Efficacy and safety of interventions to control myopia progression in children: an overview of systematic reviews and meta-analyses.

Background: Myopia is a common visual disorder with increasing prevalence. Halting progression of myopia is critical, as high myopia can be complicated by a number of vision-compromising conditions.

Methods: Literature search was conducted in the following databases: Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica dataBASE (EMBASE), Cochrane Database of Systematic Reviews (CDSR), Database of Abstracts of Reviews of Effects (DARE) and Centre for Reviews and Dissemination (CRD) Health Technology Assessment (HTA) database. Systematic reviews and meta-analyses investigating the efficacy and safety of multiple myopia interventions vs control conditions, were considered. Methodological quality and quality of evidence of eligible studies were assessed using the ROBIS tool and GRADE rating. The degree of overlapping of index publications in the eligible reviews was calculated with the corrected covered area (CCA).

Results: Forty-four unique primary studies contained in 18 eligible reviews and involving 6400 children were included in the analysis. CCA was estimated as 6.2% and thus considered moderate. Results demonstrated the superior efficacy of atropine eyedrops; 1% atropine vs placebo (change in refraction: -0.78D, [- 1.30 to - 0.25] in 1 year), 0.025 to 0.05% atropine vs control (change in refraction: -0.51D, [- 0.60 to - 0.41] in 1 year), 0.01% atropine vs control (change in refraction: -0.50D, [- 0.76 to - 0.24] in 1 year). Atropine was followed by orthokeratology (axial elongation: - 0.19 mm, [- 0.21 to - 0.16] in 1 year) and novel multifocal soft contact lenses (change in refraction: -0.15D, [- 0.27 to - 0.03] in 1 year). As regards adverse events, 1% atropine induced blurred near vision (odds ratio [OR] 9.47, [1.17 to 76.78]) and hypersensitivity reactions (OR 8.91, [1.04 to 76.03]).

Conclusions: Existing evidence has failed to convince doctors to uniformly embrace treatments for myopic progression control, possibly due to existence of some heterogeneity, reporting of side effects and lack of long-term follow-up. Research geared towards efficient interventions is still necessary.