Objective: To evaluate and compare the effectiveness of Defocus Incorporated Multiple Segments (DIMS) lenses and Highly Aspherical Lenslets (HAL) lenses in controlling axial growth, refractive error progression, and the onset of myopia in pre-myopic children. Methods: This retrospective study included 60 pre-myopic children (60 eyes), aged between 6 and 14 years, who wore either DIMS or HAL lenses for a minimum of 12 months from March 2021 to May 2025. Based on the type of lenses they wore, the participants were split into two groups: the DIMS group (n = 30) and the HAL group (n = 30). We compared baseline characteristics, annual axial growth, annual change in refractive error, and the incidence of myopia at the end of follow-up period between the two groups. Appropriate statistical analyses were carried out, including independent-sample t-test, Mann-Whitney U test, or chi-square test. Multiple linear regression was used to account for potential confounding factors, and a post-hoc power analysis was performed to assess the reliability of the results. Results: There were no notable differences in baseline age, gender, axial length, or spherical equivalent refraction between the two groups (all P > 0.05). After the follow-up, the HAL group showed significantly less annual axial growth (0.13 ± 0.19 mm/year) compared to the DIMS group (0.24 ± 0.14 mm/year, P = 0.012). Multiple linear regression analysis revealed that, even after adjusting for confounding factors, the type of lens remained a significant independent predictor influencing annual axial growth (B = −0.111, P = 0.016). The incidence of myopia was also markedly lower in the HAL group (43.3%) than in the DIMS group (70.0%, P = 0.037). In the HAL group, 4 eyes (13.3%) showed axial shortening and 3 eyes (10.0%) exhibited refractive regression, while no such changes were observed in the DIMS group. There was no significant difference in the annual change in refractive error between the two groups (P = 0.128). Conclusions: Among pre-myopic children, HAL lenses proved to be more effective than DIMS lenses in slowing axial length growth and reducing the incidence of myopia. Some patients in the HAL group even experienced axial shortening and refractive regression, indicating that HAL lenses hold promise as a more effective optical intervention for pre-myopia.