

CONCLUSION

The evidence supporting myopia management now extends beyond efficacy alone, encompassing long-term follow-up, real-world evidence, emerging patient populations, and refinements in lens technologies. Together, these findings provide clinicians with insight into how interventions perform across different patient populations, clinical settings and stages of care, supporting evidence-based decisions for children at risk of myopia.

As research continues to evolve, evidence generated from randomised clinical trials, long-term follow-up investigations, and routine clinical practice will continue to expand understanding of myopia management and support improved outcomes for children and adolescents.

This article was sponsored by EssilorLuxottica.

Sephora Miao is an optometrist and the Head of Medical and Professional Affairs for EssilorLuxottica ANZ. A graduate of UNSW with a Bachelor of Optometry (Honours), Ms Miao has contributed across industry committees, including Early Career Optometrists NSW/ACT and university advisory boards. Her research interests include myopia and posterior ocular pathology. With extensive experience across the eye care industry, Ms Miao is committed to elevating patient care standards and driving innovation in eye care across ANZ.

Notes and references available at mivision.com.au.