Efficacy Comparison of 16 Interventions for Myopia Control in Children: A Network Meta-analysis.
By Jinhai Huang, Daizong Wen, Qin-Mei Wang, C. McAlinden, I. Flitcroft, Haisi Chen, Seang Mei Saw, Hao Chen, F. Bao, Yun-e Zhao and 11 more. Ophthalmology (Rochester, Minn.), 2016
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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.
Subfields: Atomic and Molecular Physics, and Optics, Epidemiology, Radiology, Nuclear Medicine and Imaging
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Citations in the corpus
- Low-Concentration Atropine for Myopia Progression (LAMP) Study: A Randomized, Double-Blinded, Placebo-Controlled Trial of 0.05%, 0.025%, and 0.01% Atropine Eye Drops in Myopia Control. (2019, positive): “In a meta-analysis reported in 2016 that included 7 studies of high, moderate, and low concentrations of atropine, atropine was efficacious in slowing myopia progression, but with no concentration-dependent effect.(21) Likewise, another meta-analysis of 19 studies suggested the efficacy of atropine ”
- IMI – Defining and Classifying Myopia: A Proposed Set of Standards for Clinical and Epidemiologic Studies (2019, methodology): “The studies chosen for analysis met the criteria for inclusion in two recent meta-analyses covering these two aspects of myopia research and, therefore, have been prevalidated in terms of study quality.(2,3) A full list of these studies and their references are included in online Appendix 1.”