Effectiveness of Bifocal and Progressive Addition Spectacle Lenses in Controlling Myopia Progression in Children

Background: Childhood myopia is increasing globally due to lifestyle factors such as prolonged near work and reduced outdoor activity. Bifocal and progressive addition lenses (PALs) are commonly used optical strategies to control myopia progression, but their effectiveness remains debated.

Objective: To evaluate the effectiveness of bifocal and progressive addition spectacle lenses in slowing myopia progression and axial elongation in children.

Methods: A systematic review and meta-analysis were conducted following PRISMA guidelines. Major databases including PubMed, Scopus, Web of Science, and Cochrane Central were searched up to December 2025. Randomized controlled trials and longitudinal studies involving myopic children aged 5–16 years were included. Outcomes assessed were annual changes in spherical equivalent refraction (SER) and axial length. A random-effects model was used for pooled analysis.

Results: Fourteen studies involving 3,842 children were included. Bifocal and PALs significantly reduced myopia progression by −0.29 D/year (95% CI: −0.38 to −0.20; p < 0.001) and axial elongation by −0.12 mm/year (95% CI: −0.17 to −0.07; p < 0.001). PALs showed slightly greater efficacy than bifocal lenses. Greater benefits were observed in children with high accommodative lag and younger age.

Conclusion: Bifocal and PALs provide a modest but significant reduction in myopia progression and remain a safe, accessible option in pediatric myopia management.