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Clinical observation of the development of juvenile myopia wearing glasses with full correction and under-correction

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Y.-H. Chen
Y.-H. Chen
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Abstract

AIM: To observe the effect of wearing glasses with full correction or under-correction on the development of juvenile myopia. METHODS: This study included 132 cases (264 eyes) from January 2008 to September 2012 who were collected from our clinic.They were divided into 2 groups, full correction and under-correction. Students in group 1 wore glasses with full correction, students in group 2 wore glasses with under-correction 0.25D to 0.5D lower than normal. Reexamination was done every 6mo.After 12mo, refractions were checked, the development of myopia was compared. RESULTS: There were no statistically significant differences between two groups after 6mo(P=0.0693); however, there were significant differences after 12mo(P=0.0013). CONCLUSION: The development of myopia is slow if students often wear glasses with full correction.
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·临床报告·
青少年近视足矫与欠矫配镜的临床观察
陈耀华
作者单位:(226001) 中国江苏省南通市中医院眼科
作者简介:陈耀华,毕业于南通大学,硕士,主治医师,研究 方向:
眼视光、眼表疾病、白内障。
通讯作者:陈耀华. pingping0118@ hotmail. com
收稿日期: 2014-02-13摇 摇 修回日期: 2014-07-07
Clinical observation of the development of
juvenile myopia wearing glasses with full
correction and under-correction
Yao-Hua Chen
Department of Ophthalmology, Nantong Hospital of Traditional
Chinese Medicine, Nantong 226001,Jiangsu Province,China
Correspondence to: Yao - Hua Chen. Department of Ophthalmology,
Nantong Hospital of Traditional Chinese Medicine, Nantong 226001,
Jiangsu Province,China. pingping0118@ hotmail. com
Received:2014-02-13摇 摇 Accepted:2014-07-07
Abstract
誗AIM:To observe the effect of wearing glasses with full
correction or under -correction on the development of
juvenile myopia.
誗METHODS:This study included 132 cases (264 eyes )
from January 2008 to September 2012 who were collected
from our clinic. They were divided into 2groups,full
correction and under -correction. Students in group 1
wore glasses with full correction,students in group 2
wore glasses with under -correction 0.25D to 0.5D lower
than normal. Reexamination was done every 6mo. After
12mo,refractions were checked,the development of
myopia was compared.
誗RESULTS:There were no statistically significant
differences between two groups after 6mo (P= 0 .0693 ) ;
however,there were significant differences after 12mo(P=
0.0013).
誗CONCLUSION:The development of myopia is slow if
students often wear glasses with full correction.
誗KEYWORDS:myopia;comprehensive optometry;
full correction
Citation:Chen YH. Clinical observation of the development of
juvenile myopia wearing glasses with full correction and under -
correction. Guoji Yanke Zazhi(Int Eye Sci) 2014;14(8):1553-1554
摘要
目的:观察青少年近视患者足矫或欠矫配镜的近视发展
程度。
方法:选 取 2008 - 01 / 2012 - 09 在我科就诊的青少年近视
患者 132 例264 眼。分为足矫与欠矫两组,足矫组给予完
全矫正并要求配镜后常戴,欠矫组给予低矫-0. 25 ~ -0. 50D。
每隔 6mo 复查,随访 12mo 对比两组患者近视屈光度。
结果:足矫组与 欠矫组相比,6mo 时两 组 间平均近视度无
明显差异(P= 0 . 0693) ;12mo 时两组间比较有显著性差 异
(P= 0. 0013) 。
结论:足矫并且常戴镜患者的近视发展相对较慢。
关键词:近视;综合验光;足矫
DOI:10. 3980 / j. issn. 1672 -5123. 2014. 08. 58
引用:陈耀华.青少年近视足矫与欠矫配镜的 临床观察.国际眼
科杂志 2014;14(8 ) :1553-1554
0引言
摇 摇 青少年近视作为眼科常见病,随着电视、电脑、手机等
数码产品的普及和网络的发展,青少年近视的发生和发展
逐渐呈上升趋势。目前最主流的矫正方法仍旧是框架眼
镜,但在验配过程中近视足矫或欠矫一直是争论的焦
点[1 - 3] 。我科 在 2008 - 01 / 2012 - 09 对132 例青 少 年 近 视
患者验光后予配戴框架眼镜并跟踪随访,现报告如下。
1对象和方法
1. 1 对象摇选取 2008 -01 / 2012 - 09 在我科就 诊的青少年
近视患 者 132 例264 眼,男69 例,女63 例,年 龄 12 ~ 18
岁。其中 < - 3 . 00 DS 者145 眼, - 3. 00 ~ - 6. 00 DS 者78
眼,>-6. 00DS 者41 眼。伴有近视散 光患者 207 眼,散光
度-0. 50 ~ -1. 50DC。
1. 2 方法摇屈光矫正 准 确的医学验光 是 确 诊 真 性 近 视 的
基础[4,5]。将患者分为足矫组和欠矫组,足矫组 154 眼,欠
矫组 110 眼。两组在年龄、性别 等方面 无 明显 差 异 (P>
0郾 05) 。 两组患者在近视程度(低度 近视、中度近视、高度
近视)分布无明显差异(字2= 3 . 2023,P= 0. 202 ),以及 平均
近视度比较无明显 差异(t= 1. 8300,P= 0. 0684) 。 足矫组
给予完全矫正并要求配镜后常戴,欠矫组给予低矫 -0 . 25 ~
-0. 50D 也要求配镜后常戴。两组患者在医学验光前均经
眼科常规检查,排除眼球器质性病变及内斜、外斜。 (1 ) 初
级阶段:首先检查其裸眼 视 力,屈光间质,眼底检查,排除
器质性病变,然后进行验光。对于配合程度较好的患者直
接进行综合验光检查,少部分患者配合程度较差,无法完
成综合验光,可先电脑验光然后带状检影验光检查。其
中,多数近视患者不散 瞳验光,少数近视极度疲劳者须散
瞳验光后方能确定屈光度,经复 查后验配矫正。 ( 2) 精 确
阶段:主要针对配合程度较好的患儿。对初级阶段的数据
进行检验。使用的仪器为综合验光仪,借助多组辅助镜片
及散光表,红绿视标按照首先进行初次的单眼最正之最佳
视力,进行初次的单眼红绿平衡,交叉圆柱镜对柱镜的轴
向和度数进行精细 调 整,再次进行单眼的最正之最佳视
力,进行双眼平衡。 ( 3 ) 终极阶段:试镜 架测试。
3551
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摇摇摇摇摇摇摇摇摇摇摇摇表1摇 足矫与欠矫组近视发展情况 (軃
x依s,D)
组别 眼数 配镜前 配镜后 6mo 配镜后 12mo
足矫组 154 -3. 96 依0. 59 -4. 16 依0. 69 -4. 48 依0. 62
欠矫组 110 -4. 11 依0. 74 -4. 32 依0. 72 -4. 71 依0. 48
根据患者适应程度决定最后的配镜处方。每 隔 6mo 复
查,随访 12mo 并记录患者的屈光度,对比两组患者近视
屈光度。
摇 摇 统计学分析:记录患者在我科初诊,配镜 6,12mo 时屈
光度,分析数据采取等效球镜,即直接把散光度数折半再
加球镜度数计为患者近视度数。采用 STATA 7. 0 统计软
件进行数据处理,计量资料用均数依标准差(軃
x依s)表示,采
用成组 t检验比较,计数资料采用 字2检验。检验水准为 琢 =
0. 05。
2结果
摇 摇 欠矫及足矫患者近视发展情况见表 1。 欠矫组患者
与足矫组相比,配镜 6mo 后两组间平均近视度无明显差
异(t= 1. 8241,P= 0 . 0693 );配镜 12mo 后两组间比较有显
著性差异(t= 3 . 2552,P= 0 . 0013 )。
3讨论
摇 摇 近视是指平行光线经 眼球屈光 系统聚焦在视 网 膜 之
前的一种屈光状态。近 年 来,近视的发病率增加,近视患
者低龄化也十分突出。国内有调查发现,青少年近视率高
达50% ~ 60% ,占世界近视患者总数的 33% [6] 。传统观
点认为近距离长时间视近,由此所引发的调节是近视产生
和进展的原因,基于该理论,验光时通过减少度数降低看
近所需的调节以达到延缓近视发展的目的,但在看远时往
往处于欠矫[7] 。在长期的验配工作中发现,降低看近所需
的调节而看远处于欠矫 状态的验 配模式并没 有 延 缓患者
近视的进一步发展。越来越多的研究者对传统的近视调
节理论产生了质疑[8] 。
摇 摇 临床验配工作中,一般所遵循的原则是最大正镜最佳
矫正视力,但 在我 们 的一 线 工 作 中,常常把远视力达到
1郾 0 的最低近视度数作为最后的验配处方。按照以往的
原则,势必存在最佳视力大于 1. 0 的患儿有某种程度上的
欠矫[9] ,从而可能加速了这部分患儿的近视发展,因此,在
验配工作中,应该足矫配镜,避免患儿视物时欠矫。
摇 摇 越来越多的人支持近视离焦假说[ 10] 。该假说认为模
糊的视网膜成像质量是引 起近视的重要 原 因。近视 是 患
儿视物模糊的主要原因,模糊的影像使眼对聚焦的敏感性
下降,触发视网膜神经介质 2 - 视网膜 黏 蛋白介导的巩膜
生长机制,使巩膜扩张加速,眼轴延长,促使眼球近视化。
也就是说,近视患者不及时矫正,则视网膜难以清晰成像,
眼轴延长,会促进近视的发生。
摇 摇 对青少年近视患者是否采用散瞳验光,在实践中我们
发现,不散瞳和散瞳的验光结果几乎相同。多数近视患者
不散瞳可验光,在就诊患者中,如有近视极度疲劳者须散
瞳验光后方能确定屈光度[11] 。
摇 摇 对于研究中配合较好的患者,我们主要通过综合验光
仪对其进行的主觉验光,对屈光性质、屈光 度、散 光 轴 位、
双眼平衡、主导眼的确认均可以进行,相对于常规验光更
加结合眼部实际情况,验光结果更符合患者自身的近视 状
态,能最大程度上提高 患者的视觉 功 能,可以达到配镜清
晰舒适,阅读持久及医疗保健能力的目的。
摇 摇 本研究存在着一些不足之处。首先,参与随访的病例
数相对不多,可能会使结果 存在一定偏倚,即过高估计足
矫配镜对近视进展的影响。其次,随诊的时间相对较短,
有待更久的随访来验证。
摇 摇 我们在验配中,长期随访近视足矫和欠矫的青少年患
者,足矫并且常戴镜患儿的近视发展相对较慢。近视患儿
戴上足矫的眼镜使视网 膜接收到 的信息更加 清 晰 从而离
焦影响减到最小。
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... The corrected amount of myopia (full-correction or under-correction) has been the topics of several studies and discussed in several literatures. 6,30,31,33,37,38 Under-correction has been believed that can reduce the accommodative stimulus and demand at near, 47 and subsequently reduce the blur drive for accommodation, which may be a myopigenic factor. 48 Moreover, animal studies have also revealed that myopic defocus resulting from under correction or lack of correction could slow myopia. ...
... Some studies showed that under-correction slows down the myopia progression, 31,37 however, other studies reveled that full-correction could be effective in reducing myopia progression. 6,30,33,38 This systematic review and meta-analysis showed that the rate of myopia progression significantly differs between under-correction and full-correction approaches. The difference was statistically significant but clinically did not reach the significance level. ...
... 55 Moreover, our findings show that, the results of two studies with cycloplegic refraction 31,37 could not be comparable with other four non-cycloplegic studies. 6,30,33,38 The reason may be that Li 31 and Sun,37 in their studies, have applied different amount of under-correction, and just in one study 31 the exact rate of progression was reported based on each amount of under-correction, which was a limitation in Sun study. Sun et al. 37 have just reported the myopia progression for no correction group and compared it with full-correction. ...
Under-correction or full correction of myopia? A meta-analysis
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  • Jun 2020
Purpose To compare the effect of full-correction versus under-correction on myopia progression. Methods A literature search was performed in PubMed, Scopus, Science Direct, Ovid, Web of Science and Cochrane library. Methodological quality assessment of the literature was evaluated according to the Critical Appraisal Skills Program. Statistical analysis was performed using Comprehensive Meta-Analysis (version 2, Biostat Inc., USA). Results The present meta-analysis included six studies (two randomized controlled trials [RCTs] and four non-RCTs) with 695 subjects (full-correction group, n = 371; under-correction group, n = 324) aged 6 to 33 years. Using cycloplegic refraction, the pooled difference in mean of myopia progression was – 0.179 D [lower and higher limits: −0.383, 0.025], which was higher but not in full correction group as compared to under correction group (p = 0.085). Regarding studies using non-cycloplegic subjective refraction according to maximum plus for maximum visual acuity, the pooled difference in myopia progression was 0.128 D [lower and higher limits: −0.057, 0.312] higher in under-correction group compared with full-correction group (p = 0.175). Although, difference in myopia progression did not reach significant level in either cycloplegic or non-cycloplegic refraction. Conclusions Our findings suggest that, myopic eyes which are fully corrected with non-cycloplegic refraction with maximum plus sphere, are less prone to myopia progression, in comparison to those which were under corrected. However, regarding cycloplegic refraction, further studies are needed to better understand these trends.
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... A number of existing studies have explored the impact of under-correction on myopia progression, in an attempt to cause myopic defocus and eliminate the accommodative demand in near activities. Nonetheless, contradictory findings have been reported, from restriction up to worsening of myopia progression in response to under-correction [6][7][8][9][10][11][12][13][14][15]. In addition, evidence regarding the impact of part-time spectacle use on myopia progression is scarce. ...
Part-time Versus Full-time Spectacles for Myopia Control (ParMA Study): A Randomized Clinical Trial
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  • Jun 2022
Introduction To compare myopia progression in school-aged children of Caucasian origin wearing part-time vs. full-time full correction with single-vision spectacles. Methods This prospective, randomized controlled trial included 30 children with bilateral myopia, who received either full-time or part-time treatment with single-vision spectacle lenses. Myopia progression was assessed as the mean change in cycloplegic spherical equivalent refraction (SE), mean change in axial length (AL), and mean change in sub-foveal choroidal thickness (SChT), over a 12-month follow-up period. Results A total of 32 eyes were treated with part-time single-vision spectacles (intervention group) and 28 eyes with full-time single-vision spectacles (control group), respectively. The part-time treated group reported no spectacle use during near-work activities for a mean of 6.2 hours/day. At the 12-month assessment, there was no significant difference between part-time and full-time correction groups in mean SE change (MD: -0.05 D, 95% CI: -0.50 - 0.39 D; P 0.81), in mean AL change (MD: -0.07 mm; 95% CI: -0.20 - 0.06 mm; P 0.30), and in mean SChT change (MD: -11.45 μm; 95% CI -22.60 - 14.16 μm; P 0.67). Conclusion Myopia progression in Caucasian children treated with part-time, single-vision spectacle use was not different compared to full-time, single-vision spectacle use, over a 12-month follow-up period.
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... Chen [114] designed a study in which 77 fully corrected eyes were compared to 55 undercorrected eyes. e two groups were matched for the age, sex, and refractive error. ...
Myopia: Mechanisms and Strategies to Slow Down Its Progression
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  • Jun 2022
This topical review aimed to update and clarify the behavioral, pharmacological, surgical, and optical strategies that are currently available to prevent and reduce myopia progression. Myopia is the commonest ocular abnormality; reinstated interest is associated with high and increasing prevalence, especially but not, in the Asian population and progressive nature in children. The growing global prevalence seems to be associated with both genetic and environmental factors such as spending more time indoor and using digital devices, particularly during the coronavirus disease 2019 pandemic. Various options have been assessed to prevent or reduce myopia progression in children. In this review, we assess the effects of several types of measures, including spending more time outdoor, optical interventions such as the bifocal/progressive spectacle lenses, soft bifocal/multifocal/extended depth of focus/orthokeratology contact lenses, refractive surgery, and pharmacological treatments. All these options for controlling myopia progression in children have various degrees of efficacy. Atropine, orthokeratology/peripheral defocus contact and spectacle lenses, bifocal or progressive addition spectacles, and increased outdoor activities have been associated with the highest, moderate, and lower efficacies, respectively.
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... An open-field autorefractor was used to obtain refraction data and ocular biometry results were determined using A-Scan ultrasonography. At two years, the mean amount that myopia progressed in children in the full-correction group (−0.54 AE 0.26 D) was not significantly different from that of the children in the undercorrection group (−0.50 AE 0.22 D) (p = 0.31).Chen15 recruited age, sex and refractive error-matched groups of 77 fully corrected and 55 under-corrected (by −0.25 to −0.50 D) children with myopia and followed them for one year. Randomisation and masking were not reported. ...
Role of un‐correction, under‐correction and over‐correction of myopia as a strategy for slowing myopic progression
Article
  • Dec 2019
This systematic review investigates the association between un‐, under‐ and over‐correction of myopic refractive error and myopia progression in children and adolescents (up to 18 years of age). The literature search included three databases (PubMed, Web of Science, and Cochrane Central Register of Controlled Trials [CENTRAL]), and reference lists of retrieved studies in any language. Eight prospective cohort studies and one retrospective analysis of clinical data provided comparison data on un‐ and under‐correction of myopia versus full‐correction of myopia; however, the quality of studies and length of follow‐up times varied. A forest plot showed no beneficial effect of under‐correction with some studies finding an increase in myopia progression. While one study suggested that myopia progression is slower in an un‐corrected cohort compared to those who are fully corrected, another study suggests the opposite. One study utilised anisomyopes to allow comparison of under‐correction of one eye with full‐correction of the fellow eye indicating that under‐correction in one eye appears to slow the rate of myopia progression in that eye. Another study on full‐correction only in one eye found that progression was faster in the un‐corrected eye. No benefits of over‐correction of myopia was found. The overall findings are equivocal with under‐correction causing a faster rate of myopia progression. There is no strong evidence of benefits from un‐correction, monovision or over‐correction. Hence, current clinical advice advocates for the full‐correction of myopia. Further studies are warranted to determine the level of myopia that can be left uncorrected without impacting on myopia progression and how this changes with time.
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Interventions for myopia control in children: a living systematic review and network meta‐analysis
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  • Feb 2023
Background: Myopia is a common refractive error, where elongation of the eyeball causes distant objects to appear blurred. The increasing prevalence of myopia is a growing global public health problem, in terms of rates of uncorrected refractive error and significantly, an increased risk of visual impairment due to myopia-related ocular morbidity. Since myopia is usually detected in children before 10 years of age and can progress rapidly, interventions to slow its progression need to be delivered in childhood. Objectives: To assess the comparative efficacy of optical, pharmacological and environmental interventions for slowing myopia progression in children using network meta-analysis (NMA). To generate a relative ranking of myopia control interventions according to their efficacy. To produce a brief economic commentary, summarising the economic evaluations assessing myopia control interventions in children. To maintain the currency of the evidence using a living systematic review approach. SEARCH METHODS: We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register), MEDLINE; Embase; and three trials registers. The search date was 26 February 2022. SELECTION CRITERIA: We included randomised controlled trials (RCTs) of optical, pharmacological and environmental interventions for slowing myopia progression in children aged 18 years or younger. Critical outcomes were progression of myopia (defined as the difference in the change in spherical equivalent refraction (SER, dioptres (D)) and axial length (mm) in the intervention and control groups at one year or longer) and difference in the change in SER and axial length following cessation of treatment ('rebound'). DATA COLLECTION AND ANALYSIS: We followed standard Cochrane methods. We assessed bias using RoB 2 for parallel RCTs. We rated the certainty of evidence using the GRADE approach for the outcomes: change in SER and axial length at one and two years. Most comparisons were with inactive controls. Main results: We included 64 studies that randomised 11,617 children, aged 4 to 18 years. Studies were mostly conducted in China or other Asian countries (39 studies, 60.9%) and North America (13 studies, 20.3%). Fifty-seven studies (89%) compared myopia control interventions (multifocal spectacles, peripheral plus spectacles (PPSL), undercorrected single vision spectacles (SVLs), multifocal soft contact lenses (MFSCL), orthokeratology, rigid gas-permeable contact lenses (RGP); or pharmacological interventions (including high- (HDA), moderate- (MDA) and low-dose (LDA) atropine, pirenzipine or 7-methylxanthine) against an inactive control. Study duration was 12 to 36 months. The overall certainty of the evidence ranged from very low to moderate. Since the networks in the NMA were poorly connected, most estimates versus control were as, or more, imprecise than the corresponding direct estimates. Consequently, we mostly report estimates based on direct (pairwise) comparisons below. At one year, in 38 studies (6525 participants analysed), the median change in SER for controls was -0.65 D. The following interventions may reduce SER progression compared to controls: HDA (mean difference (MD) 0.90 D, 95% confidence interval (CI) 0.62 to 1.18), MDA (MD 0.65 D, 95% CI 0.27 to 1.03), LDA (MD 0.38 D, 95% CI 0.10 to 0.66), pirenzipine (MD 0.32 D, 95% CI 0.15 to 0.49), MFSCL (MD 0.26 D, 95% CI 0.17 to 0.35), PPSLs (MD 0.51 D, 95% CI 0.19 to 0.82), and multifocal spectacles (MD 0.14 D, 95% CI 0.08 to 0.21). By contrast, there was little or no evidence that RGP (MD 0.02 D, 95% CI -0.05 to 0.10), 7-methylxanthine (MD 0.07 D, 95% CI -0.09 to 0.24) or undercorrected SVLs (MD -0.15 D, 95% CI -0.29 to 0.00) reduce progression. At two years, in 26 studies (4949 participants), the median change in SER for controls was -1.02 D. The following interventions may reduce SER progression compared to controls: HDA (MD 1.26 D, 95% CI 1.17 to 1.36), MDA (MD 0.45 D, 95% CI 0.08 to 0.83), LDA (MD 0.24 D, 95% CI 0.17 to 0.31), pirenzipine (MD 0.41 D, 95% CI 0.13 to 0.69), MFSCL (MD 0.30 D, 95% CI 0.19 to 0.41), and multifocal spectacles (MD 0.19 D, 95% CI 0.08 to 0.30). PPSLs (MD 0.34 D, 95% CI -0.08 to 0.76) may also reduce progression, but the results were inconsistent. For RGP, one study found a benefit and another found no difference with control. We found no difference in SER change for undercorrected SVLs (MD 0.02 D, 95% CI -0.05 to 0.09). At one year, in 36 studies (6263 participants), the median change in axial length for controls was 0.31 mm. The following interventions may reduce axial elongation compared to controls: HDA (MD -0.33 mm, 95% CI -0.35 to 0.30), MDA (MD -0.28 mm, 95% CI -0.38 to -0.17), LDA (MD -0.13 mm, 95% CI -0.21 to -0.05), orthokeratology (MD -0.19 mm, 95% CI -0.23 to -0.15), MFSCL (MD -0.11 mm, 95% CI -0.13 to -0.09), pirenzipine (MD -0.10 mm, 95% CI -0.18 to -0.02), PPSLs (MD -0.13 mm, 95% CI -0.24 to -0.03), and multifocal spectacles (MD -0.06 mm, 95% CI -0.09 to -0.04). We found little or no evidence that RGP (MD 0.02 mm, 95% CI -0.05 to 0.10), 7-methylxanthine (MD 0.03 mm, 95% CI -0.10 to 0.03) or undercorrected SVLs (MD 0.05 mm, 95% CI -0.01 to 0.11) reduce axial length. At two years, in 21 studies (4169 participants), the median change in axial length for controls was 0.56 mm. The following interventions may reduce axial elongation compared to controls: HDA (MD -0.47mm, 95% CI -0.61 to -0.34), MDA (MD -0.33 mm, 95% CI -0.46 to -0.20), orthokeratology (MD -0.28 mm, (95% CI -0.38 to -0.19), LDA (MD -0.16 mm, 95% CI -0.20 to -0.12), MFSCL (MD -0.15 mm, 95% CI -0.19 to -0.12), and multifocal spectacles (MD -0.07 mm, 95% CI -0.12 to -0.03). PPSL may reduce progression (MD -0.20 mm, 95% CI -0.45 to 0.05) but results were inconsistent. We found little or no evidence that undercorrected SVLs (MD -0.01 mm, 95% CI -0.06 to 0.03) or RGP (MD 0.03 mm, 95% CI -0.05 to 0.12) reduce axial length. There was inconclusive evidence on whether treatment cessation increases myopia progression. Adverse events and treatment adherence were not consistently reported, and only one study reported quality of life. No studies reported environmental interventions reporting progression in children with myopia, and no economic evaluations assessed interventions for myopia control in children. Authors' conclusions: Studies mostly compared pharmacological and optical treatments to slow the progression of myopia with an inactive comparator. Effects at one year provided evidence that these interventions may slow refractive change and reduce axial elongation, although results were often heterogeneous. A smaller body of evidence is available at two or three years, and uncertainty remains about the sustained effect of these interventions. Longer-term and better-quality studies comparing myopia control interventions used alone or in combination are needed, and improved methods for monitoring and reporting adverse effects.
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Interventions to slow progression of myopia in children
Article
  • Jan 2020
Background: Nearsightedness (myopia) causes blurry vision when one is looking at distant objects. Interventions to slow the progression of myopia in children include multifocal spectacles, contact lenses, and pharmaceutical agents. Objectives: To assess the effects of interventions, including spectacles, contact lenses, and pharmaceutical agents in slowing myopia progression in children. Search methods: We searched CENTRAL; Ovid MEDLINE; Embase.com; PubMed; the LILACS Database; and two trial registrations up to February 2018. A top up search was done in February 2019. Selection criteria: We included randomized controlled trials (RCTs). We excluded studies when most participants were older than 18 years at baseline. We also excluded studies when participants had less than -0.25 diopters (D) spherical equivalent myopia. Data collection and analysis: We followed standard Cochrane methods. Main results: We included 41 studies (6772 participants). Twenty-one studies contributed data to at least one meta-analysis. Interventions included spectacles, contact lenses, pharmaceutical agents, and combination treatments. Most studies were conducted in Asia or in the United States. Except one, all studies included children 18 years or younger. Many studies were at high risk of performance and attrition bias. Spectacle lenses: undercorrection of myopia increased myopia progression slightly in two studies; children whose vision was undercorrected progressed on average -0.15 D (95% confidence interval [CI] -0.29 to 0.00; n = 142; low-certainty evidence) more than those wearing fully corrected single vision lenses (SVLs). In one study, axial length increased 0.05 mm (95% CI -0.01 to 0.11) more in the undercorrected group than in the fully corrected group (n = 94; low-certainty evidence). Multifocal lenses (bifocal spectacles or progressive addition lenses) yielded small effect in slowing myopia progression; children wearing multifocal lenses progressed on average 0.14 D (95% CI 0.08 to 0.21; n = 1463; moderate-certainty evidence) less than children wearing SVLs. In four studies, axial elongation was less for multifocal lens wearers than for SVL wearers (-0.06 mm, 95% CI -0.09 to -0.04; n = 896; moderate-certainty evidence). Three studies evaluating different peripheral plus spectacle lenses versus SVLs reported inconsistent results for refractive error and axial length outcomes (n = 597; low-certainty evidence). Contact lenses: there may be little or no difference between vision of children wearing bifocal soft contact lenses (SCLs) and children wearing single vision SCLs (mean difference (MD) 0.20D, 95% CI -0.06 to 0.47; n = 300; low-certainty evidence). Axial elongation was less for bifocal SCL wearers than for single vision SCL wearers (MD -0.11 mm, 95% CI -0.14 to -0.08; n = 300; low-certainty evidence). Two studies investigating rigid gas permeable contact lenses (RGPCLs) showed inconsistent results in myopia progression; these two studies also found no evidence of difference in axial elongation (MD 0.02mm, 95% CI -0.05 to 0.10; n = 415; very low-certainty evidence). Orthokeratology contact lenses were more effective than SVLs in slowing axial elongation (MD -0.28 mm, 95% CI -0.38 to -0.19; n = 106; moderate-certainty evidence). Two studies comparing spherical aberration SCLs with single vision SCLs reported no difference in myopia progression nor in axial length (n = 209; low-certainty evidence). Pharmaceutical agents: at one year, children receiving atropine eye drops (3 studies; n = 629), pirenzepine gel (2 studies; n = 326), or cyclopentolate eye drops (1 study; n = 64) showed significantly less myopic progression compared with children receiving placebo: MD 1.00 D (95% CI 0.93 to 1.07), 0.31 D (95% CI 0.17 to 0.44), and 0.34 (95% CI 0.08 to 0.60), respectively (moderate-certainty evidence). Axial elongation was less for children treated with atropine (MD -0.35 mm, 95% CI -0.38 to -0.31; n = 502) and pirenzepine (MD -0.13 mm, 95% CI -0.14 to -0.12; n = 326) than for those treated with placebo (moderate-certainty evidence) in two studies. Another study showed favorable results for three different doses of atropine eye drops compared with tropicamide eye drops (MD 0.78 D, 95% CI 0.49 to 1.07 for 0.1% atropine; MD 0.81 D, 95% CI 0.57 to 1.05 for 0.25% atropine; and MD 1.01 D, 95% CI 0.74 to 1.28 for 0.5% atropine; n = 196; low-certainty evidence) but did not report axial length. Systemic 7-methylxanthine had little to no effect on myopic progression (MD 0.07 D, 95% CI -0.09 to 0.24) nor on axial elongation (MD -0.03 mm, 95% CI -0.10 to 0.03) compared with placebo in one study (n = 77; moderate-certainty evidence). One study did not find slowed myopia progression when comparing timolol eye drops with no drops (MD -0.05 D, 95% CI -0.21 to 0.11; n = 95; low-certainty evidence). Combinations of interventions: two studies found that children treated with atropine plus multifocal spectacles progressed 0.78 D (95% CI 0.54 to 1.02) less than children treated with placebo plus SVLs (n = 191; moderate-certainty evidence). One study reported -0.37 mm (95% CI -0.47 to -0.27) axial elongation for atropine and multifocal spectacles when compared with placebo plus SVLs (n = 127; moderate-certainty evidence). Compared with children treated with cyclopentolate plus SVLs, those treated with atropine plus multifocal spectacles progressed 0.36 D less (95% CI 0.11 to 0.61; n = 64; moderate-certainty evidence). Bifocal spectacles showed small or negligible effect compared with SVLs plus timolol drops in one study (MD 0.19 D, 95% CI 0.06 to 0.32; n = 97; moderate-certainty evidence). One study comparing tropicamide plus bifocal spectacles versus SVLs reported no statistically significant differences between groups without quantitative results. No serious adverse events were reported across all interventions. Participants receiving antimuscarinic topical medications were more likely to experience accommodation difficulties (Risk Ratio [RR] 9.05, 95% CI 4.09 to 20.01) and papillae and follicles (RR 3.22, 95% CI 2.11 to 4.90) than participants receiving placebo (n=387; moderate-certainty evidence). Authors' conclusions: Antimuscarinic topical medication is effective in slowing myopia progression in children. Multifocal lenses, either spectacles or contact lenses, may also confer a small benefit. Orthokeratology contact lenses, although not intended to modify refractive error, were more effective than SVLs in slowing axial elongation. We found only low or very low-certainty evidence to support RGPCLs and sperical aberration SCLs.
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