Interocular differential axial growth and refractive progression in children with myopic anisometropia treated with spectacle lenses with highly aspherical lenslets.

PURPOSE: To evaluate interocular differences in axial length (AL) growth and refractive progression in children with myopic anisometropia using spectacle lenses with highly aspherical lenslets (HALs). METHODS: This retrospective study included 246 children aged 8-14 years with myopic anisometropia. Among them, 116 wore HALs (HAL group) and 130 wore single-vision lenses (SP group). Axial length (AL), spherical equivalent refraction (SER), and interocular differences were analyzed using linear mixed-effects models adjusted for key covariates. An additional subgroup with both 6- and 12-month visits evaluated interval-specific AL changes. RESULTS: Over 12 months, interocular anisometropia decreased in the SP group, with reductions in both anisotropic SER (adjusted mean difference, - 0.13 ± 0.04 D; p < 0.001) and anisotropic AL (- 0.05 ± 0.01 mm; p < 0.001). In contrast, the HAL group showed no change in anisotropic SER (0.00 ± 0.04 D; p = 0.963) but an increase in anisotropic AL (0.04 ± 0.01 mm; p = 0.003). Eye-type contrasts indicated greater 1-year axial elongation in the less myopic eyes than in the more myopic eyes in the SP group (difference, 0.06 ± 0.01 mm; p < 0.001), whereas the opposite pattern was observed in the HAL group (difference, -0.03 ± 0.01 mm; p = 0.02). In subgroup analyses, the SP subgroup showed greater AL elongation in the less myopic eyes at months 0-6 (0.05 ± 0.02 mm; p < 0.001), but not at months 6-12 (0.02 ± 0.02 mm; p = 0.20). HAL subgroup showed no between-eye differences, while AL elongation in both eyes slowed in months 0-6 (both p = 0.01). CONCLUSIONS: Single-vision correction was associated with a modest reduction in anisometropia, driven by relatively faster AL elongation of the less myopic eyes. In contrast, HALs were linked to reduced AL elongation of the less myopic eyes, leading to more symmetric axial growth between fellow eyes and largely stable refractive anisometropia. CLINICAL TRIAL REGISTRATION: Not Applicable.