Junior High Age Childrenʼs Myopia Progression in Soft Lenses vs. Spectacles.

218

132

Istotność kontroli krótkowzroczności jest związana z rosnącym odsetkiem światowej populacji obarczonej tą wadą wzroku, a jest ona jednym z czynników ryzyka wystąpienia innych chorób oczu. W licznych pracach poddawano analizie wpływ różnych metod optycznych i farmakologicznych na spowolnienie progresji krótkowzroczności. Stosowano zarówno korekcję okularową i soczewkami kontaktowymi o konstrukcjach dwu-i wieloogniskowych, jak i ortokeratologię. Wśród leków badano przede wszystkim wpływ różnych stężeń atropiny na zahamowanie progresji krótkowzroczności. Rzadziej opisywano zastosowanie innych leków, np. pirenzepiny. Za najbardziej skuteczne metody, powodujące największe spowolnienie zwiększania się krótkowzroczności, uznano zastosowanie soczewek kontaktowych modyfikujących obwodowe rozogniskowanie, soczewek ortokeratologicznych oraz użycie atropiny, przede wszystkim w niskich stężeniach. W licznych opracowaniach podkreślono też szkodliwy -przyspieszający narastanie krótkowzroczności -wpływ niedokorygowania. Podnosi się też możliwy hamujący wpływ na progresję tej wady refrakcji czasu spędzanego na zewnątrz pomieszczeń, czyli na świeżym powietrzu. Aby osiągnąć sukces w kontroli krótkowzroczności, należy wcześnie wykryć wadę, skorygować ją w pełni i zastosować najbardziej skuteczne metody zahamowania jej progresji.

Section: Resultsmentioning

confidence: 99%

Interventions to slow progression of myopia in children

Walline

Lindsley

Vedula

et al. 2011

218

132

Interventions to slow progression of myopia in children

Walline

Lindsley

Vedula

et al. 2020

143

147

Background-Nearsightedness (myopia) causes blurry vision when looking at distant objects. Highly nearsighted people are at greater risk of several vision-threatening problems such as retinal detachments, choroidal atrophy, cataracts and glaucoma. Interventions that have been explored to slow the progression of myopia include bifocal spectacles, cycloplegic drops, intraocular pressurelowering drugs, muscarinic receptor antagonists and contact lenses. The purpose of this review was to systematically assess the effectiveness of strategies to control progression of myopia in children. Objectives-To assess the effects of several types of interventions, including eye drops, undercorrection of nearsightedness, multifocal spectacles and contact lenses, on the progression of nearsightedness in myopic children younger than 18 years. We compared the interventions of interest with each other, to single vision lenses (SVLs) (spectacles), placebo or no treatment. Search methods-We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register

Interventions for myopia control in children: a living systematic review and network meta-analysis

Lawrenson

Shah

Huntjens

et al. 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 c...