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

Jinhai Huang, Daizong Wen, Qinmei Wang, Colm Michael McAlinden, Ian Flitcroft, Haisi Chen, Seangmei Saw, Hao Chen, Fangjun Bao, Yune Zhao, Liang Hu, Xuexi Li, RongRong Gao, Weicong Lu, Yaoqiang Du, Zhengxuan Jinag, Ayong Yu, Hengli Lian, Qiuruo Jiang, Ye YuJia Qu

    Research output: Contribution to journalReview articlepeer-review

    412 Citations (Scopus)

    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.

    Original languageEnglish
    Pages (from-to)697-708
    Number of pages12
    JournalOphthalmology
    Volume123
    Issue number4
    DOIs
    Publication statusPublished - 1 Apr 2016

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