Comparable myopia control efficacy of highly aspherical lenslets and diffusion optics technology spectacle lenses: a one-year real-world cohort study

PURPOSE: To compare the real-world efficacy of Highly Aspherical Lenslets (HAL) spectacles, Diffusion Optics Technology (DOT) spectacles, and single vision lenses (SVL) for controlling myopia progression in children and adolescents. METHODS: A total of 159 participants aged 6 to 13 years were enrolled from the Ophthalmology Clinic of Nanjing Children's Hospital between April 2024 and September 2025, comprising 53 subjects each in the HAL, DOT, and SVL groups. Participants were further stratified into a younger subgroup (6 to < 10 years) and an older subgroup (10 to13 years). One-way analysis of variance was used to compare changes in spherical equivalent (SE) and axial length(AL) after one year. RESULTS: Both HAL and DOT groups were associated with significantly slower progression in SE and AL than the SVL group (all P < 0.001), with no statistically significant differences between the two treatment groups (P = 0.35 for SE; P = 0.22 for AL). In both age subgroups, axial elongation was similar between HAL and DOT (P = 0.52 and P = 0.15), and both were significantly slower than SVL in the older subgroup (both P < 0.001). In the younger subgroup, HAL also slowed axial elongation significantly compared with SVL (P = 0.003), whereas the difference between DOT and SVL did not reach statistical significance after Bonferroni correction (P = 0.02), although the observed absolute difference of 0.11 mm per year may still be clinically meaningful. Pearson correlation analysis showed that only age was significantly correlated with AL elongation in both the HAL (r= - 0.35, P = 0.024) and DOT groups (r= - 0.48, P = 0.001). CONCLUSION: In this real-world cohort, both HAL and DOT lenses were linked to slower myopia progression, with similar progression rates between HAL and DOT. However, the efficacy of DOT in younger children (aged 6 to < 10 years) requires further investigation with larger sample sizes.