Clinical

A Study: Interventions to Control Myopia Progression

By Divya Jagadeesh
PhD student, Brien Holden Vision Institute

This study provides an overview of systematic reviews and meta-analyses on the safety and efficacy of interventions used for myopic control. In this overview, the authors screened 2319 non-duplicates from 3057 records that led to the inclusion of 18 eligible systematic reviews and meta-analyses published between 2002 and 2017. These 18 eligible systematic reviews and meta-analyses included 28 randomized control trials and 16 observational studies (total 44 eligible publications) that reported on 6400 children.

Effects of interventions
The authors assessed the outcomes based on the change in refractive error and change in axial length from baseline to 1 year and baseline to 2 years for different myopia interventions. The key results were:

  • While considering the effects of under-corrected and fully corrected spectacles, the under-corrected group showed a greater change in the refractive error at 1 year (mean difference 0.15, 95% CI 0.00 to 0.29) 0.29), and 2 years from baseline (MD 0.20, 95% CI 0.01 to 0.39) with a moderate level of evidence quality of the outcome.
  • There was no difference with the use of bifocal spectacles for myopia control and single vision lens spectacles as suggested by sensitivity analysis of 3 randomized control trails.
  • A comparison of 1% atropine and placebo showed atropine to reduce refractive error change (MD -0.92, 95% CI -1.08 to − 0.76) and favor less axial length change (MD – 0.36, 95% CI -0.43 to − 0.29) compared to placebo.
  • In a comparison of 0.025 to 0.05% atropine versus control, atropine showed less refractive change at 1 year (MD -0.51, 95% CI -0.60 to − 0.41) when compared to control. Similarly, a favorable effect was observed with 0.01% atropine compared to the control in a cohort study that examined 60 children. The refractive error change at 1 year was (MD -0.50, 95% CI -0.76 to − 0.24). However, the quality of evidence was very low.
  • 2% Pirenzepine gel had a favorable effect in slowing myopia (reduced axial length by -0.10 mm in 1 year compared to placebo). It should also be noted that Pirenzepine may induce abnormality of accommodation and reduce visual acuity.
  • No difference in the axial length change was observed between rigid gas permeable contact lenses when compared to spectacles or single vision lenses.
  • Concentric ring bifocal soft contact lenses showed a favorable change of -0.15 DS in a year compared to single vision contact lenses. However, contact lens-related discomfort or unwillingness to wear contact lenses was reported in 2 trials (261 children).
  • Peripheral add multifocal soft contact lenses showed no change in refractive error but demonstrated axial length change (1 year) compared to single vision lenses.
  • Orthokeratology lenses showed a change in axial length elongation ( 1 year) by -0.19 mm after subgroup analysis of 2 randomized control trials and a change in axial length elongation in 1 year by -0.18 mm after subgroup analysis of 6 cohort studies. The reported reactions include mild corneal erosion as reported by 2 cohort studies (151 children).
  • Progressive addition lenses showed a reduction in the refractive error change by − 0.26D (95% CI, − 0.39 to − 0.12), with moderate inconsistency among the 2-year results from 4 randomized control trials (940 children). An axial length change of −0.10mm (95% CI -0.20 was also reported in 3 randomized control trials, however, inconsistencies was observed between the studies.

The authors conclude that atropine was an efficient myopia control intervention followed by orthokeratology and novel multifocal contact lenses. They also discussed the lack of a uniform method of intervention that can be adapted to control myopia progression due to heterogeneity amongst the reported studies, side effects of the interventions and lack of long-term follow-up. Their recommendations for future research were for effective interventions and combinations therapies.

Abstract
Efficacy and safety of interventions to control myopia progression in children: an overview of systematic reviews and meta-analyses

Efthymia Prousali, Anna-Bettina Haidich , Andreas Fontalis, Nikolaos Ziakas , Periklis Brazitikos and Asimina Mataftsi

Background: Myopia is a common visual disorder with increasing prevalence. Halting progression of myopia is critical, as high myopia can be complicated by a number of vision-compromising conditions.

Methods: Literature search was conducted in the following databases: Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica dataBASE (EMBASE), Cochrane Database of Systematic Reviews (CDSR), Database of Abstracts of Reviews of Effects (DARE) and Centre for Reviews and Dissemination (CRD) Health Technology Assessment (HTA) database. Systematic reviews and meta-analyses investigating the efficacy and safety of multiple myopia interventions vs control conditions, were considered. Methodological quality and quality of evidence of eligible studies were assessed using the ROBIS tool and GRADE rating. The degree of overlapping of index publications in the eligible reviews was calculated with the corrected covered area (CCA).

Results: Forty-four unique primary studies contained in 18 eligible reviews and involving 6400 children were included in the analysis. CCA was estimated as 6.2% and thus considered moderate. Results demonstrated the superior efficacy of atropine eyedrops; 1% atropine vs placebo (change in refraction: -0.78D, [− 1.30 to − 0.25] in 1 year), 0.025 to 0.05% atropine vs control (change in refraction: -0.51D, [− 0.60 to − 0.41] in 1 year), 0.01% atropine vs control (change in refraction: -0.50D, [− 0.76 to − 0.24] in 1 year). Atropine was followed by orthokeratology (axial elongation: − 0.19 mm, [− 0.21 to − 0.16] in 1 year) and novel multifocal soft contact lenses (change in refraction: -0.15D, [− 0.27 to − 0.03] in 1 year). As regards adverse events, 1% atropine induced blurred near vision (odds ratio [OR] 9.47, [1.17 to 76.78]) and hypersensitivity reactions (OR 8.91, [1.04 to 76.03]).

Conclusions: Existing evidence has failed to convince doctors to uniformly embrace treatments for myopic progression control, possibly due to existence of some heterogeneity, reporting of side effects and lack of long-term follow-up. Research geared towards efficient interventions is still necessary.

Source
Prousali, E., Haidich, A. B., Fontalis, A., Ziakas, N., Brazitikos, P., & Mataftsi, A. (2019). Efficacy and safety of interventions to control myopia progression in children: an overview of systematic reviews and meta-analyses. BMC ophthalmology, 19(1), 106.

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