The Comparative Effectiveness of Four Myopia-Control Spectacle Lenses: A Real-World AIPW Cohort Study

Purpose: We aimed to compare the real-world effectiveness of four myopia-control spectacle lens interventions for childhood myopia control using a doubly robust causal inference framework. Design: This was a retrospective cohort study with multi-treatment augmented inverse probability weighting. Participants: A total of 2764 myopic children (right eyes) aged 3-18 years were included, screened from 13,071 electronic medical records at Ineye Hospital, Chengdu University of Traditional Chinese Medicine, between January 2023 and January 2026. Methods: Participants were allocated to four myopia-control spectacle lens groups and one single-vision spectacle lens group: Higher-Order Aberration Defocus (n = 912), Defocus Incorporated Multiple Segments (n = 800), Highly Aspherical Lenslets (n = 476), Diversified Segmental Defocus Optimization (n = 238), and single-vision lenses (n = 338). A doubly robust estimator combining multinomial propensity-score weighting with outcome regression was applied to adjust for confounding. Outcome Measures: The primary outcomes were one-year changes in axial length and spherical equivalent. The secondary outcomes were the rates of rapid progression. Treatment-effect heterogeneity was explored across prespecified baseline age, refractive error, and axial length subgroups. Results: After adjustment, all four myopia-control designs significantly outperformed single-vision correction (p < 0.05). The design based on Higher-Order Aberration Defocus demonstrated the greatest efficacy, with an axial length change of 0.107 mm and a spherical equivalent change of -0.146 D. Within this group, 25.5% of children exhibited rapid axial elongation (≥0.36 mm/year) and 8.3% exhibited rapid myopic progression (≥-0.50 D/year). The treatment effect was statistically significant in children with low myopia or an axial length no greater than 26 mm (p < 0.05), but not in those with high myopia or pathological axial elongation. Conclusions: All four myopia-control spectacle lens designs demonstrated significant advantages over single-vision correction in real-world clinical practice. Particular emphasis should be placed on the role of myopia-control spectacles during the early stages of myopia. As myopia progresses to high myopia or pathological axial elongation, the efficacy of myopia-control spectacle lenses as a standalone intervention diminishes, and combined approaches incorporating multiple myopia management strategies may be warranted.