Comparison of effectiveness of four myopia control interventions in Chinese children: a real-world retrospective study

BACKGROUND: Myopia is a global public health issue, necessitating effective control strategies. Defocus incorporated multiple segments (DIMS) and highly aspherical lenslet (HAL) spectacle lenses, as well as their combination with low-concentration atropine (0.01%), have been shown to control myopia effectively. However, direct comparisons among these regimens, DIMS, HAL, DIMSA (DIMS + atropine), and HALA (HAL + atropine), are lacking. In this real-world study, we compared their effectiveness in slowing myopia progression. METHODS: This single-center retrospective cohort study included 347 children (694 eyes) aged 6-14 years who received one of the four interventions for at least 1 year. The primary outcome was the annual change in axial length (AL). The secondary outcome was the annual change in spherical equivalent refraction (SER). The treatment response was categorized as good, fair, or poor. Linear mixed models and generalized estimating equations were used for analysis, adjusting for covariates. RESULTS: After adjustment, annual axial elongation differed significantly among the groups (P < 0.001), with marginal means of 0.23 mm (DIMS), 0.15 mm (HAL), 0.20 mm (DIMSA), and 0.12 mm (HALA). Post hoc comparisons revealed that both HAL and HALA were superior to DIMS (P < 0.001) and that HALA was superior to DIMSA (P = 0.022). Adding 0.01% atropine to either optical monotherapy did not provide a significant additional benefit in terms of mean AL or SER outcomes. Compared with DIMS, HALA significantly increased the odds of a good response for AL (OR = 4.34, P < 0.001) and SER (OR = 5.85, P < 0.001), whereas this effect was not observed with DIMSA. Older age independently predicted better response (AL: OR = 1.46/year; SER: OR = 1.26/year; both P < 0.001). CONCLUSIONS: In this non-randomized real-world comparison, HAL monotherapy was associated with slower SER progression, compared with DIMS. Although adding atropine did not improve mean outcomes, HALA showed the highest likelihood of a good response, suggesting a clinically meaningful benefit in response distribution. Although HALA did not consistently outperform HAL monotherapy across analyses, its advantage in achieving favourable individual responses supports its consideration for children requiring maximal intervention. These findings require confirmation in prospective randomized trials.