Objective  Compare the effectiveness of three different optical microstructure lens designs—defocus- incorporated multiple segments (DIMS), highly aspherical lenslets (HAL), and diffusion optics technology (DOT)—in controlling myopia progression in children.

Methods  This multicenter retrospective cohort study collected clinical data from myopic children wearing microstructure-designed spectacle lenses who visited West China Hospital of Sichuan University, Wuhou West China Likang Optometry Clinic, Meishi Kang Eye Optometry Center, and Chengdu Xiaoai Eye Clinic for refraction and follow-up between May 2024 and December 2025. A total of 210 myopic children (210 right eyes) were enrolled and equally divided into three groups: DIMS group, HAL group, and DOT group, with 70 cases in each group. Follow-up evaluations were conducted at 6 and 12 months after lens wear. Changes in axial length and refractive error were compared and analyzed among the three groups.

Results  There were no statistically significant differences among the three groups in age, gender distribution, refractive power, axial length, astigmatism, etc. The baseline characteristics of the groups were well balanced. For axial length, the main effects of group (F = 8.629, P < 0.001) and time (F = 165.150, P< 0.001) were both significant, and the interaction between group and time was also statistically significant (F = 4.754, P = 0.010). After 6 and 12 months of wearing glasses, axial elongation (mean) in the DOT group (6 months: －0.02 mm; 12 months: 0.03 mm) was lower than in the HAL group (6 months: 0.05 mm; 12 months: 0.13 mm) and the DIMS group (6 months: 0.03 mm; 12 months: 0.13 mm) (P < 0.05). The main effect of group for spherical equivalent refraction (SER) was significant (F = 5.311, P = 0.006), and the increase in myopic diopters in the DOT group after 6 and 12 months of wearing glasses was smaller than in the other two groups (P < 0.05). For subjective refraction of total astigmatism, the main effect of time was significant (F = 11.802, P = 0.001), whereas the effects of group (F = 2.961, P = 0.054) and the interaction between group and time (F = 0.323, P = 0.725) were not statistically significant. The pattern of the effect of different lenses on astigmatism was essentially consistent over the observation period.

Conclusion  All three types of optical microstructure-designed lenses can delay elongation of the ocular axis and progression of myopia. The DOT design shows a more significant effect in preventing myopia. After wearing these lenses, the subjective refraction of myopic children shows a slight increase in astigmatism, but this has no clinical significance.