The Comparative Effectiveness of Four Myopia-Control Spectacle Lenses: A Real-World AIPW Cohort Study

Purpose: We aimed to compare the real-world effectiveness of four myopia-control spectacle lens interventions for childhood myopia control using a doubly robust causal inference framework. Design: This was a retrospective cohort study with multi-treatment augmented inverse probability weighting. Participants: A total of 2764 myopic children (right eyes) aged 3–18 years were included, screened from 13,071 electronic medical records at Ineye Hospital, Chengdu University of Traditional Chinese Medicine, between January 2023 and January 2026. Methods: Participants were allocated to four myopia-control spectacle lens groups and one single-vision spectacle lens group: Higher-Order Aberration Defocus (n = 912), Defocus Incorporated Multiple Segments (n = 800), Highly Aspherical Lenslets (n = 476), Diversified Segmental Defocus Optimization (n = 238), and single-vision lenses (n = 338). A doubly robust estimator combining multinomial propensity-score weighting with outcome regression was applied to adjust for confounding. Outcome Measures: The primary outcomes were one-year changes in axial length and spherical equivalent. The secondary outcomes were the rates of rapid progression. Treatment-effect heterogeneity was explored across prespecified baseline age, refractive error, and axial length subgroups. Results: After adjustment, all four myopia-control designs significantly outperformed single-vision correction (p < 0.05). The design based on Higher-Order Aberration Defocus demonstrated the greatest efficacy, with an axial length change of 0.107 mm and a spherical equivalent change of −0.146 D. Within this group, 25.5% of children exhibited rapid axial elongation (≥0.36 mm/year) and 8.3% exhibited rapid myopic progression (≥−0.50 D/year). The treatment effect was statistically significant in children with low myopia or an axial length no greater than 26 mm (p < 0.05), but not in those with high myopia or pathological axial elongation. Conclusions: All four myopia-control spectacle lens designs demonstrated significant advantages over single-vision correction in real-world clinical practice. Particular emphasis should be placed on the role of myopia-control spectacles during the early stages of myopia. As myopia progresses to high myopia or pathological axial elongation, the efficacy of myopia-control spectacle lenses as a standalone intervention diminishes, and combined approaches incorporating multiple myopia management strategies may be warranted.