Purpose <p>This study sought to determine whether specially-designed myopia control spectacle lenses had any effect on astigmatism in clinical practice.</p> Methods <p>Medical records of 74 patients (age: 6 to 12 years old) involving the use of MyoVision (<i>n</i> = 23), DIMS (<i>n</i> = 22) and Stellest lenses (<i>n</i> = 29) were collected from the West China Hospital. Data collection included baseline age, sex and spectacle lens prescription at baseline and at the 2-year follow-up. Astigmatism, determined by cycloplegic objective and subjective refraction, was divided into its power vector components, J₀ and J₄₅.</p> Results <p>After 2 years of lens wear, for the MyoVision, DIMS and Stellest groups, the total astigmatism increased by −0.41 ± 0.29 D, −0.42 ± 0.34 D and −0.41 ± 0.31 D, respectively (all <i>p</i> &lt; 0.001). The J₀ vector increased by 0.19 ± 0.15 D, 0.19 ± 0.18 D and 0.20 ± 0.16 D, respectively (all <i>p</i> &lt; 0.001). The J₄₅ vector did not change significantly for MyoVision and Stellest (<i>p</i> = 0.12, 0.21), but did decrease significantly with DIMS (<i>p</i> = 0.02) although the magnitude (−0.07 ± 0.14 D) was not clinically significant. The changes in total astigmatism, J₀ and J₄₅ were comparable between the three groups (<i>p</i> = 0.99, 0.97 and 0.32, respectively). Multivariate linear regression analyses showed that the change in astigmatism was correlated only with the change of SER (standard <i>β</i> = 0.31, <i>p</i> = 0.006).</p> Conclusion <p>The use of specially-designed myopia control spectacle lenses over 2 years resulted in a slight, but clinically insignificant (&lt;0.50 D) increase in refractive astigmatism. The increase was not associated with lens type, but rather with the increase in myopia.</p>