Efficacy of multifocal spectacles for myopia control in pre-myopic children: a multicenter real-world study

Purpose : To evaluate the efficacy of multifocal (MF) spectacles compared with single-vision (SV) spectacle lenses in controlling myopia progression and delaying myopia onset among Chinese children with pre-myopia (spherical equivalent [SE] ≤ +0.75 D and > –0.50 D). Methods : A multicenter retrospective case-control study was conducted, with baseline characteristics balanced using propensity score matching (PSM). Results : A total of 1,501 participants were included in the analysis, comprising 835 in the MF group and 666 in the SV group. After 12 months, MF spectacles significantly slowed SE progression (difference: –0.35 ± 0.63 D; P < 0.001) and axial length (AL) elongation (difference: 0.23 ± 0.27 mm; P < 0.001) compared with the SV group. The proportion of children with rapid myopia progression was significantly lower in the MF group (SE progression > 0.50 D: 20.8% vs. 45.1%, χ ² = 78.15, P < 0.001; AL elongation > 0.2 mm: 34.2% vs. 73.5%, χ ² = 165.9, P < 0.001). Kaplan–Meier analysis showed a significantly lower 1-year cumulative incidence of myopia in the MF group than in the SV group (42.6% vs. 65.6%; log-rank P < 0.001). Conclusion : This large-scale, multicenter study demonstrated that MF spectacles effectively slow SE progression and AL elongation and delay myopia onset in pre-myopic children. Despite the inherent limitations of retrospective designs relative to randomized controlled trials, the findings provide strong real-world evidence supporting the potential of MF spectacles as an effective, non-pharmacologic intervention for preemptive myopia control.