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Laser photocoagulation for treating choroidal new vessels near the centre of the retina in people with high myopia

In people with high myopia (refractive error ‐6 diopters or worse) new blood vessels can grow under the retina of the eye (choroidal neovascularisation). For decades laser coagulation has been used to destroy lesions that are not central. This review found one small study, including 70 participants, which compared laser photocoagulation with no treatment for people with this disease. This study was inadequately reported and analysed, although it suggested a benefit with photocoagulation during the first two years of follow up. Another small study compared three laser wavelengths to achieve photocoagulation of the lesion, but actually had very little power to demonstrate a difference between them as only 27 participants were included. Therefore, despite its widespread use for many years, the amount of benefit achieved with photocoagulation and the possibility that it is maintained over the years remains unknown. Furthermore, these and other studies suggest that the enlargement of the laser scar could be a potentially vision‐threatening long‐term complication after two years, since it may cause the gradual occurrence of a blind spot in the centre of the visual field due to progressive atrophy of the retina.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Interventions to slow progression of nearsightedness in children

Nearsightedness (myopia) causes blurry vision when looking at distant objects. Approximately 33% of the population in the United States is nearsighted, and some Asian countries report that up to 80% of children are nearsighted. Several studies have examined a variety of methods (including eye drops, incomplete correction (known as 'undercorrection') of nearsightedness, multifocal lenses and contact lenses) to slow the worsening of nearsightedness.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Anti‐VEGF for treatment of choroidal neovascularisation (new blood vessels) in people with pathological (severe) myopia

The aim of this Cochrane Review was to find out if anti‐vascular endothelial growth factor (called anti‐VEGF) treatment of new blood vessels in people with severe myopia (also known as nearsightedness or shortsightedness) prevents vision loss. Cochrane researchers collected and analysed all relevant studies to answer this question and found six studies.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2017

Laser‐assisted in‐situ keratomileusis (LASIK) compared to photorefractive keratectomy (PRK) for correcting short‐sightedness

Myopia is the term used to describe short or near‐sightedness, which means that you cannot see objects in the distance clearly. Most people with myopia wear spectacles or contact lenses. Glasses can be uncomfortable and are not practical for sport; contact lenses can be associated with corneal infections. For these reasons, some people choose to have surgery for myopia. Two commonly used surgical techniques are LASIK and PRK. Both these procedures use laser to remove corneal tissue and reshape the cornea. This review analyses the results from 13 clinical trials where 1923 eyes of 1135 participants were randomly treated with either LASIK or PRK. We considered the overall quality of evidence from these studies to be low. There was some evidence that LASIK gives a faster visual recovery than PRK, and is a less painful technique, although visual results one year after surgery were comparable. Surgical techniques are improving all the time and further trials are needed to see whether LASIK and PRK, as currently practised, are equally safe.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Excimer laser versus phakic intraocular lenses for the correction of moderate to high short‐sightedness

Myopia is a condition in which the focusing power (refraction) of the eye is greater than that required for clear vision of distant objects. Myopia is a common cause of visual disability throughout the world. The World Health Organization (WHO) has grouped myopia and uncorrected refractive error among the leading causes of blindness and vision impairment in the world. The overall power of the lens that would be needed to correct the myopia is expressed in diopters (D) of a sphere. Most people have some degree of astigmatism where the eye is better at focusing light in one meridian than it is at another. It is possible to combine the effect of any astigmatism with the overall focusing power of the eye as a spherical equivalent in diopters. There are two main types of surgical correction for moderate to high myopia; excimer laser and phakic intraocular lenses (IOLs). Excimer laser refractive surgery for myopia works by removing corneal stroma to lessen the refractive power of the cornea and to bring the image of a viewed object into focus onto the retina rather than in front of it. Phakic IOLs for the treatment of myopia work by diverging light rays so that the image of a viewed object is brought into focus onto the retina rather than in front of it. They can be placed either in the anterior chamber of the eye in front of the iris or in the posterior chamber of the eye between the iris and the natural lens.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Acupuncture for near‐sightedness in children

Myopia, also called near‐sightedness or short‐sightedness, is one of the most commonly occurring eye problems in children and adolescents. Early detection and treatment of initial myopia is associated with better outcomes of visual improvement and correction. Myopia is usually managed by wearing glasses and/or contact lenses. It is common practice for traditional Chinese medicine practitioners to use acupuncture for the treatment of myopia. Acupuncture is the stimulation of acupuncture points by needle insertion, acupressure, surface electrical and laser stimulation. This review aimed to assess the effectiveness and safety of acupuncture in slowing the progression of myopia in children and adolescents. We included two studies conducted in Taiwan with a total of 131 school children and did not combine the results as the two trials assessed different outcomes. One study found no significant difference in changes in the length of the eyes. Both studies found several children experienced mild pain while pressing and dropped out. The included studies in this review were unable to provide evidence of the effect of acupuncture for slowing the progression of myopia. More trials should be conducted where acupuncture is compared to placebo, other types of acupuncture are investigated, compliance with treatment for at least six months is explored and axial length elongation of the eye should be for at least one year.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Aflibercept (Eylea) for myopic choroidal neovascularization: Overview

The drug aflibercept (trade name Eylea) has been approved in Germany since October 2015 for adults with declining eye-sight due to myopic choroidal neovascularization.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: March 1, 2016

Amblyopia in children: Overview

In some children one eye is favored by the brain because it provides a better image. If this happens, the other eye is neglected from childhood on, and it does not get the chance to fully develop. This is known as amblyopia or “lazy eye.”

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: September 24, 2014

How can presbyopia be corrected?

Our ability to see nearby objects gets worse with age. This is known as presbyopia. Although it can’t be reversed, it is easy to correct. The simplest way is to wear reading glasses. Laser treatment and other kinds of eye surgery have hardly any advantages, but are associated with a lot of risks.Presbyopia usually becomes noticeable in your mid-forties, and at first is often only a problem when reading. Wearing reading glasses is then a simple and effective solution for people who don’t already have other problems with their eyesight. Those who already had to wear glasses or contact lenses beforehand can use varifocal or multifocal glasses to avoid having to switch between different pairs. Multifocal contact lenses are an alternative to multifocal glasses. They also allow you to see both nearby and distant objects clearly.Laser treatment and other kinds of eye surgery are called refractive surgery. The aim of these procedures is to change the refractive power (focusing power) of the eye in order to correct your vision. They can’t yet effectively reverse presbyopia. What’s more, most of the procedures are still being tested. The advantages of not having to wear glasses or contact lenses have to be weighed against the possible risks associated with the procedure. For instance, your spatial vision may be worse afterwards, or you may suddenly have trouble seeing things that are further away. The costs of these procedures aren’t covered by statutory health insurers in Germany. People have to pay for them themselves.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: January 26, 2017

Two different surgical procedures for people who are near‐sighted

Myopia (short‐sightedness or near‐sightedness) is a condition whereby people cannot see distant objects clearly. The prevalence of myopia is increasing worldwide, especially in some Asian areas. Spectacles and contact lenses are commonly used for correction of this condition. Surgical procedures such as laser‐assisted subepithelial keratectomy (LASEK) and photorefractive keratectomy (PRK) also can be used for correction of myopia. In both procedures, a laser is used to remove corneal tissue (front of the eye); these procedures have been performed in human eyes for nearly 30 years.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Two different surgeries to treat near‐sightedness

The aim of this Cochrane Review was to find out whether laser‐assisted subepithelial keratectomy (LASEK) surgery is better than laser‐assisted in‐situ keratomileusis (LASIK) surgery for treating near‐sightedness (myopia). Cochrane researchers collected and analyzed all relevant studies to answer this question and found four studies.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2017

Anti‐vascular endothelial growth factor (VEGF) drugs for treatment of retinopathy of prematurity

Retinopathy of prematurity (ROP) is a vascular disorder of the immature retina that can result in impairment of vision and even blindness in premature infants. It is treated primarily by removal of the part of the retina without any blood vessels ('avascular' retina) by cryotherapy or laser therapy. Though these treatments result in a significant improvement in long‐term outcomes, the results are far from perfect. In addition, they cause permanent loss of the peripheral visual field. Recently, studies have been done to evaluate the use of anti‐VEGF agents to treat ROP. These agents inhibit the action of vascular endothelial growth factor (VEGF), a key regulator of new vessel formation in fetal life. Animal studies had shown significant reduction in the neovascular response following injection of anti‐VEGF antibodies into the vitreous cavity of the eyes ('intravitreal' therapy).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Surgical interventions for rhegmatogenous retinal detachment

In this review we aimed to determine whether pneumatic retinopexy or scleral buckle is a better surgical treatment for rhegmatogenous retinal detachment (RRD).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Glaucoma: Overview

As we age, we may develop eye conditions that impair our eyesight or have more serious consequences. Glaucoma is one of these eye conditions, but early diagnosis and treatment can help delay loss of eyesight.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: May 3, 2016

Amblyopia in children: Treatment options for amblyopia

There are different options for treating amblyopia in children, mostly depending on the type and severity of the condition.Some children only have one eye that focuses properly. This is known as amblyopia or "lazy eye" and is caused by the eyes sending two different images to the brain, which can happen when a child has strabismus (a squint) or is more nearsighted or farsighted in one eye than the other. The brain then ends up preferring the information coming from the stronger eye and neglecting the other.The severity of amblyopia largely determines the kind of treatment needed. The standard treatment options are:Glasses to correct refractive errors (nearsightedness or farsightedness, distorted vision).Eye patching (occlusion therapy): The stronger eye is covered with an eye patch for several hours a day. Children who wear glasses can fit the patch over one of the lenses. This is done to encourage the weaker eye to work harder so that vision improves. The word occlusion comes from Latin and means "closed."Drug therapy: Eye drops containing atropine or a similar drug are used to temporarily blur vision in the "good" eye. They relax the muscles in the eye so that the lens will not focus for a few hours.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: September 24, 2014

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