Myopia control strategies: A systematic review and meta-meta-analysis

To summarise pooled estimates of the efficacies of various myopia control interventions, as drawn from published meta-analyses.

PubMed, SCOPUS and Web of Science were searched from inception to February 2024 for systematic reviews and meta-analyses reporting treatment effects of various myopia control strategies. The qualities of the included meta-analyses were assessed using the 16-item A MeaSurement Tool to Assess systematic Reviews (AMSTAR) 2. An intervention was defined as having a clinically significant effect if it resulted in a change in spherical equivalent refraction (SER) of ≥0.50 D/year or axial length (AL) change of ≤−0.18 mm/year.

A total of 38 studies were identified. The overall respective changes in SER and AL, mean difference (95% CI) were high-concentration (≥0.5%) atropine 0.67 D (0.58–0.77) and −0.24 mm (−0.36 to −0.11); moderate-concentration (>0.05% to <0.5%) atropine 0.48 D (0.34–0.62) and −0.23 mm (−0.27 to −0.19); low-concentration (0.01%, 0.025%, 0.05%) atropine 0.33 D (0.23–0.43) and −0.14 mm (−0.19 to −0.09); orthokeratology −0.47 mm (−0.66 to −0.28); peripheral plus soft contact lenses 0.30 D (0.18–0.42) and −0.35 mm (−0.62 to −0.08); peripheral plus spectacles 0.77 D (0.40–1.14) and −0.43 mm (−0.78 to −0.08); multifocal spectacles 0.21 D (0.11–0.31); repeated low-level red light therapy 0.55 D (0.46–0.65) and −0.25 mm (−0.29 to −0.20); outdoor time 0.17 D (0.16–0.18) and −0.04 mm (−0.06 to −0.01).

High and moderate concentrations of atropine, orthokeratology, peripheral plus spectacles and repeated low-level red light demonstrated clinically significant effects on slowing AL elongation, while high and moderate concentrations of atropine, peripheral plus spectacles and repeated low-level red light demonstrated clinically significant effects on slowing SER progression.