July 5, 2023
By Dwight Akerman, OD, MBA, FAAO, FBCLA, FIACLE
Most published myopia clinical trials study a single intervention versus control, lacking direct head-to-head comparisons. Conventional meta-analyses enable comparisons between two interventions only, do not enable comparisons between multiple treatments, and most meta-analyses give statistical advice only on the efficacy of a single intervention.
In practice, two or more therapies are often combined to treat childhood myopia, especially myopia progressing rapidly. Previously, the additive effect of combined intervention in preventing and controlling myopia has been proposed; however, conclusions still need to be supported by a large amount of evidence. Therefore, this network meta-analysis directly or indirectly compared the efficacy of 37 interventions, including combined interventions, and ranked them to provide more comprehensive and reliable evidence-based medical recommendations for preventing and controlling myopia in children.
The researchers selected 81 randomized controlled trials involving 27,227 eyes. The primary outcomes included mean annual change in axial length (millimeters/year) and refraction (diopters/year).
For slowing axial progression, the cumulative probability ranking results for each intervention showed that the top ten were 1% atropine + bifocal spectacle lenses (88.6%) > 0.01% atropine + orthokeratology (80.9%) > 1% atropine (75.9%) > 0.01% atropine + single vision spectacle lenses (74.0%) > orthokeratology (72.9%) > 1% atropine + progressive multifocal spectacle lenses (68.2%) > 0.5% atropine (67.8%) > 0.1% atropine (65.8%) > 0.05% atropine (64.7%) > 1% atropine + racanisodamine (64.0%), suggesting 1% atropine + bifocal spectacle lenses may be the most effective measure to delay axial growth.
For slowing refraction progression, the cumulative probability ranking results for each intervention showed that the top ten were 1% atropine + bifocal spectacle lenses (94.8%) > 0.01% atropine + orthokeratology (85.7%) > bifocal spectacle lenses + eye massage (84.3%) > progressive multifocal soft contact lenses (82.0%) > 0.5% atropine (78.7%) > 0.01% atropine + single vision spectacle lenses (77.9%) > 1% atropine + progressive multifocal spectacle lenses (75.9%) > 0.05% atropine (70.9%) > orthokeratology (69.6%) > single vision spectacle lenses + red light (69.2%), suggesting that 1% atropine + bifocal spectacle lenses may be the most effective measure to slow refractive progress.
The researchers concluded that their network meta-analysis provides valuable evidence-based guidelines for analyzing the effectiveness of myopia prevention and control measures. Most of the combination therapies were more effective than monotherapy.
Abstract
Myopia Prevention and Control in Children: A Systematic Review and Network Meta-Analysis
Guanghong Zhang, Jun Jiang, Chao Qu
Objectives: 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 one 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 (27,227 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 multifocal spectacle lenses (0.42, [0.00, 0.85], P < 0.05), progressive multifocal 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 multifocal 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 + eye 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 monotherapy.
Zhang G, Jiang J, Qu C. Myopia prevention and control in children: a systematic review and network meta-analysis. Eye. April 27, 2023. [Epub ahead of print].
DOI: https://doi.org/10.1038/s41433-023-02534-8
