A Shifting Landscape
The recent FDA approval of spectacle lenses (EssilorStellest) marks a milestone for myopia control in the United States. Following years of global use and long-term data showing effective slowing of myopia progression,1 this entry signals a new era of accessibility. However, with wider availability comes new questions. Many clinicians invested in orthokeratology (ortho-k) and specialty contact lenses are asking: Where does this leave us?
Based on my experience in Canada, this expansion is a growth opportunity rather than a threat. The arrival of anti-myopia spectacles provides a chance to introduce more families to myopia management early, often before a patient is ready for contact lens wear.
Over time, many of these same patients will evolve toward more advanced interventions, including ortho-k.
Valid Concerns Within the Ortho-k Community
It’s natural that ortho-k practitioners express curiosity about the impact of spectacle-based myopia control. Several concerns echo through the professional conversation:
- Fewer referrals for myopia control, as more general practices can now prescribe a “control option”
- Decreased demand for contact lenses among existing patients
- Revenue pressures, particularly when branded spectacles appear in “box store” environments at reduced pricing
- Questions around real-world compliance, given that children may not wear their glasses fulltime
These are all valid issues, but history shows that, as new modalities enter the market, initial novelty gives way to differentiation, and patients ultimately return to practitioners who provide comprehensive, customized care.
Spectacle-Based Myopia Control: Strength and Realities
Modern anti-myopia spectacle designs share a goal of inducing myopic defocus or reducing retinal contrast to slow eye growth. Controlled clinical trials consistently show reduction in myopia progression compared to single vision lenses.1
Spectacles remain the most accessible and least invasive myopia-control intervention.2 They require no handling skills, carry minimal risk, and can be implemented immediately. They are ideal for younger children, pre-myopes, or families uncertain about contact lens wear.
That said, compliance remains a key limitation. Real-world studies suggest that average wear time may fall well below the recommended full-time use.3 Efficacy is proportional to consistent wear, so patient education and follow-up are essential. Optical zones, pupil size, and aberration profiles vary among designs, but all depend on stable centration and full-time wear to achieve their intended effect.
Ortho-k: The “OG” Modality
Ortho-k retains unique advantages that spectacles cannot match. By reshaping the cornea overnight, ortho-k creates a customized, full-field myopic defocus with strong evidence for slowing axial elongation versus single-vision controls.4
For moderate myopes (-1.00 to -5.00 D) with astigmatism up to -1.50 D, ortho-k remains one of the most potent optical interventions available. Its behavioral compliance advantage and no daytime device to wear makes it highly successful for children in sports or high-activity lifestyles or for those seeking cosmetic freedom. However, ortho-k requires commitment, corneal health, and consistent follow-up.
Triage and Clinical Decision Pathway
The choice of intervention for new myopes is determined by factors including refractive error, patient age, axial elongation, corneal shape, visual environment, and caregiver readiness. It is also important to look at lifestyle, hobbies, and visual goals.
This comprehensive approach ensures that modality selection is guided by data and individual context, not practitioner preference or cost.
Combination Therapy
Ortho-k is not typically combined with myopia control spectacles. Use full-strength single vision lenses as backup, half-strength single vision lenses for short breaks from wear, and a low-minus option (–0.50 D) for evening or night driving if mild regression occurs in older teens and adults.
Looking Forward
The arrival of anti-myopia spectacles in the United States is not the end of ortho-k; it’s the expansion of the myopia management conversation. As these technologies enter mainstream awareness, more families will be educated, more children will start earlier, and more clinicians will participate.
Yes, there may be short-term shifts in referrals and lens sales. But as patient sophistication increases, they will seek customized, lifestyle-based, multi-tool solutions precisely where specialty contact lens practitioners excel.
In the end, both modalities share the same mission: to slow eye growth and preserve lifelong vision. The tools may differ, but the outcome depends on matching the right option to the right patient at the right time.
Modern myopia control isn’t about one tool, and there are seats for many strategies at the table.
References
- Lupon M,Nolla-Colomer C, Cardona, G. New designs of spectacle lenses for the control of myopia progression: a scoping review. J Clin Med. 2024;13(1157). doi:10.3390/jcm13041157. PMID: 38398469.
- Lam, CSY, Tang, WC, Zhang, HY, et al. Long-term myopia control effect and safety in children wearing DIMS spectacle lenses for 6 years. Sci Rep. 2023;13(1):5475. doi:10.1038/s41598-023-32700-7. PMID: 37015996.
- Morgan PB, Efron N, Papas E, Barnett M, Carnt N, Dutta D, Hepworth A, Little JA, Nagra M, Pult H, Schweizer H, Shen Lee B, Subbaraman LN, Sulley A, Thompson A, Webster A, Markoulli M. BCLA CLEAR Presbyopia: Management with contact lenses and spectacles. Cont Lens Anterior Eye. 2024 Aug;47(4):102158. doi: 10.1016/j.clae.2024.102158. Epub 2024 Apr 16. PMID: 38631935.
- Verkicharla PK, Thakur S, Kekunnaya R, et al. The "IMPACT" myopia management guidelines. Indian J Ophthalmol. 2023;71(7):2882-2884. doi:10.4103/IJO.IJO_744_23. PMID: 37417138.
