Pupil Size Influences Efficacy of Peripheral Defocus Spectacle Lenses for Myopia

Research suggests it may be valuable to consider pupil area when selecting optical strategies for pediatric myopia management. While children with smaller pupils benefited equally from all three types of peripheral defocus spectacle lenses evaluated in this study, those with larger pupils experienced significantly less axial elongation and reduced SER progression with highly aspherical lenslets. Photo: Hoya; Essilor. Click image to enlarge. As the prevalence of myopia continues to rise among children worldwide, various interventions have been explored to mitigate its progression. Among these, peripheral defocus spectacle lenses have been used for years in several countries to control axial elongation and refractive error progression. The technology has recently made its way to the United States with the approval of the Essilor Stellest lens in September.Given the growing interest in this modality, understanding the clinical factors that may influence the efficacy of peripheral defocus lenses is essential. A recent study published in Translational Vision Science & Technology contributes to this understanding by suggesting that pupil area plays a role; specifically, it found that children with larger pupils may reap greater benefits from highly aspherical lenslets. Conversely, no significant differences were observed among the lens types in children with smaller pupils.The retrospective analysis included 310 myopic children aged between seven and 14 years recruited from a single hospital in China over three years. Each participant was assigned to wear one of three types of peripheral defocus spectacle lenses for at least 12 months:Type A (48.4%): defocus incorporated multiple segments (DIMS) designType B (26.5%): highly aspherical lenslets (HAL) designType C (25.2%): freeform optical design customized to each patient’s retinal profileTo assess the effectiveness of these lenses, researchers collected data on axial length and spherical equivalent refractive error (SER) at baseline, six months and 12 months. Participants were further categorized based on their pupil area, with those above the mean being classified as having larger pupils. The analysis revealed that children with larger pupils wearing HAL lenses experienced significantly less axial elongation, showing a difference of 0.17mm at the 12-month mark compared to those using other lens types. Additionally, these children exhibited a reduced progression of SER by 0.15D. Interestingly, for those with smaller pupils, no significant differences were noted among the various lens types, indicating that pupil size might influence the effectiveness of specific designs. In the discussion portion of their paper, the researchers proposed an explanation for these findings, stating that “larger pupils allow a greater proportion of peripheral light to reach the retina, thereby expanding the retinal area exposed to myopic defocus.” They continued, “This may strengthen inhibitory signals against axial elongation, consistent with the ocular growth homeostasis hypothesis and animal studies demonstrating region-specific responses to peripheral retinal defocus.” Conversely, the authors noted that smaller pupils may restrict peripheral retinal illumination, which could diminish the efficacy of defocus-based treatments.Prior research also reinforces the notion that pupil size may influence the effects of optical designs. For example, one study from 2025 “suggested that larger pupils expand the retinal area over which peripheral defocus is distributed, which could enhance the efficacy of certain lens designs.” Another study from last year indicated that “highly aspherical lenslets may be more effective in children with larger pupils,” although that investigation assessed combination therapy with atropine, while the current study focused solely on spectacle lens design.While multicenter studies are warranted to confirm these results, the authors conclude that their findings “suggest the potential clinical value of considering pupil area in the selection and design of personalized optical interventions, while recognizing that the effect was not consistent across all lens types.”Click here for the journal source. Zhu J, Yang Z, Xu J, et al. Pupil area may influence the efficacy of peripheral defocus spectacle lenses for myopia control in children: a retrospective study. Transl Vis Sci Technol. 2026;15(1):9. This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.