TOPIC
This systematic review and meta-analysis aimed to evaluate the 12-month effectiveness of defocus incorporated multiple segments (DIMS) spectacle lenses compared with single-vision (SV) lenses in slowing myopia progression in children.
CLINICAL RELEVANCE
DIMS spectacle lenses incorporate simultaneous myopic defocus to reduce axial elongation in children. Although randomized trials have demonstrated efficacy, comparative evidence remains limited. Evaluation of 12-month outcomes is clinically relevant to inform evidence-based myopia management and future research.
METHODS
A systematic review and meta-analysis were conducted following PRISMA guidelines. PubMed, Scopus, Embase, and Web of Science were searched to November 2025 for studies comparing DIMS vs SV lenses in children. Two reviewers independently screened studies, extracted data, and assessed quality. Random-effects models generated pooled mean differences (MD) for spherical equivalent refractive (SER) progression and axial elongation. We used I 2 to assess heterogeneity. Sensitivity analysis was conducted using the leave-one-out method to assess the effect of removing each study. Studies were included if they enrolled children with myopia and compared DIMS lenses with SV lenses.
RESULTS
Six studies involving 1224 children were included, and 80.1% of them were from China. The included studies were conducted in Asia and Europe and included pediatric participants with a mean aged around 10 years. Compared with SV lenses, DIMS lenses significantly slowed myopia progression over the first 12 months, showing less SER deterioration (MD = 0.37 D; P <.0001) and reduced axial elongation (MD =–0.16 mm; P <.0001). Heterogeneity ranged from moderate to high, but sensitivity analyses confirmed the stability of all pooled estimates.
Conclusion
DIMS lenses provide consistent slowing of myopia progression, reduce axial growth, and improve refractive outcomes during the first year in children. These findings demonstrate a benefit during the first 12 months; however, the durability of this effect beyond the first year remains uncertain, and the rate of change after year one is likely less. These findings apply specifically to DIMS lenses and should not be generalized to other defocus spectacle lens designs. Most children were from China, which may affect the generalization of these results.
Introduction
Myopia is a significant issue that affects an increasing number of individuals around the world, affecting approximately 30% of the world’s population and projected to rise to nearly 50% by 2050. ,, Axial length growth is the main factor responsible for myopia progression. It has been associated with a higher likelihood of vision-threatening complications. , Highly myopic eyes carry an elevated risk of developing sight-threatening complications such as retinal degeneration and glaucoma. , There is no doubt that the myopia epidemic imposes a substantial burden both on individuals and on public health. Myopia is now recognized as one of the pressing issues highlighted by the WHO’s Global Initiative for the Elimination of Avoidable Blindness.
Current interventions, including low-dose atropine, dual-focus contact lenses, and orthokeratology, have demonstrated potential in slowing myopia progression in school children. Spectacle lenses using defocus technology, which is specifically developed for myopia-control, have been introduced recently into clinical practice due to their convenience and comparatively low cost, including bifocal spectacle lenses, progressive addition lenses, and defocus incorporated multiple segments (DIMSs). , Spectacle lenses incorporating defocus-based optical designs specifically developed for myopia control have recently been introduced into clinical practice due to their convenience and comparatively low cost. These include bifocal spectacle lenses, progressive addition lenses, DIMSs, highly aspherical lenslet target (H.A.L.T.) designs, cylindrical annular refractive element–based designs (CARE), and extended depth-of-focus spectacle lenses. The present review focuses specifically on evaluating the effectiveness of DIMS lenses. DIMSs are dual-focus lens that features a central optical zone that corrects distance refractive error, along with an annular mid-peripheral zone composed of multiple segments that provide a relative positive power of +3.50 D. A double-masked randomized clinical trial showed a 52% reduction in myopia progression and a 62% decrease in axial elongation in children wearing DIMS lenses compared with those using SV lenses over 2 years.
To our knowledge, this systematic review and meta-analysis is the first to systematically pool existing studies on DIMS lenses vs SV lenses. By consolidating fragmented data into a unified analysis, it offers clearer evidence base for clinicians and policymakers. In essence, it provides a robust, consolidated resource that can guide more informed myopia management strategies.
METHODS
This systematic review and meta-analysis were undertaken in accordance with the PRISMA reporting framework.
SEARCH STRATEGY AND ELIGIBILITY CRITERIA
A comprehensive literature search was performed to locate studies comparing DIMS spectacles with single-vision (SV) lenses in pediatric myopia. We included both RCTs and observational cohort studies. Searches were carried out in PubMed, Scopus, Embase, and Web of Science from database inception to November 2025. To ensure broad coverage, we manually inspected the reference lists of all eligible papers.
We applied the following search string: ((“Myopia” OR “Nearsightedness” OR “short sight*” OR “short-sight*” OR “near sight* OR “near-sight*”) AND (“DIMS” OR “Defocus Incorporated Multiple Segment* OR “defocus spectacle*”)). Studies were considered for inclusion if they: (1) Enrolled children with myopia. (2) Compared DIMS lenses with SV lenses.
STUDY SCREENING AND DATA RETRIEVAL
Two reviewers independently evaluated all retrieved citations by title and abstract, followed by full-text assessment against the eligibility criteria. Any discrepancy was handled by discussion, and a third reviewer mediated unresolved disagreements. Data extraction was performed independently using a predesigned form. Extracted elements comprised: study design, participant count, age, proportion of females, country, baseline spherical equivalent refractive (SER), baseline axial length, and follow-up duration. The primary endpoints were 12-month SER progression and 12-month axial elongation. When necessary, medians and ranges/IQRs were transformed into means and standard deviations using the approach of Wan and colleagues. Change scores were standardized following Cochrane recommendations.
One study separated the results into patients under and patients above 10 years, so it was also analyzed separately and appeared as two studies in the meta-analysis.
ASSESSMENT OF STUDY QUALITY
The methodological rigor of randomized trials was examined using the ROB-2 tool, while observational studies were appraised with the Newcastle–Ottawa Scale (NOS). Each tool was applied according to guidance for its specific study design to ensure consistent and transparent evaluation of bias.
STATISTICAL APPROACH
Quantitative synthesis employed a random-effects model using R (version 4.1.2) and the metafor package. Because outcomes were continuous, pooled effects were expressed as mean differences (MD) with corresponding 95% confidence intervals. Statistical significance was defined as a two-tailed P -value below.05. Heterogeneity (which refers to the degree of variation in effect sizes between the included studies) was quantified using tau-squared and the I² statistic; an I² value above 50% denoted considerable heterogeneity. Robustness of the results was explored using sensitivity analyses, whereby individual studies were removed sequentially.
RESULTS
LITERATURE SEARCH RESULTS
The initial search across the databases produced 180 records from PubMed ( n = 60), Scopus ( n = 76), and WOS ( n = 44). After duplicates were removed, 124 records were left. Screening of titles and abstracts narrowed the list to 23 records. Following full-text evaluation, 6 records met the inclusion criteria and were added to the final analysis. The full selection process is presented in Figure 1 .
PRISMA flow chart of the included studies.
CHARACTERISTICS OF THE INCLUDED STUDIES
Our review included six studies, published between 2020 and 2025, involving a total of 1224 children with myopia. ,,,,, Three studies were conducted in China, while the remaining were conducted in Turkey, Italy, and Malaysia. Study designs consisted of three RCTs and three retrospective cohort studies. The mean age of participants showed some variation across studies, ranging from 8.75 to 11.5 years in the DIMS groups and 8.76 to 11.2 years in the SV groups. The percentage of female participants also differed, as rates ranged from 38% to 75% in the DIMS groups and 41.9% to 44.9% in the SV groups, with no uniform pattern in sex distribution across studies. Sample sizes varied widely, too. The number of children receiving DIMS lenses ranged from 20 to 489, while the comparator SV groups ranged from 18 to 156 participants. This variation reflects differences in study design, clinical setting, and recruitment scope. Overall, the included studies represented a diverse and clinically meaningful sample of pediatric patients with myopia, showing variability in age, sex distribution, sample size, and study methodology, which strengthens our review. Most included studies measured refraction using cycloplegic techniques, although one large real-world cohort did not clearly specify cycloplegia. Table 1 summarizes the characteristics of all included studies.
TABLE 1
Characteristics of the Included Studies
| Study | Country | Study Design | Number of Patients (DIMS/ SV) | Mean Age (DIMS/ SV) | % Female (DIMS/ SV) | Axial Length in mm (DIMS/ SV) | Spherical Equivalent (DIMS/ SV) | Aim | Conclusion |
|---|---|---|---|---|---|---|---|---|---|
| Akagun et al. (2025) | Turkey | Retrospe- ctive cohort study | 54/ 43 | 9.60/ 9.85 | 55.6%/ 41.9% | 24.4/ 24/5 | −2.8/ −2.8 | To evaluate the effectiveness of DIMS spectacle lenses in controlling myopia progression and axial elongation. | DIMS lenses led to substantially less spherical-equivalent progression and axial elongation than SV lenses. |
| Buzzonetti et al. (2024) | Italy | Retrospe- ctive cohort study | 40/40 | 11.5/ 11.2 | 24.3/ 24.4 | −2.9/ −2.7 | To evaluate how effective DIMS spectacle lenses are at slowing myopia progression in 6-16-y-old European children. | DIMS lenses slowed myopia progression vs SV lenses, with the strongest benefit in children older than 10 y. | |
| Chun et al. (2025) | China | Retrospe- ctive cohort study | 489/156 | 8.75/ 8.76 | 49.3%/ 44.9% | 24.6/ 24.2 | −3.03/ −2.36 | To use real-world clinic data to examine the effect of DIMS lenses on myopia progression and axial elongation. | DIMS lenses retarded axial elongation and reduced myopia progression compared with SV lenses in routine practice. |
| Li et al. (2025) | China | RCT | 72/ 79 | 10.7/ 10.4 | 41.1%/ 44.3% | 24.8/ 25.0 | −3.16/ −3.13 | To assess the efficacy of DIMS spectacle lenses for myopia control and their impact on vision-related quality of life. | DIMS lenses slowed myopia progression relative to SV lenses without adversely affecting children’s vision-related quality of life. |
| Dardin et al. (2024) | Malaysia | RCT | 20/18 | 9.6/9.5 | 75%/ 44.5% | 24.5/ 24.3 | −2.8/ −3.1 | To determine how effective DIMS lenses are at controlling myopia progression among myopic Malay school children. | Full-time wear of DIMS lenses significantly reduced myopia progression and axial-length elongation compared with SV lenses in Malay school children. |
| Zhang et al. (2020) | China | RCT | 93/90 | 10.2/ 10.0 | 38%/ 44.4% | 24.9/ 24.7 | −2.9/ −2.7 | To compare changes in relative peripheral refraction associated with myopia progression in children wearing DIMS lenses vs SV lenses. | DIMS lenses produced a different peripheral refraction profile and significant myopia-control effect vs SV lenses. |
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