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The global increase in childhood myopia underscores the need for effective control strategies. This study evaluated the effectiveness of Defocus Incorporated Multiple Segments (DIMS) spectacle lenses versus 0.01% atropine eye drops in slowing myopia progression in European children over two years. A total of 110 Polish and Ukrainian children aged 6-16 years without significant ocular pathology were randomised to single-vision spectacles plus nightly 0.01% atropine (group A) or DIMS lenses plus nightly placebo (group B). Primary outcomes were changes in cycloplegic spherical equivalent refraction (SER) and axial length, assessed at 6-month intervals. At 24 months, mean axial elongation was lower in group B (0.22 ± 0.22 mm) than in group A (0.32 ± 0.29 mm), particularly among children aged 6-11 years (0.30 ± 0.23 mm vs 0.48 ± 0.31 mm). Similar patterns were observed for SER progression: 0.47 ± 0.47 D in group B versus 0.70 ± 0.58 D in group A, with the greatest difference in younger children (0.59 ± 0.48 D vs 1.05 ± 0.64 D). Differences in older children were smaller. In this study, DIMS lenses were associated with greater efficacy than 0.01% atropine in reducing myopia progression, particularly in children aged 6-11 years. Differences in adherence between the interventions should be considered when interpreting these findings. DIMS lenses may represent an effective option for myopia control in European populations.

The aim of this study was to determine whether routinely recorded baseline clinical factors, alone or combined with machine-learning predictive modeling, can provide individual risk stratification for myopia control by identifying children who will progress more than 0.25 diopters (D) during their first year of low-dose atropine treatment. From a 555-child source cohort treated initially with atropine 0.01% or 0.02%, 468 children had qualifying 9- to 15-month follow-up; 427 children started atropine monotherapy without a baseline optical adjunct. A child was classified as poorly responsive if either treated eye progressed more than 0.25 D of spherical equivalent refraction from baseline to the qualifying visit. This threshold was a practical clinical refraction boundary and was tested in sensitivity analyses using a 0.50-D threshold, annualized progression, and an annualized >0.50 D/year threshold. A prevalence reference, age-plus-refraction logistic regression, elastic-net regression, gradient boosting, and an exploratory multilayer-perceptron neural network were compared by repeated cross-validation. Of 427 children, 159 (37%) were poorly responsive. Discrimination was poor and machine learning provided no improvement: the area under the curve (AUC) was 0.60 for logistic regression and 0.57 for gradient boosting [difference -0.03; 95% confidence interval (CI) -0.06 to 0.01]. Age alone performed similarly (AUC 0.60). No threshold was clinically useful; a high-sensitivity rule flagged 85% of children to identify 88% of poor responders, with positive predictive value 0.39. Routinely recorded baseline factors did not provide clinically useful individual-level prediction of the first-year progression category. With this predictor set, observing early on-treatment progression remains the practical way to identify children who may need escalation.

To characterise the age-continuous distribution of anisometropia in a large school-based cohort, derive age-specific centile curves and determine whether age-related increases in anisometropia reflect a generalised distributional shift or selective divergence in the upper tail. This school-based cross-sectional study included 389 056 children aged 6-18 years from five prefectures of Xinjiang, China, examined from March to June 2025 after prespecified exclusions. Spherical-equivalent anisometropia (Aniso_SE) was the absolute interocular difference in spherical equivalent; clinically significant anisometropia was defined as Aniso_SE≥1.00 dioptre (D). Age-specific prevalence was modelled using restricted cubic splines; centile curves were generated by quantile regression; and school-level clustering was accounted for using mixed-effects models. Mean age was 11.79 years and 50.2% were male. Mean Aniso_SE was 0.44 D and 42 917 participants (11.03%) had clinically significant anisometropia. Prevalence increased non-linearly with age, peaking at approximately 17%-19% around age 16 years. The median remained stable at about 0.25 D, whereas the 90th percentile exceeded 1.00 D by age 12 years and reached 1.4 D by age 16 years. Age and myopia severity were independently associated with clinically significant anisometropia. Age-related worsening of anisometropia was driven by selective upper-tail divergence rather than a generalised distributional shift. Age-continuous centile curves may help identify children requiring closer monitoring in school-based myopia control programmes.

Low-dose atropine eye drops slow childhood myopia progression, but randomized evidence in European children and for intermediate concentrations remains limited. This study evaluated 0.02% and 0.04% atropine for 12-month myopia control in Czech children. The MARS study was an investigator-initiated, phase IIIb, multicenter, randomized, double-masked, placebo-controlled trial. Children aged 6-11 years with documented accelerated prerandomization axial length (AL) elongation and cycloplegic spherical equivalent refraction (SER) from -0.50 to -4.75 D were randomized 2:1:1 to nightly 0.02% atropine, 0.04% atropine, or placebo. The primary endpoint was the between-group difference in AL change at Month 12 for 0.02% atropine versus placebo. Linear mixed-effects models accounted for inter-eye correlation. Repeated-measures and multiple-imputation sensitivity analyses assessed the effect of missing data. A total of 191 participants (351 eyes) were included in the primary analysis. Compared with placebo, adjusted mean between-group differences in AL change were -0.144 mm for 0.02% atropine (95% confidence interval [CI] -0.201 to -0.087; P < 0.0001) and -0.157 mm for 0.04% atropine (95% CI -0.222 to -0.092; P < 0.0001). Corresponding differences in SER progression were 0.352 D (95% CI 0.199 to 0.505; P < 0.0001) and 0.389 D (95% CI 0.214 to 0.564; P < 0.0001). No statistically significant difference was detected between 0.02 and 0.04% atropine for AL (0.013 mm; 95% CI -0.043 to 0.069; P = 0.8935) or SER (-0.037 D; 95% CI -0.189 to 0.115; P = 0.8802). Sensitivity analyses yielded consistent AL estimates. Nightly 0.02% and 0.04% atropine reduced axial elongation and myopia progression over 12 months compared with placebo. The trial was not designed or powered to establish equivalence between the active doses; within this sample, no statistically significant difference was detected between them. European Clinical Trials Database (EudraCT no. 2020-002046-16), Clinical Trials Information System (CTIS), EU Clinical Trial (EU CT) no. 2024-515888-54-00. Myopia (nearsightedness) often worsens as a child’s eye grows longer, increasing the risk of eye disease later in life. Atropine eye drops can slow this progression, but evidence in European children and for intermediate doses is limited. In the MARS trial, Czech children aged 6–11 years were randomly assigned to use 0.02% atropine, 0.04% atropine, or inactive placebo drops every night. Neither families nor investigators knew the assignment. After 12 months, both atropine groups had less eye growth and less worsening of myopia than the placebo group. Analyses that accounted for missing measurements gave similar results. The study did not detect a statistically significant difference between the two atropine doses, but it was not designed to prove that the doses are equivalent. Corneal measurements did not explain the treatment effect; the difference was driven by slower eye growth. Detailed pupil, accommodation, visual-comfort, and adverse-event outcomes are reported or planned separately. These findings support both 0.02% and 0.04% atropine as effective options for slowing myopia progression in the studied population, while longer follow-up is needed to assess durability, tolerability, and rebound after treatment stops.

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.

Defocus Incorporated Multiple Segments (DIMS) lenses slow myopia progression, but some children continue to experience rapid axial elongation despite treatment. This study evaluated whether adjunctive 0.05% atropine was associated with additional myopia control in children with an insufficient response to DIMS monotherapy. This retrospective matched cohort study included 54 children with rapid myopia progression during initial DIMS lens wear. We matched 27 children receiving adjunctive 0.05% atropine with 27 children who continued DIMS monotherapy by age, sex, axial length, and spherical equivalent refraction (SER). A pre-intervention observation period of approximately 6 months was used to identify children with rapid axial elongation during initial DIMS monotherapy, followed by an approximately 12-month intervention period to compare progression outcomes between groups. Statistical analyses included t tests, chi-square tests, analysis of covariance, and multivariable linear regression. Baseline characteristics were comparable between groups. During the pre-intervention phase, the time-normalized axial elongation rate was similar between the monotherapy and combination groups (0.47 ± 0.03 vs. 0.54 ± 0.03 mm/year, P = 0.170), whereas the combination group showed greater myopic SER progression than the monotherapy group (- 0.98 ± 0.10 vs. - 0.61 ± 0.11 D/year, P = 0.016). During the intervention phase, after adjustment for the corresponding pre-intervention progression rate, the adjusted axial elongation rate was lower in the combination group than in the monotherapy group (0.12 ± 0.04 vs. 0.31 ± 0.04 mm/year, P = 0.001), as was SER progression (- 0.19 ± 0.08 vs. - 0.55 ± 0.08 D/year, P = 0.001). In children with rapid myopia progression during DIMS lens treatment, adjunctive 0.05% atropine was associated with a lower axial elongation rate and slower SER progression than continued DIMS monotherapy. These findings support further prospective evaluation of this treatment strategy.

Myopia has become an increasingly serious global issue. Preventing myopia and avoiding the risks of high myopia has become an important concern for children, adolescents and their parents. Dual-mechanism myopia control lenses (DMMCL) is a specialized design spectacle lens based on peripheral defocus theory and retinal contrast theory. Although the benefits of peripheral defocus lenses and retinal contrast-designed lenses (RCDL) in myopia prevention have been confirmed, whether the lenses integrating both two designs can effectively prevent further progression of myopia still requires further research. To report the protocol of a clinical trial designed to evaluate the efficacy and safety of DMMCL vs. RCDL alone for slowing the progression of myopia among school-age children in China. The primary objective of this study is to evaluate whether DMMCL are equivalent to RCDL in controlling myopia progression. This is a prospective, single-center, non-randomized, equivalence trial designed to compare the efficacy and safety of DMMCL vs. RCDL for controlling myopia progression in children aged 6-12 years over a 12-month period. The primary outcome is change in axial length (AL) from baseline to 12 months. We hypothesize that the two treatments are equivalent within a prespecified margin of ±0.15 mm. This study will enroll 120 myopic children, aged 6-12 years, with cycloplegic spherical equivalent (SE) ranging from -0.50 D to -6.00 D in both eyes. Eligible participants will be assigned to the DMMCL group (n = 60) or the RCDL group (n = 60) according to their own preferences, or those of their guardians. Participants will be advised to wear their assigned spectacles full-time throughout the trial. All participants will be advised to engage in at least 2 h outdoors per day and will be scheduled for regular follow-up visits. AL, cycloplegic SE, and binocular visual function will be assessed at baseline and throughout the 12-month study period. Both groups will complete questionnaires on adaptation and visual quality one week and one month after wearing the lenses. Participants from both groups will require a follow up visit every 3 months. The primary endpoint is the 12-month change from baseline in AL. Secondary outcomes include changes in cycloplegic SE and binocular vision. Adaption and vision quality questionnaire results are pre-specified outcomes. Primary outcomes: Twelve-month changes in AL Secondary outcomes: Twelve-month changes in SE from baseline and binocular visual function parameters. Other pre-specified outcomes Adaption and vision quality questionnaire results. The future findings of this trial are expected to provide valuable reference for optimizing myopia management strategies and may contribute to the evidence base that informs pediatric eye care policy.Trial Registration: https://www.chictr.org.cn/, https://www.chictr.org.cn/showproj.html?proj=301629, identifier ChiCTR2600116438.

To identify predictive factors of myopia progression in children wearing highly aspherical lenslets (HAL) and defocus incorporated multiple segment (DIMS) spectacles. The 3-year longitudinal, retrospective real-world study included progressive children (≤ -0.5 dioptre (D)/year), aged 4-14 years collected from the French Myopia Cohort, between 2020 and 2025 who were prescribed myopia control spectacles (MCS). Myopia progression (spherical equivalent, D/year) was assessed at 12±3, 24±3 and 36±3 months after treatment initiation. A latent class growth model, adjusted for age, identified potential poor responders to MCS. Model performance was evaluated using Akaike information criterion, entropy and posterior class-membership probabilities. Logistic regression was then used to determine factors associated with persistent progression under MCS, including treatment group, renewal rate, baseline age, spherical equivalent, J0 and J45, sex and initial progression. A total of 723 children (mean age 8.9 ± 2.4 years) were included, with no baseline differences between the DIMS and the HAL groups. Latent class growth modelling identified three distinct progression profiles: stable, moderate myopia progression and progressive myopia, with slopes of -0.05, -0.31 and -0.58 D/year, respectively. Fast initial progression strongly predicted progressive myopia class, while neither treatment type influenced class allocation. Progression risk under treatment was statistically independent of age, sex and baseline myopia. Our study is limited as it examines only two types of myopia control treatments and lacks data on environmental factors. Myopic children treated with DIMS or HAL showed three distinct progression trajectories, with a small group of progressors continuing to progress at a clinically meaningful rate.

Myopia is a public health concern, and its prevalence is estimated to increase in the near future. Multiple myopia control strategies have been developed to slow myopia progression and reduce potential ocular alterations. Public interest in myopia and its management has increased, with parents seeking information on myopia from available sources, such as the internet. The goal of this study was to systematically evaluate the quality, reliability, and educational value of YouTube videos for myopia control in children and their alignment with current scientific evidence and clinical guidelines. A comprehensive search was conducted on YouTube in February 2025 using four primary keywords related to myopia control in children, both in English and Spanish. The first 50 videos for each keyword were screened; of the resulting 400 videos, 235 met the inclusion criteria. Three optometrists independently assessed the videos via the modified DISCERN (mDISCERN), the Journal of the American Medical Association (JAMA) benchmarks, and the Global Quality Score (GQS). Interobserver reliability was evaluated using two-way mixed-effects intraclass correlation coefficients (ICC) with absolute agreement. Quantitative engagement metrics (views, likes, dislikes, the view ratio, and the video power index (VPI) were also recorded. Non-parametric tests were used for subgroup comparisons by language, topic, source, and presenter gender, with Bonferroni adjustments applied for multiple comparisons. Among the 235 videos analysed, 52.8% were in English, and 47.2% were in Spanish. Overall video quality and reliability were highly variable. Interobserver reliability across the entire dataset was good for GQS (ICC = 0.832) and mDISCERN (ICC = 0.750), but poor for JAMA (ICC = 0.447). Good interevaluator agreement was maintained across all tools for Spanish videos (ICC range: 0.701-0.803), whereas English videos showed lower agreement for mDISCERN (ICC = 0.768) and JAMA (ICC = 0.536), but excellent agreement for GQS (ICC = 0.849). Spanish-language videos scored significantly higher on mDISCERN (P = 0.026), while JAMA and GQS scores showed no significant differences between languages after adjusting for multiple comparisons. Videos from universities or professional organisations were of higher quality and reliability but constituted a minority of the sample. The presenter's gender did not impact quality or engagement. English-language videos had higher view ratios and VPI values, indicating greater visibility, although not necessarily higher scientific quality. YouTube provides a wide range of content on pediatric myopia control, but its overall quality, realiability and scientific alignment are inconsistent. The use of standardized evaluation tools reveals significant differences in subjective assessment depending on the scoring instrument and video language. The increased participation of healthcare professionals in creating evidence-based videos is needed to increase public health literacy.