Oculomotor Profiles in Children Wearing Different Myopia Control Lenses: A Real-World Eye Tracking Study

To compare oculomotor profiles among children wearing orthokeratology, defocus spectacle, and diffusion optics technology lenses in a routine pediatric myopia management setting. This real-world observational study included children who had worn one of the three lens types for approximately one year and had available eye tracking data. Lens type was selected during routine clinical care rather than assigned by the investigators. Oculomotor parameters were compared among lens groups using Kruskal-Wallis tests with false discovery rate correction. One-year spherical equivalent change was examined only in the defocus spectacle and diffusion optics technology groups. Adjusted and exploratory analyses included age, sex, baseline spherical equivalent, baseline axial length, axial elongation, and parental education categories. A total of 134 children were analyzed, including 46 in the orthokeratology group, 49 in the defocus spectacle group, and 39 in the diffusion optics technology group. Significant group differences were observed for microsaccade frequency (FDR adjusted p = 0.00099), peak velocity (FDR adjusted p = 0.00099), latency (FDR adjusted p = 0.00395), fixation disparity (FDR adjusted p = 0.00395), and conjugacy (FDR adjusted p = 0.0274). Saccade frequency and saccade amplitude did not differ significantly. One-year spherical equivalent change did not differ significantly between the defocus spectacle group and the diffusion optics technology group (-0.27 ± 0.43 D vs. -0.34 ± 0.36 D, p = 0.312). No statistically significant correlation was observed between spherical equivalent change and microsaccade frequency in the two spectacle lens groups (Spearman r = -0.231, p = 0.069). Parental education categories showed no consistent association with oculomotor parameters after correction for multiple comparisons. Children wearing different myopia control lenses showed selective differences in oculomotor profiles. Refractive change in the two spectacle lens groups was similar, and the observed oculomotor differences should not be interpreted as direct indicators of myopia control efficacy. Eye tracking may provide complementary information about visual behavior and lens adaptation, but prospective studies with age-balanced designs and longitudinal refractive and axial length outcomes are needed.