EARLY OPTICAL INTERVENTION WITH LOW-POWER PLUS LENSES TO DELAY MYOPIA ONSET IN AT-RISK CHILDREN

Abstract

Background: Childhood myopia is increasing in prevalence worldwide, and earlier age of onset is strongly associated with higher levels of myopia and greater lifetime risk of sight-threatening complications. Children identified as “pre-myopic” non-myopic but with reduced hyperopic reserve, longer axial length, and a positive parental history of myopia represent a target population in whom prophylactic optical intervention, rather than progression control after onset, may yield the greatest benefit. Objective: To determine whether spectacle lenses incorporating low-power (+0.5-+0.75 D add equivalent) peripheral/annular plus-power optical treatment zones delay the onset of myopia, relative to standard single-vision spectacle lenses, in pre-myopic children identified as being at elevated risk of developing myopia. Methodology: A total of 444 participants were required for this Prospective, multicenter, double-masked, parallel-group randomized controlled trial with 24-month follow-up. School- and clinic-based recruitment across three optometric centers. Pre-myopic children aged 6–10 years (cycloplegic spherical equivalent refraction [SER] between +0.75 D and −0.50 D in the least hyperopic eye) with at least one additional risk factor for myopia onset (parental myopia, elevated axial length-to-corneal radius ratio, or low hyperopic reserve for age, stratified using a validated risk-scoring framework. Randomization (1:1) to (i) low-power annular/peripheral plus-power treatment-zone spectacle lenses or (ii) standard single-vision spectacle lenses, both worn full-time for 24 months. Primary outcome was cumulative incidence of myopia onset (cycloplegic SER ≤ −0.50 D in either eye) at 24 months. Secondary outcomes Rate of axial elongation, change in SER, change in AL/CR ratio, treatment adherence, and adverse visual symptoms. Results: The study anticipate a lower cumulative incidence of myopia onset in the low-power plus-lens group (approximately 29–32%) compared with the single-vision group (approximately 44–48%) at 24 months, corresponding to a relative risk reduction of approximately 30–35%, alongside significantly slower axial elongation in the intervention arm. Conclusion: Low-power plus-lens spectacles could provide a scalable, non-pharmacological strategy for primary prevention of myopia by delaying onset of myopia in high-risk children and complementing lifestyle-based approaches such as increased outdoor time.