Effectiveness of spectacle lenses with highly aspherical lenslets (HAL) in slowing axial elongation and spherical equivalent refraction progression in myopic and pre-myopic children: a systematic review and meta-analysis

To systematically evaluate the efficacy of highly aspherical lenslet (HAL) spectacle lenses on axial length (AL) elongation and spherical equivalent refraction (SER) progression in myopic and pre-myopic Children. PubMed, Embase, Cochrane Library, Web of Science, CNKI, VIP, and WanFang databases were systematically searched from inception to June 2026. Randomized controlled trials (RCT) and prospective cohort studies comparing HAL lenses with single-vision lenses (SVL) for myopia control or prevention were included. Two investigators independently screened literature, extracted data, and assessed the risk of bias. Meta-analysis was performed using RevMan 5.4 software. A total of six RCTs and two prospective cohort studies, comprising 717 participants, were included. Meta-analysis showed that compared with SVL, HAL lenses significantly slowed AL elongation (MD = − 0.15 mm, 95% CI: −0.20 to − 0.10, P < 0.001) and SER progression (MD = − 0.28 D, 95% CI: −0.41 to − 0.15, P < 0.001). Subgroup analysis based on baseline refractive status revealed that HAL lenses were effective in both myopic and pre-myopic children. However, the treatment effect was more pronounced in myopic children (AL: MD = − 0.17 mm; SER: MD = − 0.33 D) than in pre-myopic children (AL: MD = − 0.09 mm; SER: MD = − 0.13 D). Current evidence suggests that HAL spectacle lenses may slow axial elongation and SER progression in myopic children. In pre-myopic children, HAL lenses may offer a smaller benefit, particularly with high adherence, but the evidence is limited and of low quality, precluding a strong recommendation for routine myopia prevention. Given the modest number of studies, short follow-up, and substantial heterogeneity, all findings warrant cautious interpretation.