Myopia prevention and control in children: a systematic review and network meta-analysis

Objectives To analyse 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. The main outcomes included mean annual change in axial length (AL) (millimetres/year) and in refraction (R) (dioptres/year). Results A total of 80 RCTs (27103 eyes) were included. In comparison with control, orthokeratology (AL, −0.36 [−0.53, −0.20], P < 0.05; R, 0.56 [0.34, 0.77], P < 0.05), 1%Atropine (AL, −0.39 [−0.65, −0.13], P < 0.05; R, 0.54 [0.31, 0.77], P < 0.05), 0.01%Atropine + orthokeratology (AL, −0.47 [−0.80, −0.14], P < 0.05; R, 0.81 [0.43, 1.20], P < 0.05) could significantly slow the progression of myopia; in addition, progressive multi-focal spectacle lenses (PMSL) (0.42, [0.06, 0.79], P < 0.05), bifocal soft contact lenses (0.40, [0.03, 0.77], P < 0.05), 0.5%Atropine (0.67 [0.25, 1.10], P < 0.05), 0.1%Atropine (0.42 [0.15, 0.71], P < 0.05), 0.05%Atropine (0.57 [0.28, 0.86], P < 0.05), 0.01%Atropine (0.33 [0.15, 0.52], P < 0.05), 1%Atropine + bifocal spectacle lenses (BSL) (1.30 [0.54, 2.00], P < 0.05), 1%Atropine + PMSL (0.66 [0.23, 1.10], P < 0.05), 0.01%Atropine + single vision spectacle lenses (SVSL) (0.70 [0.23, 1.10], P < 0.05), 0.01%Atropine + orthokeratology (0.81 [0.43, 1.20], P < 0.05), BSL + Massage (0.85 [0.22, 1.50], P < 0.05), SVSL + Red light (0.59 [0.06, 0.79], P < 0.05) showed significant slowing effect on the increase in R. Conclusions This network meta-analysis suggests that the combined measures were most effective in AL and R, followed by Atropine.