Methodological quality of the review: Low confidence

Author: Su Ann Tay, Sonal Farzavandi, Donald Tan

Region: China, Hong Kong, Malaysia, Nepal, Cambodia, Vientiane, India, Iran, Australia, Finland, United Kingdom (UK), South Africa, Chile, Poland, USA, Mexico, Sweden

Sector: Myopia

Subsector: Interventions to reduce myopia

Equity focus: No

Study population: Children

Type of programme: Community based

Review type: Other review

Quantitative synthesis method: Systematic review

Qualitative synthesis method: Not applicable

Background: Myopia is a refractive disorder of the eye that is increasingly prevalent. Its prevalence is increasing not only in East Asian populations, but also in the West, with an increasing prevalence of myopia in Europe demonstrated in a recent meta-analysis of population-based, cross-sectional studies from the European Eye Epidemiology Consortium. Furthermore, there has been an increase in the prevalence of high myopia, affecting up to 20 per cent of secondary-school children in East Asian populations. In addition to the costs of optical correction, high myopia is associated with significant ocular morbidity and visual disability. It is important to determine if all therapies available can reduce myopia progression in children and subsequently reduce the prevalence of pathological high myopia and its economic and social burden.

Objectives: The aim of this study was to determine if all these therapies can reduce myopia progression in children and subsequently reduce the prevalence of pathological high myopia and its economic and social burden.

Main findings: Authors note that atropine showed the largest dose-related effect on myopia progression control. Although higher doses are associated with side effects of pupil dilatation, loss of accommodation, near vision blur and rebound phenomenon, low-dose atropine has also been shown to provide effective myopia control with minimal side effects and rebound. To a lesser degree, bifocal soft contact lenses have also been shown to be effective in reducing the progression of myopia, though compliance is an issue. Similarly, orthokeratology lenses have also been shown to be effective in reducing axial length elongation and myopia progression, though long-term data on its rebound effects are unavailable.

Methodology: This review article involved a literature review where all English-language articles relating to myopia control therapies published from January 2000 to April 2016 were retrieved using a keyword search of Medline, PubMed, Embase, the Cochrane Collaborations and Science Citation Index databases, and representative articles for each therapeutic intervention were selected by the authors. Additional selected articles involving myopia epidemiology or studies evaluating theories on mode of action of specific therapeutic modalities were added to the literature review.

Applicability/external validity: Not discussed.

Geographic focus: Not discussed.

Summary of quality assessment:

There is low confidence in the conclusions about the effects of this study, as important limitations were identified. Authors provided very little detail on the methods used to identify, screen studies of inclusion, extract data and quality assessment of included studies.