DSDO Lenses Reduce Axial Elongation More Than DIMS in Myopic Children

Mitigating Axial Elongation in the Pediatric Population

The global surge in pediatric myopia has established it as a significant public health priority, driven largely by environmental shifts such as increased near work and reduced outdoor activity [1, 2]. While traditional single-vision lenses provide refractive correction, they do not address the underlying axial elongation, which is the progressive lengthening of the eye from front to back, that increases the risk of sight-threatening complications in adulthood [3, 4]. Current management strategies include pharmacological agents like low-dose atropine and specialized optical designs such as Defocus Incorporated Multiple Segments (DIMS) lenses, which utilize peripheral myopic defocus, a technique that projects light in front of the peripheral retina to signal a slowing of eye growth [5, 6, 7]. Recent meta-analyses of 23 randomized controlled trials involving 13,315 subjects confirm that these specialized lenses significantly reduce axial length elongation by a mean of 0.15 mm (95% CI, -0.20 to -0.09; p < 0.00001) compared to single-vision controls [8, 9]. A multicenter randomized clinical trial evaluating 450 children now provides data on diversified segmental defocus optimization (DSDO) designs, showing a 1-year cumulative myopia incidence of 5.8% in the treatment group compared to 15.3% in the control group (p = 0.02) [10].

Comparative Efficacy in Myopic Cohorts

A prospective, multicenter, real-world investigation across eight Aier Eye Hospital Group centers in China enrolled 1,541 participants to evaluate the efficacy of Diversified Segmental Defocus Optimization (DSDO) lenses. To ensure a rigorous comparison between lens designs, the study utilized propensity score matching (a statistical method that balances baseline characteristics to minimize selection bias and mimic the conditions of a randomized trial). This process ensured that the treatment groups were well-balanced regarding age, sex, spherical equivalent (the calculated refractive power of the eye), and axial length (the physical measurement of the eye from the anterior surface of the cornea to the retina). Clinical assessments were performed at baseline, 6 months, and 12 months to track the progression of myopia over time. In the myopic cohort, which included 654 participants using DSDO lenses and 661 using Defocus Incorporated Multiple Segments (DIMS) lenses, the DSDO group demonstrated a statistically significant reduction in eye growth. At the 6-month follow-up, axial length elongation was 0.07 ± 0.12 mm in the DSDO group compared to 0.09 ± 0.10 mm in the DIMS group (P = 0.026). This trend continued through the 12-month mark, where axial length elongation reached 0.17 ± 0.18 mm with DSDO lenses versus 0.19 ± 0.16 mm with DIMS lenses (P = 0.019). These findings indicate that DSDO lenses provide a statistically significant advantage in slowing axial growth in myopic children over a one-year period, suggesting that the specific geometry of the DSDO design may offer superior control of the ocular growth signals compared to existing defocus technologies.

Suppression of Physiological Growth in Non-Myopic Eyes

The study also investigated the potential for Diversified Segmental Defocus Optimization (DSDO) lenses to modulate eye growth in children who had not yet developed myopia, a cohort consisting of 85 participants using DSDO lenses and 141 untreated controls. By monitoring these children over a one-year period, the researchers aimed to determine if optical intervention could suppress physiological axial elongation, which is the natural lengthening of the eye that often precedes the onset of refractive errors. At the 12-month follow-up, the data indicated a significant difference in growth rates between the two groups. Specifically, axial length growth was 0.18 ± 0.14 mm with DSDO lenses compared to 0.29 ± 0.14 mm in untreated controls (P = 0.01). This reduction suggests that the DSDO technology may exert a stabilizing effect on the eye even before a clinical diagnosis of myopia is confirmed, potentially shifting the clinical focus from treatment to primary prevention. Further analysis revealed that the intervention was particularly effective in the hyperopic/emmetropic subgroup, defined by a spherical equivalent between 0.00 and 1.50 diopters (D), where the suppression of axial growth was even more pronounced (P = 0.004). For clinicians, these findings highlight the potential for early intervention in children who are at risk for myopia but currently present with hyperopia (farsightedness) or emmetropia (normal vision). By slowing the physiological axial growth in these pre-myopic stages, DSDO lenses may offer a preventative strategy to delay or mitigate the progression toward myopia. The researchers noted that the most significant advantage of the lenses occurred during the first 6 months of use, suggesting that the timing of the intervention is a critical factor in managing pediatric eye development.

Predictors of Treatment Response and Clinical Timing

The temporal dynamics of the study indicate that the timing of intervention is a critical factor in achieving optimal myopia control, as the most pronounced treatment effect for DSDO lenses occurred within the first 6 months of use. This suggests that the initial period of exposure to the lens design is when the eye is most responsive to the optical defocus signals, emphasizing the need for prompt fitting once a child is identified as a candidate. Subgroup analysis within the myopic cohort further refined the target demographic, showing greater efficacy in children aged 10 years or younger (P = 0.022). This finding suggests that the younger pediatric population, who typically experience more rapid ocular growth, may derive the most significant benefit from early optical intervention. The baseline refractive state and physical dimensions of the eye also served as key indicators of treatment success. Analysis of the myopic cohort revealed greater efficacy in the low-myopia subgroup (P = 0.001), which highlights the clinical value of initiating treatment before high levels of myopia are reached. Furthermore, baseline axial length was a significant determinant of subsequent axial length changes in the myopic cohort. This relationship suggests that the initial physical state of the eye at the start of treatment can help clinicians anticipate the likely trajectory of axial elongation and tailor their management strategies accordingly. Statistical modeling identified that age and intervention type were independent predictors of axial length changes, confirming that both the patient's developmental stage and the specific lens technology used are primary drivers of the clinical outcome. Conversely, sex was not an independent predictor of axial length changes, indicating that the treatment effect is consistent across male and female patients. These findings emphasize the importance of early, individualized intervention, particularly for younger children with low baseline refractive errors, to maximize the suppression of axial elongation during the most responsive phases of ocular development.

References

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