Effectiveness of myopia control interventions: A systematic review of 12 randomized control trials published between 2019 and 2021

Abstract

PurposeThis study aims to investigate the effectiveness of interventions to control myopia progression. In this systematic review, the primary outcomes were mean differences (MD) between treatment and control groups in myopia progression (D) and axial length (AL) elongation (mm).ResultsThe following interventions were found to be effective (p < 0.001): highly aspherical lenslets (HAL, 0.80 D, 95% CI, 0.77–0.83; −0.35 mm, 95% CI −0.36 to −0.34), MiSight contact lenses (0.66 D, 95% CI, 0.63–0.69; −0.28 mm, 95% CI −0.29 to −0.27), low dose atropine 0.05% (0.54 D, 95% CI, 0.38–0.70; −0.21 mm, 95% CI-0.28 to −0.14), Biofinity +2.50 D (0.45 D, 95% CI, 0.29, 0.61; −0.24 mm, 95% CI −0.33 to −0.15), defocus incorporated multiple segments [DIMS] (0.44 D, 95% CI, 0.42–0.46; −0.34 mm, 95% CI −0.35 to −0.33) and ortho-k lenses (−0.24 mm, 95% CI −0.33 to −01.5).ConclusionLow-dose atropine 0.01% was not effective in reducing AL progression in two studies. Treatment efficacy with low-dose atropine of 0.05% showed good efficacy. Spectacles (HAL and DIMS) and contact lenses (MiSight and Biofinity) may confer a comparable treatment benefit compared to atropine, to slow myopia progression.

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

“…However, head-to-head comparisons revealed no statistical difference among atropine concentrations, except for 0.01% vs. 1% (MD, − 0.42; 95% CI − 0.71 to − 0.13) [ 48 ]. Similarly, in another recently published systematic review the estimated mean difference (MD) for myopia progression for atropine was found to be 0.29 D (95% CI 0.22–0.36; p = 0.03) [ 58 ]. In the present review, the most recent 16 out of initial 41 articles on RCTs were analyzed (Supplementary Table 3 ): a noticeable difference between these studies can be observed in terms of sample size [ 107 – 109 ], study length and design [ 110 – 114 ], the age of the children studied [ 106 , 109 ], location of trial [ 115 – 117 ], and the different atropine doses, which varied between 0.0025% and 1%, as well as the application frequency of drops [ 110 , 114 , 118 , 119 ], and lastly their aims [ 109 , 111 , 112 , 120 ].…”

“…In children with faster myopia progression, effectiveness may improve with increased wear time, and with lens designs possessing higher hyperopic power in the mid-periphery (up to 6 D) [ 164 , 165 ]. In a recent meta-analysis Lanca et al [ 58 ] estimated the myopia progression mean differences (MD) for SCL at 0.39 D (95% CI 0.21, 0.56; p < 0.001); however, different types of myopia-controlling bifocal and multifocal SCL were included in this investigation. Besides the study reported by Lam et al, in which defocus incorporated soft contact (DISC) lenses reduced myopia progression by 60% [ 166 ], four more recently published RCTs about different SCL to reduce myopia progression were included in this review (Supplementary Table 5 ) [ 167 – 170 ]: The first reported results from a double-masked RCT conducted in multiple centers in China and North America involved approximately 200 children, randomly assigned to four arms: two prototype myopia control SCL with non-coaxial ring-focus designs, one for enhancing efficacy (EE) and one for enhancing vision (EV), compared to dual-focus and SV SCL.…”

“…Myopia control spectacles, e.g., DIMS and HAL, have gained popularity owing to their safety, and they are considered effective if children are compliant [ 66 ]. The evidence, however, is still very limited and validation of the effectiveness of novel myopia control spectacles regarding their long-term effectiveness and rebound in the real world is necessary [ 19 , 58 , 66 , 201 , 209 ]. Myopia control multifocal SCL are also gaining popularity for active school-going children, and daily disposable modalities carry a tenfold lower risk for microbial keratitis compared to overnight OK lenses [ 242 – 245 ].…”

“…As clinicians grapple with rebound and attempt to address these concerns about long-term sustained effects, strategies that employ interventions in combination or sequentially are gaining attention [ 246 , 247 ]. These approaches are also considered in children who are “unresponsive” to their initial modality [ 58 ]. Within the framework of this review, four publications on RCTs investigating different combinations of treatments were identified and included (Supplementary Table 7 ) [ 248 – 251 ].…”

Myopia control: short-term effect of 0.01% atropine vs. defocus incorporated multiple segment lenses—a retrospective study in European children

“…A recent systematic review investigating the effectiveness of myopia control interventions by Lanca et al reported that low-dose atropine 0.01% was not effective in reducing AL progression in two studies at 12 months. Treatment efficacy with low-dose atropine of 0.05% showed good efficacy [ 21 ].…”