Atropine Slows Myopia Progression More in Asian than White Children by Meta-analysis

Li, Shiming; Wu, Shanshan; Kang, Meng-Tian; Liu, Ying; Jia, S.; Li, Si-Yuan; Zhan, Siyan; Liu, Luo-Ru; He, Lin; Chen, Wei; Zhou, Yang; Sun, Yu; Wang, Ke; Millodot, Michel

doi:10.1097/opx.0000000000000178

Cited by 80 publications

(84 citation statements)

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“…5 Interestingly, we found a greater effect of orthokeratology in Asian children than in Caucasian children with a difference of 0.06 mm in axial elongation during two years. This finding was consistent with those of our previous reports on atropine 23 and multifocal lenses. 22 Therefore, Asian children can benefit more from myopia interventions than Caucasian children, which may be due to initial higher myopia 28 and more rapid myopia progression 29 in Asian children than Caucasian children.…”

Section: Discussionsupporting

confidence: 95%

“…In agreement with our previous meta-analysis on atropine, 23 RCTs and cohort studies on orthokeratology in this study also achieved similar effect size (À0.28 mm versus À0.27 mm) and thus were comparable. This finding is meaningful because it is relatively difficult to perform RCTs on orthokeratology at the current condition to confirm its effect on controlling myopia progression in children.…”

Section: Discussionsupporting

confidence: 93%

“…In the present study, the difference in slowing myopia progression for orthokeratology versus control between Asian and Caucasian children was about 0.1 D/year. The ethnic difference was 0.19 D/year for atropine 23 and 0.05 D/year for multifocal lenses. 22 Consistent with previous study, 22 the benefit from orthokeratology was greater in children with higher myopia at baseline than children with low myopia with a difference of 0.05 mm (about 0.15 D) during two years.…”

Section: Discussionmentioning

confidence: 98%

“…21 We have found that Asian children with low myopia benefit more (0.19D) from wearing multifocal spectacle lenses compared to Caucasian children (0.09D) with low myopia during 24 months, 22 and Asian children also benefit more (0.54D) from atropine compared to Caucasian children (0.35D). 23 It is unclear whether orthokeratology also has different effects on slowing axial elongation correspondent to ethnicity.…”

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confidence: 99%

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Efficacy, Safety and Acceptability of Orthokeratology on Slowing Axial Elongation in Myopic Children by Meta-Analysis

Kang

et al. 2015

Current Eye Research

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Section: Discussionsupporting

confidence: 95%

Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 98%

mentioning

confidence: 99%

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Efficacy, Safety and Acceptability of Orthokeratology on Slowing Axial Elongation in Myopic Children by Meta-Analysis

Kang

et al. 2015

Current Eye Research

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111

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“…In recent years, many groups have reported the efficacy of various treatments in reducing progression of myopia, such as atropine eyedrops[8,9], orthokeratology[10,11], and specialized contact lens[12]. However, all these treatment options may suffer potentially severe side effects [8,13], and thus may raise challenges in clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Identifying Children at Risk of High Myopia Using Population Centile Curves of Refraction

et al. 2016

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PurposeTo construct reference centile curves of refraction based on population-based data as an age-specific severity scale to evaluate their efficacy as a tool for identifying children at risk of developing high myopia in a longitudinal study.MethodsData of 4218 children aged 5–15 years from the Guangzhou Refractive Error Study in Children (RESC) study, and 354 first-born twins from the Guangzhou Twin Eye Study (GTES) with annual visit were included in the analysis. Reference centile curves for refraction were constructed using a quantile regression model based on the cycloplegic refraction data from the RESC. The risk of developing high myopia (spherical equivalent ≤ -6 diopters [D]) was evaluated as a diagnostic test using the twin follow-up data.ResultsThe centile curves suggested that the 3rd, 5th, and 10th percentile decreased from -0.25 D, 0.00 D and 0.25 D in 5 year-olds to -6.00 D, -5.65D and -4.63 D in 15 year-olds in the population-based data from RESC. In the GTES cohort, the 5th centile showed the most effective diagnostic value with a sensitivity of 92.9%, a specificity of 97.9% and a positive predictive value (PPV) of 65.0% in predicting high myopia onset (≤-6.00D) before the age of 15 years. The PPV was highest (87.5%) in 3rd centile but with only 50.0% sensitivity. The Mathew’s correlation coefficient of 5th centile in predicting myopia of -6.0D/-5.0D/-4.0D by age of 15 was 0.77/0.51/0.30 respectively.ConclusionsReference centile curves provide an age-specific estimation on a severity scale of refractive error in school-aged children. Children located under lower percentiles at young age were more likely to have high myopia at 15 years or probably in adulthood.

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Efficacy and Adverse Effects of Atropine in Childhood Myopia

et al. 2017

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IMPORTANCE Some uncertainty about the clinical value and dosing of atropine for the treatment of myopia in children remains. OBJECTIVE To evaluate the efficacy vs the adverse effects of various doses of atropine in the therapy for myopia in children. DATA SOURCES Data were obtained from PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials, from inception to April 30, 2016. The reference lists of published reviews and clinicaltrials.gov were searched for additional relevant studies. Key search terms included myopia, refractive errors, and atropine. Only studies published in English were included. STUDY SELECTION Randomized clinical trials and cohort studies that enrolled patients younger than 18 years with myopia who received atropine in at least 1 treatment arm and that reported the annual rate of myopia progression and/or any adverse effects of atropine therapy were included in the analysis. DATA EXTRACTION AND SYNTHESIS Two reviewers independently abstracted the data. Heterogeneity was statistically quantified by Q, H, and I 2 statistics, and a meta-analysis was performed using the random-effects model. The Cochrane Collaboration 6 aspects of bias and the Newcastle-Ottawa Scale were used to assess the risk for bias. MAIN OUTCOMES AND MEASURES The primary outcome was a difference in efficacy and the presence of adverse effects at different doses of atropine vs control conditions. The secondary outcomes included the differences in adverse effects between Asian and white patients. RESULTS Nineteen unique studies involving 3137 unique children were included in the analysis. The weighted mean differences between the atropine and control groups in myopia progression were 0.50 diopters (D) per year (95% CI, 0.24-0.76 D per year) for low-dose atropine, 0.57 D per year (95% CI, 0.43-0.71 D per year) for moderate-dose atropine, and 0.62 D per year (95% CI, 0.45-0.79 D per year) for high-dose atropine (P < .001), which translated to a high effect size (Cohen d, 0.97, 1.76, and 1.94, respectively). All doses of atropine, therefore, were equally beneficial with respect to myopia progression (P = .15). High-dose atropine were associated with more adverse effects, such as the 43.1% incidence of photophobia compared with 6.3% for low-dose atropine and 17.8% for moderate-dose atropine (χ 2 2 = 7.05; P = .03). In addition, differences in the incidence of adverse effects between Asian and white patients were not identified (χ 2 1 = 0.81; P = .37 for photophobia). CONCLUSIONS AND RELEVANCE This meta-analysis suggests that the efficacy of atropine is dose independent within this range, whereas the adverse effects are dose dependent.

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Atropine Slows Myopia Progression More in Asian than White Children by Meta-analysis

Abstract: Atropine could significantly slow myopia progression in children, with greater effects in Asian than in white children. Randomized controlled trials and cohort studies provided comparable effects.

Cited by 80 publications

References 32 publications

Efficacy, Safety and Acceptability of Orthokeratology on Slowing Axial Elongation in Myopic Children by Meta-Analysis

Efficacy, Safety and Acceptability of Orthokeratology on Slowing Axial Elongation in Myopic Children by Meta-Analysis

Identifying Children at Risk of High Myopia Using Population Centile Curves of Refraction

Efficacy and Adverse Effects of Atropine in Childhood Myopia

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