A systematic review and meta-analysis of the efficacy of different optical interventions on the control of myopia in children

Effectiveness of various atropine concentrations in myopia control for Asian children: a network meta-analysis

Objectives

To assess the effectiveness of various atropine concentrations in managing myopia among children in East, South, and Southeast Asia, and to determine the most effective concentration.

Methods

A systematic literature review was conducted using PubMed, Web of Science, Cochrane Library, and EMBASE. The search was limited to articles published up to 1 June 2024, and included studies in Chinese or English. Two researchers independently screened the literature, extracted relevant data, and assessed the data quality using the Revised Cochrane risk-of-bias 2 (RoB2) tool. A network meta-analysis was performed using Stata 14.2 software to compare the efficacy of different atropine concentrations in delaying myopia progression, measured by changes in refraction and axial length.

Results

The analysis included 39 studies with 7,712 participants, examining 10 atropine concentrations ranging from 0.005% to 1%. Forest plots indicated that five concentrations (0.01%, 0.02%, 0.025%, 0.05%, and 1%) were more effective than a placebo in controlling myopia progression. The cumulative ordination plot indicated that 0.05% atropine most effectively delayed refraction change, which the mean change per year was 0.62D, while 1% was superior in slowing axial length progression, which the mean change per year was -0.43 mm. Considering both measures, 1% atropine showed the highest efficacy which the mean changes per year were 0.56D in spherical equivalent refraction and -0.43 mm in axial length, followed by 0.05% and 0.125% atropine.

Conclusion

While 1% atropine demonstrated the highest efficacy in myopia control among East, South and Southeast Asian children, its use is not recommended due to increased adverse effects and a rapid rebound in myopia after cessation. Considering both efficacy and safety, 0.05% atropine is suggested as the optimal concentration for myopia management in this population.

Interactions Between High-Intensity Light and Unrestricted Vision in the Drive for Hyperopia

Purpose

To evaluate the impact of optical vs. illuminance factors and their duration-dependency on lens-induced hyperopia (LIH) in chick eyes.

Methods

Hyperopia was induced in one eye in chicks (10 groups; n = 126) from day 1 after hatching until day 8 using +10-diopter lenses with fellow eyes as controls. One group (LIH) served as the control without any interventions. The remaining groups were exposed to 2, 4, or 6 hours of unrestricted vision (UnV), high-intensity light (HL; 15,000 lux), or both (HL + UnV). Ocular axial length (AL), refractive error, and choroidal thickness were measured on days 1, 4, and 8. Inter-ocular difference (IOD = experimental - contralateral control eye) ± SEM was used to express outcome measures.

Results

By day 8, LIH decreased AL (-0.42 ± 0.03 mm) and produced hyperopic refraction (+3.48 ± 0.32 diopters) and choroidal thickening (+85.81 ± 35.23 µm) in the LIH group (all P < 0.001). Exposure to UnV reduced LIH (i.e., hyperopic refraction, axial shortening, and choroidal thickening) in a duration-dependent manner, whereas HL potentiated the development of LIH in a duration-dependent manner. When combined, UnV overpowered HL, with resultant impact on refraction and AL being close to UnV alone, except at 6 hours, when HL + UnV induced shorter AL compared with UnV alone (P = 0.03).

Conclusions

Daily exposure to HL, UnV, and HL + UnV altered LIH in a duration-dependent manner with UnV and LIH producing competing signals. The signal generated by UnV was generally stronger than HL in combined exposure, yet longer durations of HL affected the drive for emmetropization in eyes with UnV.

Incidence of microbial keratitis associated with overnight orthokeratology: a multicenter collaborative study

PURPOSE

To investigate the incidence of microbial keratitis among Japanese patients wearing orthokeratology (ortho-k) lenses STUDY DESIGN: Retrospective multicenter study METHOD: This study was conducted at 4 hospitals in Japan and involved 1438 patients who had been prescribed ortho-k lenses and had worn them for at least 3 months. Data on patient demographics, lens characteristics, lens care systems, and presence of microbial keratitis were extracted from the medical records. Duration of ortho-k lens wear was calculated from the original fitting date to the patient's last visit, with the total years of lens wear used as person-years of lens wear. The incidence of microbial keratitis was calculated by dividing the number of infected cases by the total person-years of lens wear for all enrolled participants.

RESULTS

Among the 1438 patients, 753 were male and 685 were female, with a mean age of 12.7 ± 5.4 years. The mean duration of ortho-k lens wear was 5.2 ± 4.5 years, and the mean lens power was -3.52 ± 1.41 D. The total person-years of lens wear for all enrolled patients was 7415. Four cases of microbial keratitis were identified, resulting in an overall incidence of microbial keratitis of 5.4 (95% CI: 1.0-9.8) per 10,000 patient-years among ortho-k lens wearers.

CONCLUSION

This study represents the largest sample size to date for estimating the incidence of microbial keratitis associated with ortho-k lenses. The incidence was similar to or slightly lower than that of previous studies on ortho-k-related microbial keratitis and also comparable to that of daily wear soft contact lenses.

Myopia Control: Are We Ready for an Evidence Based Approach?

INTRODUCTION

Myopia and its vision-threatening complications present a significant public health problem. This review aims to provide an updated overview of the multitude of known and emerging interventions to control myopia, including their potential effect, safety, and costs.

METHODS

A systematic literature search of three databases was conducted. Interventions were grouped into four categories: environmental/behavioral (outdoor time, near work), pharmacological (e.g., atropine), optical interventions (spectacles and contact lenses), and novel approaches such as red-light (RLRL) therapies. Review articles and original articles on randomized controlled trials (RCT) were selected.

RESULTS

From the initial 3224 retrieved records, 18 reviews and 41 original articles reporting results from RCTs were included. While there is more evidence supporting the efficacy of low-dose atropine and certain myopia-controlling contact lenses in slowing myopia progression, the evidence about the efficacy of the newer interventions, such as spectacle lenses (e.g., defocus incorporated multiple segments and highly aspheric lenslets) is more limited. Behavioral interventions, i.e., increased outdoor time, seem effective for preventing the onset of myopia if implemented successfully in schools and homes. While environmental interventions and spectacles are regarded as generally safe, pharmacological interventions, contact lenses, and RLRL may be associated with adverse effects. All interventions, except for behavioral change, are tied to moderate to high expenditures.

CONCLUSION

Our review suggests that myopia control interventions are recommended and prescribed on the basis of accessibility and clinical practice patterns, which vary widely around the world. Clinical trials indicate short- to medium-term efficacy in reducing myopia progression for various interventions, but none have demonstrated long-term effectiveness in preventing high myopia and potential complications in adulthood. There is an unmet need for a unified consensus for strategies that balance risk and effectiveness for these methods for personalized myopia management.

Effectiveness of a Spectacle Lens with a Specific Asymmetric Myopic Peripheral Defocus: 12-Month Results in a Spanish Population

BACKGROUND

Different designs of ophthalmic lenses have been studied to control the progression of myopia in children. This study aims to evaluate the short-term efficacy of a new design of ophthalmic lens with asymmetric myopic peripheral defocus (MPDL) on myopia progression in children compared to a control group wearing a single-vision lens (SVL).

METHODS

Children aged 5 to 12 with myopia up to -0.50 D, astigmatism and anisometropia under 1.50 D, and corrected visual acuity over 20/20 were randomized to either the study group (MPDL) or control group (SVL). The myopia progression was evaluated by measuring axial length (AL) growth (IOL Master; Zeiss) over a period of one year.

RESULTS

Ninety-two subjects were recruited. Forty-six children were randomly assigned to the control group, and 46 to the study group. In total, 83 children completed the clinical trial, with a mean age of 10.81 [9.53-11.92] years, among which 59.04% were female. After one year of treatment, there was less AL elongation in the study group compared to the control group (0.16 ± 0.16 mm vs. 0.24 ± 0.16 mm, p = 0.034).

CONCLUSIONS

The MPDL significantly reduced the absolute growth of AL by 39% (p = 0.014) and relative growth of AL by 37.3% (p = 0.012) after 12 months in comparison to the control group in a Spanish population.