Slowing of myopia progression by spectacles with highly aspherical lenslets-A narrative review.

Abstract

Purpose: A new generation of myopia control spectacles has emerged, including spectacle lenses with highly aspherical lenslet technology (HAL lenses). To date, HAL lenses have only been thoroughly evaluated in a single site randomized clinical trial in China and a recently published, multicenter, North American clinical trial. The goal of this review is to explore and summarize additional studies of HAL lenses.

Methods: A search of both PubMed and Scopus was conducted in December 2025 using the terms: (myopi*) AND (child* OR adolescen*) AND (aspherical lenslets OR Stellest OR high aspherical lenticule). All abstracts were reviewed and, when appropriate and available, full papers were evaluated. Data extracted included study duration, mean age, mean myopia progression, and mean axial elongation.

Results: Among the 78 papers identified that discuss HAL lenses, many reported vision or choroidal changes, or were review articles. Overall, 26 independent studies reported myopia progression, axial elongation, or both for children wearing HAL lenses for at least 6 months, of which 17 were conducted in China. Collectively, the 26 papers report data on 4079 children wearing HAL lenses and all but two report axial length data. There were four randomized clinical trials, six prospective studies, and 16 retrospective studies. Eleven studies included a single vision comparison group, eight compared HAL lens wearers to children wearing other myopia control spectacles, 10 compared HAL lenses to overnight orthokeratology, and five studies reported on HAL lenses used in combination with atropine. All mean axial elongations values for children wearing HAL lenses were below those for untreated children. Among studies with a single vision comparison group (mean age 10.2 years), median 1-year axial elongation for HAL wearers was 0.12 mm compared with 0.32 mm in the single vision group. Among studies comparing HAL lenses to overnight orthokeratology, six showed slower axial elongation for HAL lenses in at least one subgroup. Atropine increased the effectiveness of HAL lenses and vice versa.

Conclusion: Regardless of study design and location, evidence suggests that axial elongation in children wearing HAL lenses is lower than those wearing single vision lenses.