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. To assess the effects of interventions,
including spectacles, contact lenses, and pharmaceutical agents in slowing myopia
progression in children. 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. 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.
We followed standard Cochrane methods. 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).
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. Interventions to slow progression
of nearsightedness in children What was the aim of this review?
To find out if there are treatments that can slow the progress of nearsightedness
(myopia) in children. Myopia is a vision condition in which people can see close objects
clearly, but objects farther away appear blurred. Key message
Eye drop medication, such as atropine, probably slows myopia progression in children.
Children taking these eye drops may have blurred near vision, sensitivity to light,
and some itching and discomfort. Multifocal lenses, either spectacles or contact lenses,
may also confer a small benefit. What did we study in this review?
During childhood and adolescence, the eyeballs can grow too long and can develop myopia.
Treatments can slow growth of the eye, thereby slowing down the progression of myopia.
Cochrane researchers assessed how certain the evidence was for each review finding,
factoring in problems such as the ways studies were done, inclusion of very small
studies, and inconsistent findings across studies. They also looked for factors that
can make the evidence more certain, including very large effects. They graded each
finding as very low, low, moderate, or high certainty. What were the main results
of this review?
Cochrane researchers found 41 studies of treatments to slow myopia progression. These
studies included a total of 6772 children. The review found that the following treatments
may slow the progression of myopia, compared with wearing ordinary spectacles. • Eye
drops, in particular antimuscarinic drugs such as atropine, pirenzepine gel, and cyclopentolate
(moderate‐certainty evidence). • Multifocal spectacles (either bifocal or progressive
addition lenses) (moderate‐certainty evidence). • Bifocal soft contact lenses (low‐certainty
evidence). • Orthokeratology contact lenses (moderate‐certainty evidence). • Combinations
of eye drops and multifocal spectacles (moderate‐certainty evidence). The review found
that the following treatments may have a small effect, or no effect, on myopia progression.
• Spherical aberration soft contact lenses (low‐certainty evidence). • Systematic
adenosine antagonists (moderate‐certainty evidence). Children who wear undercorrected
spectacles may have an increased chance of myopia progression compared with children
who wear fully corrected spectacles (low‐certainty evidence). Only very low‐certainty
evidence on rigid gas permeable contact lenses was available. Antimuscarinic eye drops
may result in blurred near vision, sensitivity to light, some discomfort and itching,
and medication residue on the eyelids or eyelashes. Some children may develop small
nodules or bumps under the eyelid. Spectacles and contact lenses, if used properly,
are safe and effective. How up‐to‐date is the review?
Cochrane researchers reviewed studies published up to February 2018.