Comparison of spectacle lenses with highly aspherical lenslets versus orthokeratology for the management of axial length elongation

CLINICAL RELEVANCE: When selecting an intervention for myopia management, parental inquiries centre around the comparative efficacy of orthokeratology versus myopic defocus spectacle lenses. This prompts an intriguing investigation into the nuanced differences between these two treatment methods. BACKGROUND: This study aimed to compare the efficacy of spectacle lenses with highly aspherical lenslets (HAL) versus orthokeratology (Ortho-k) in controlling axial length elongation. METHODS: Electronic medical records of children aged 8 to 14 years who were prescribed either spectacle lenses with HAL or one of the four Ortho-k brands were reviewed. The standardised axial length changes within one year were compared between HAL lenses and Ortho-k lenses with analysis of variance and multivariable regression analysis, adjusting for age, gender, and baseline spherical equivalent. RESULTS: A total of 308 subjects were included in the analyses. The mean (standard error) of the standardised one-year changes in axial length was 0.12 ± 0.02 mm for HAL, 0.17 ± 0.02 mm for Dreamlite, 0.22 ± 0.02 mm for Alpha, 0.21 ± 0.02 mm for Lucid, and 0.18 ± 0.02 mm for Euclid user cohorts. After adjusting for covariates, the mean differences in axial length growth between HAL and both Alpha and Lucid cohorts were estimated at 0.11 mm (95% CI, 0.03 to 0.19 mm and 95% CI, 0.03 to 0.20 mm). The differences between HAL and Dreamlite or Euclid lenses were not statistically significant. Baseline spherical equivalent demonstrated a significant positive association with axial length growth in Lucid and Euclid lens users. CONCLUSIONS: Spectacle lenses with HAL design exhibited comparable or superior efficacy in mitigating axial length growth compared to conventional Ortho-k lenses. Furthermore, orthokeratology showed greater efficacy in controlling axial length elongation among individuals with greater baseline myopia.