Objective To investigate the effects of rigid gas-permeable contact lenses (RGP) and spectacle glasses on astigmatism progression in children with compound myopic astigmatism.

Methods A prospective cohort study was conducted. Children aged 8-12 years with compound myopic astigmatism who attended the Optometry Center of Guangdong Provincial People’s Hospital from July to October 2024 were enrolled. According to the astigmatism correction method chosen by the children and their parents, participants were divided into two groups: the RGP group (33 cases initially screened, with 1 case lost to follow-up due to lens loss, resulting in 32 cases completing the study) and the spectacle group (31 cases, all using single-vision lenses, with no dropouts). Changes in total astigmatism, corneal astigmatism, and ocular residual astigmatism (ORA) were evaluated before and after correction.

Results A total of 63 cases completed the 1-year follow-up, with 1 child in the RGP group withdrawing due to lens loss. After correction, both total astigmatism and corneal astigmatism decreased in the RGP group (all P ＜ 0.05), whereas they increased in the spectacle group (both P ＜ 0.05). Analysis of covariance showed that, after controlling for baseline differences, the RGP group was superior to the spectacle group in controlling total astigmatism progression (F = 23.908, P ＜ 0.001, η² = 0.285). Specifically, the adjusted mean was −1.891 D in the RGP group and −2.394 D in the spectacle group. There was no statistically significant difference in post-correction ORA between the two groups (P ＞ 0.05). Simple effects analysis showed that the corrective advantage of RGP depended on the baseline level of corneal astigmatism: at a low level (−1.18 D), the difference between the two groups was not statistically significant (P ＞ 0.05); at medium (−2.17 D) and high (−3.16 D) levels, the corrective effect of RGP was better than that of spectacle glasses (both P ＜ 0.001).

Conclusion RGP is superior to spectacle glasses in controlling the progression of total astigmatism in children with compound myopic astigmatism, and its corrective advantage is particularly prominent in patients with moderate-to-high corneal astigmatism, making it a more advantageous option for individualized intervention.