Myopia, or nearsightedness, is a growing concern among children globally. Understanding how to effectively slow its progression is crucial. This article compares the efficacy of various interventions aimed at managing myopia progression in children, based on a comprehensive review of randomized controlled trials (RCTs).
A detailed search across major medical databases including MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials was conducted to identify relevant RCTs. The analysis focused on studies that assessed interventions for controlling myopia progression in children over at least one year. The primary outcomes measured were the annual change in refraction (diopters/year) and axial length (millimeters/year), key indicators of myopia progression.
Thirty RCTs, encompassing 5422 eyes, met the inclusion criteria and were analyzed. Network meta-analysis revealed significant differences in efficacy among various interventions compared to placebo or single vision spectacle lenses. Atropine, particularly in high, moderate, and low doses, demonstrated the most substantial impact in slowing myopia progression. High-dose atropine showed a refraction change of 0.68 and an axial length change of -0.21. Moderate and low-dose atropine also exhibited similar marked reductions in both refraction and axial length changes.
Other interventions showed moderate to slight effects. Pirenzepine, orthokeratology, and peripheral defocus modifying contact lenses presented moderate efficacy. Pirenzepine showed a refraction change of 0.29 and an axial length change of -0.09. Orthokeratology and peripheral defocus modifying contact lenses primarily affected axial length change, with reductions of -0.15 and -0.11, respectively. Progressive addition spectacle lenses showed the least effect, with a refraction change of 0.14 and an axial length change of -0.04, indicating only a slight impact on myopia progression.
In conclusion, this analysis highlights that a range of interventions can effectively reduce myopia progression compared to single vision spectacle lenses or placebo. Pharmacological interventions, specifically muscarinic antagonists like atropine and pirenzepine, were identified as the most effective. Specially designed contact lenses, including orthokeratology and peripheral defocus modifying contact lenses, offer moderate efficacy. In contrast, specially designed spectacle lenses demonstrated minimal effect. These findings suggest that while multiple options exist, pharmacological approaches and specialized contact lenses are more effective in managing myopia progression in children.
