Interventions to retard myopia progression in children: an evidence-based update.
OBJECTIVE
To evaluate the efficacy of interventions such as eyedrops, bifocal lenses, or contact lenses in retarding the progression of myopia in myopic children.


CONCLUSIONS
Myopia is a common ocular disorder, and high myopia (myopia at least -6.0 diopters) is associated with potentially blinding conditions. At present, there are no general guidelines on interventions that may decrease myopia progression in children, but some interventions such as contact lenses are offered on an ad hoc basis. METHODS OR LITERATURE REVIEWED: English and non-English language articles published from 1968 to 2000 were retrieved using a keyword search of MEDLINE, Embase, Cochrane Library, and Science Citation Index databases. Randomized controlled trials with comparisons of the effectiveness of interventions to decrease myopia progression in myopic children were reviewed.


RESULTS
Ten clinical trials of different interventions to retard myopia progression were reviewed, including three trials that evaluated atropine and one trial that evaluated soft contact lenses. Atropine eye drops of 0.5% concentration were effective in clinical trials, but no significant effect was found for tropicamide or timolol eyedrops. Five of the six trials on bifocal spectacle lenses with various additions failed to show significant retardation, and results of the remaining trial were barely significant (P = 0.047). A trial of soft contact lenses failed to show significant effects.


CONCLUSIONS
The latest evidence from randomized clinical trials does not provide sufficient information to support interventions to prevent the progression of myopia. Long-term large-scale double-masked randomized clinical trials, including cycloplegic refraction, are needed before any recommendations about interventions in clinical practice to prevent high myopia in myopic children are considered.
Saw
Seang-Mei
SM
Department of Community, Occupational and Family Medicine, National University of Singapore, 16 Medical Drive, Singapore 117597, Republic of Singapore. cofsawsm@nus.edu.sg
Shih-Yen
Edwin Chan
EC
Koh
Adrian
A
Tan
Donald
D
D001285:Atropine / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003263:Contact Lenses, Hydrophilic; D016208:Databases, Factual; D018450:Disease Progression; D019317:Evidence-Based Medicine; D005139:Eyeglasses; D006801:Humans; D009184:Mydriatics / Q000627:therapeutic use; D009216:Myopia / Q000503:physiopathology / Q000517:prevention & control*; D009883:Ophthalmic Solutions; D016032:Randomized Controlled Trials as Topic; D013999:Timolol / Q000627:therapeutic use; D014331:Tropicamide / Q000627:therapeutic use
D009184:Mydriatics; D009883:Ophthalmic Solutions; D001285:Atropine; D013999:Timolol; D014331:Tropicamide