目的：比较高非球面微透镜设计镜片(HAL)、多区正向光学离焦设计镜片(DIMS)与单光镜片(SVL)在延缓儿童青少年近视进展中的效果。

方法：回顾性队列研究。选取2023年1月至2023年6月于本院视光科就诊并验配近视矫正眼镜的6-16岁儿童及青少年为研究对象。按照患者及监护人自主选择的矫正方式分为HAL组、DIMS组、SVL组。随访12 mo，比较三组患者戴镜12 mo后球镜、柱镜、等效球镜(SE)、眼轴长度(AL)、平坦角膜曲率(K1)、陡峭角膜曲率(K2)、平均角膜曲率及双眼视功能参数\〖调节滞后量(BCC)、负/正相对调节(NRA/PRA)\〗的变化情况。进一步将纳入患者按照年龄分为≤10岁组、>10岁组，探讨年龄对离焦镜片近视防控效果的影响。

结果：本研究共纳入近视患者159例159眼(均选取右眼入组)：HAL组55例中男24例，女31例，平均年龄10.07±2.14岁，DIMS组60例中男33例，女27例，平均年龄10.02±1.88岁； SVL组44例中男21例，女23例，平均年龄10.59±1.93岁。三组患者戴镜12 mo后K1、K2、平均角膜曲率、NRA、BCC及PRA比较均无差异(均P>0.05)，球镜、柱镜、等效球镜、AL变化量比较均有差异(均P<0.05)，HAL组和DIMS组球镜、等效球镜、AL变化量均显著低于SVL组(均P<0.0167)，且DIMS 组柱镜变化量小于SVL组(P<0.0167)。在≤10岁组患者中，戴镜12 mo后HAL 组球镜变化量均小于DIMS组和SVL组(均P<0.0167)； DIMS组柱镜变化量小于SVL组(均P<0.0167)。在>10岁组患者中，戴镜12 mo HAL 组与DIMS组球镜、等效球镜、AL变化量均小于SVL组(均P<0.0167)。

结论：HAL 与 DIMS 均可有效地延缓儿童青少年近视屈光度进展与 AL 增长，且对双眼视功能无显著不良影响； 在≤10岁组患者中 HAL 镜片的球镜度控制效果更优，DIMS 镜片的散光控制效果较SVL更佳。

METHODS: In this retrospective cohort study, myopic children and adolescents aged 6-16 y who were prescribed spectacle lenses at the hospital between January 2023 and June 2023 were included. Participants were divided into the HAL, DIMS, and SVL groups according to the correction modality voluntarily selected by participants and their guardians. The follow-up duration was 12 mo. After 12 mo of wear, changes from baseline in sphere, cylinder, spherical equivalent(SE), axial length(AL), flat corneal curvature(K1), steep corneal curvature(K2), mean corneal curvature, and binocular visual function \〖binocular cross-cylinder(BCC), negative/positive relative accommodation(NRA/PRA)\〗 were compared among the three groups after 12-month spectacle wear. Three groups were further stratified by age into age≤10 y and age>10 y subgroups to explore the effect of age on myopia control efficacy of defocus lenses.

RESULTS: A total of 159 myopic participants(159 eyes; only the right eye was included for each subject)were enrolled. In the HAL group(55 participants), there were 24 males and 31 females, with a mean age of 10.07±2.14 y. The DIMS group consisted of 60 participants(33 males, 27 females), with a mean age of 10.02±1.88 y. The SVL group included 44 participants(21 males, 23 females), with a mean age of 10.59±1.93 y. There were no significant differences in K1, K2, mean corneal curvature, NRA, BCC, and PRA among the three groups after 12-month spectacle wear(all P>0.05). There were statistically significant differences in the changes in sphere, SE, and AL(all P<0.05). The changes in sphere, cylinder, SE, and AL in the HAL and DIMS groups were significantly lower than those in the SVL group(all P<0.0167). The DIMS group showed a significantly smaller cylinder progression than the SVL group(P<0.0167). In participants aged≤10 y, the change in spherical power in the HAL group was significantly smaller than those in the DIMS group and SVL group after 12-month spectacle wear(all P<0.0167). The change in cylindrical power in the DIMS group was smaller than that in the SVL group(all P<0.0167). Among participants aged>10 y, the changes in spherical power, SE, and AL in both the HAL group and DIMS group were significantly smaller than those in the SVL group after 12-month spectacle wear(all P<0.0167).

CONCLUSION: Both HAL and DIMS lenses can effectively slow the progression of refractive error and AL elongation in children and adolescents, without significant adverse effects on binocular visual function. Among children≤10 y, HAL lenses yield superior spherical power control, whereas DIMS lenses provide better astigmatism control than SVL.