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Ophthalmology. 2016 Apr;123(4):697-708. doi: 10.1016/j.ophtha.2015.11.010. Epub 2016 Jan 27.

Efficacy Comparison of 16 Interventions for Myopia Control in Children: A Network Meta-analysis.

Author information

1
School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China; Key Laboratory of Vision Science, Ministry of Health P.R. China, Wenzhou, Zhejiang, China.
2
School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China; Department of Ophthalmology, No.180 Hospital of Chinese PLA, Quanzhou, Fujian.
3
School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China; ABM University Health Board, Swansea, United Kingdom; Flinders University, Adelaide, South Australia, Australia.
4
Department of Ophthalmology, Children's University Hospital, Dublin, Ireland.
5
Department of Epidemiology and Public Health, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
6
School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China.
7
Department of Ophthalmology, No.180 Hospital of Chinese PLA, Quanzhou, Fujian.
8
Department of Ophthalmology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China.
9
Department of Biological Statistics, Eye hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
10
School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China; Key Laboratory of Vision Science, Ministry of Health P.R. China, Wenzhou, Zhejiang, China. Electronic address: jia.qu@mail.eye.ac.cn.

Abstract

PURPOSE:

To determine the effectiveness of different interventions to slow down the progression of myopia in children.

METHODS:

We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov from inception to August 2014. We selected randomized controlled trials (RCTs) involving interventions for controlling the progression of myopia in children with a treatment duration of at least 1 year for analysis.

MAIN OUTCOME MEASURES:

The primary outcomes were mean annual change in refraction (diopters/year) and mean annual change in axial length (millimeters/year).

RESULTS:

Thirty RCTs (involving 5422 eyes) were identified. Network meta-analysis showed that in comparison with placebo or single vision spectacle lenses, high-dose atropine (refraction change: 0.68 [0.52-0.84]; axial length change: -0.21 [-0.28 to -0.16]), moderate-dose atropine (refraction change: 0.53 [0.28-0.77]; axial length change: -0.21 [-0.32 to -0.12]), and low-dose atropine (refraction change: 0.53 [0.21-0.85]; axial length change: -0.15 [-0.25 to -0.05]) markedly slowed myopia progression. Pirenzepine (refraction change: 0.29 [0.05-0.52]; axial length change: -0.09 [-0.17 to -0.01]), orthokeratology (axial length change: -0.15 [-0.22 to -0.08]), and peripheral defocus modifying contact lenses (axial length change: -0.11 [-0.20 to -0.03]) showed moderate effects. Progressive addition spectacle lenses (refraction change: 0.14 [0.02-0.26]; axial length change: -0.04 [-0.09 to -0.01]) showed slight effects.

CONCLUSIONS:

This network analysis indicates that a range of interventions can significantly reduce myopia progression when compared with single vision spectacle lenses or placebo. In terms of refraction, atropine, pirenzepine, and progressive addition spectacle lenses were effective. In terms of axial length, atropine, orthokeratology, peripheral defocus modifying contact lenses, pirenzepine, and progressive addition spectacle lenses were effective. The most effective interventions were pharmacologic, that is, muscarinic antagonists such as atropine and pirenzepine. Certain specially designed contact lenses, including orthokeratology and peripheral defocus modifying contact lenses, had moderate effects, whereas specially designed spectacle lenses showed minimal effect.

PMID:
26826749
DOI:
10.1016/j.ophtha.2015.11.010
[Indexed for MEDLINE]
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