Glasses or drops? A two-year European head-to-head of DIMS lenses and 0.01% atropine

By Jagrut Lallu — BOptom (Hons), MSc Specialty Lenses (Hons), FIAOMC. Therapeutic Optometrist & Contact Lens Specialist. Founder, New Zealand Eye Research Centre; Partner, Rose Optometry; WCO Asia-Pacific Myopia Ambassador; International Myopia Institute NZ Ambassador; Clinical Senior Lecturer, Deakin School of Optometry; Honorary Teaching Fellow, University of Auckland.

Families weighing up myopia control often ask a simple question: glasses or drops? A two-year randomised trial from Poland compared Defocus Incorporated Multiple Segments (DIMS) spectacle lenses with 0.01% atropine eye drops head-to-head. Children in the DIMS group showed less eye growth on average. But what the lenses were compared against, who left the trial, and when the difference appeared all shape how far the result can be taken.

What the researchers did

The trial enrolled 110 children aged 6–16 years, of Polish or Ukrainian descent, between February and November 2023. All had myopia between −0.50 and −9.00 D, wore single-vision spectacles and had no previous myopia control. They were randomised 1:1 to:

• Group A: single-vision spectacles plus nightly 0.01% atropine drops
• Group B: DIMS spectacles plus nightly placebo drops

Children and outcome assessors were masked, although the authors note DIMS lenses can be distinguished from single-vision lenses on close inspection. Cycloplegic refraction and axial length (Tomey OA-2000) were measured every six months, analysing the right eye only. This paper is the pre-specified two-year extension of a trial whose first-year results were published in 2025. Ninety-six children completed 24 months (44 atropine, 52 DIMS).

What they found

Over 24 months, mean axial elongation was 0.22 ± 0.22 mm with DIMS versus 0.32 ± 0.29 mm with 0.01% atropine; myopia progressed 0.47 ± 0.47 D versus 0.70 ± 0.58 D. In the authors' mixed-effects model, estimated annual eye growth was 0.1 mm/year with DIMS (95% CI 0.068 to 0.131) and 0.171 mm/year with atropine (95% CI 0.136 to 0.205), a between-group contrast of 0.07 mm/year (p = 0.003). A p-value of 0.003 means a difference this large would be unlikely if the two treatments truly performed the same; a 95% confidence interval is the range in which the true value plausibly lies.

The difference was concentrated in two places:

• Younger children (under 12): 0.148 versus 0.246 mm/year (contrast 0.1 mm/year; p = 0.008). Over two years, that was 0.30 versus 0.48 mm of growth.
• Year 1: the between-group effect was significant in the first year (p = 0.002 for axial length) but not in the second, when the estimated difference was 0.047 mm/year (p = 0.12), though in the same direction.

In children aged 12 and over, the difference (0.051 versus 0.095 mm/year) was not statistically significant (p = 0.377). The authors note the younger-age effect may partly reflect faster natural progression in younger children, which the study was not designed to separate.

Refraction versus axial length

Results for refraction ran parallel to axial length, but refraction was more variable. Axial length is the more direct measure of the eye growth that drives long-term risk, so we place more weight on it. The headline percentages quoted in the paper (for example, a "29% smaller mean increase" in axial length) are descriptive differences in group means; only the younger-group contrasts reached statistical significance in the model.

Limitations of this evidence

• No untreated control. Without a placebo-only or single-vision arm, we cannot say how much either treatment slowed growth compared with no treatment.
• A modest comparator. 0.01% is the lowest commonly used atropine concentration and has shown limited effect in several trials (see our post on the atropine dose–response plateau). These results should not be extrapolated to higher concentrations such as 0.025% or 0.05%.
• Differential dropout. 11 of 55 children left the atropine group versus 3 of 55 in the DIMS group (p = 0.045), with no reasons recorded. Non-completers looked similar at baseline, and an analysis imputing missing data for all 110 children gave consistent results, which is reassuring but does not remove the concern.
• Adherence to drops was not objectively measured. Families reported missed doses during travel or illness, and the authors acknowledge they cannot separate efficacy from adherence.
• Industry involvement. HOYA, the manufacturer of DIMS lenses, supplied the spectacle lenses; the drops were co-funded through a Polish Academy of Ophthalmology grant from Théa, a pharmaceutical company. Funders were stated to have no role in the study, and the authors declared no conflicts.
• No trial registration number was reported in the paper; follow-up was two years with no data on what happens after treatment ends; a modest sample of 96 completers; and a small baseline imbalance in anterior chamber depth (p = 0.039).

No clinically significant treatment-related adverse events were reported, and no child discontinued drops because of intolerance.

What this means in practice

This trial suggests that, compared with 0.01% atropine, DIMS spectacles were associated with less eye growth over two years, mainly in younger children and mainly in the first year. It does not show that spectacles outperform atropine in general, and the right approach still depends on a child's age, rate of progression, lifestyle and what they will realistically use every day. Some children may benefit from adjusting or combining treatments over time.

The optometry team at Rose Optometry in Hamilton, including Jagrut Lallu and Jacqueline Rowe, offers myopia control including DIMS-type spectacle lenses and low-dose atropine, with axial length monitoring. If you would like to discuss the evidence for your child first, you can book a free Myopia Chat with Jagrut.

References

• Wnękowicz-Augustyn E, Wylęgała E, Kobielnik M, Teper S. Defocus Incorporated Multiple Segments (DIMS) spectacle lenses versus 0.01% atropine for myopia control: Two-year randomised trial in children from Central Europe. J Optom. 2026;100635. PMID: 42855355. https://doi.org/10.1016/j.optom.2026.100635