Additive Effect of Highly Aspherical Lenslet Target Spectacles to Children Inadequately Controlled by Atropine Monotherapy.

PURPOSE: Myopia progression in children, especially in East Asia, is a significant public health concern. This study evaluated the efficacy of combining myopia control spectacle lenses with Highly Aspherical Lenslet Target (HALT) technology and atropine in children who continued to progress on low-dose atropine (LDA).

DESIGN

Prospective cohort.

SUBJECTS: Children aged 6-11 years with ≥0.5 diopters (D) myopia progression over 6 months on LDA (0.01% or 0.025%) were recruited.

METHODS

All participants used HALT (Essilor Stellest) spectacle lenses while maintaining their LDA dose. The changes in spherical equivalent (SE) and axial length (AL) were tracked for 6 months before and 6-12 months after starting combination treatment.

MAIN OUTCOME MEASURES: Progression of SE and AL.

RESULTS

Fifty children (mean age 8.9 ± 1.1 years) were separated into group A (on 0.01% atropine daily, n20) and group B (on 0.01% atropine twice daily, n5 and 0.025% atropine nightly, n25). Most (86%) were ethnic Chinese. The baseline SE and AL showed no significant intergroup differences, with prior myopia progression (0.60D/0.24 mm) over 6 months. After adding HALT lenses, progression slowed to -0.06D/0.06 mm at 6 months and -0.15D/0.14 mm at 12 months. A hyperopic shift in AL was seen in 11 children (24%). However, the progression of >0.5D was noted in 20%, with 18% and 40% progressing by >0.3 mm and >0.15 mm, respectively. Univariate analysis suggested that children who progressed >0.10 mm over 6 months were more likely to be younger, whereas multivariate analysis suggested that change in AL was associated with smaller pupil size (possibly from poor compliance or absorption of atropine) at 6 months and younger age at 12 months, after controlling for sex, race, and baseline SE and AL. There were no complaints of glare, near, or peripheral blur in children after starting combination treatment.

CONCLUSIONS

The addition of HALT spectacle lenses significantly reduced myopia progression in children, aged 6-11 years, who were poorly controlled on LDA alone demonstrating a potential synergistic effect with LDA. These findings supported combination therapy for managing challenging myopia cases.

FINANCIAL DISCLOSURES: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.