Myopia Prevention and Control in Children: A Systematic Review and Network Meta-analysis

Abstract

AbstractObjectives To analyze and compare the efficacy of different interventions for myopia prevention and control in children. Methods We searched CNKI, VIP, Wan-Fang, CBM, Chinese Clinical Registry, PubMed, The Cochrane Library, Web of Science, Embase and ClinicalTrials.gov from inception to July 2022. We selected randomized controlled trials (RCTs) that included interventions to slow myopia progression in children with a treatment duration of at least 1 year for analysis. Both inconsistency test and node splitting method were used to analyze inconsistency. The main outcomes included mean annual change in axial length (AL) (millimeters/year) and in refraction (R) (diopters/year). RESULTS A total of 81 RCTs (27227 eyes) were included. In comparison with control, orthokeratology (AL, -0.36 [-0.53, -0.20], P < 0.05; R, 0.55 [0.31, 0.80], P < 0.05), 1%Atropine (AL, -0.39 [-0.65, -0.14], P < 0.05; R, 0.53 [0.28, 0.79], P < 0.05), 1%Atropine + bifocal spectacle lenses (AL, -0.60 [-1.1, -0.13], P < 0.05; R, 1.1 [0.55, 1.6], P < 0.05), 0.01%Atropine + orthokeratology (AL, -0.47 [-0.79, -0.14], P < 0.05; R, 0.81 [0.38, 1.2], P < 0.05) could significantly slow the progression of myopia; in addition, progressive multi-focal spectacle lenses (0.42, [0.00, 0.85], P < 0.05), progressive multi-focal soft contact lenses (0.78, [0.20, 1.4], P < 0.05), 0.5%Atropine (0.69 [0.24, 1.1], P < 0.05), 0.1%Atropine (0.43 [0.11, 0.75], P < 0.05), 0.05%Atropine (0.56 [0.24, 0.89], P < 0.05), 0.01%Atropine (0.34 [0.13, 0.54], P < 0.05), 1%Atropine + progressive multi-focal spectacle lenses (0.66 [0.17, 1.1], P < 0.05), 0.01%Atropine + single vision spectacle lenses (0.70 [0.18, 1.2], P < 0.05), bifocal spectacle lenses + Massage (0.85 [0.16, 1.5], P < 0.05) showed significant slowing effect on the increase in refraction. Conclusions This network meta-analysis suggests that the combined measures were most effective, followed by Atropine.