title: Efficacy Comparison of 16 Interventions for Myopia Control in Children: A Network Meta-analysis.
abstract: OBJECTIVE
  To determine the effectiveness of different interventions to slow down the progression of myopia in children.
  
  
  METHODS
  We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov from inception to August 2014. We selected randomized controlled trials (RCTs) involving interventions for controlling the progression of myopia in children with a treatment duration of at least 1 year for analysis.
  
  
  METHODS
  The primary outcomes were mean annual change in refraction (diopters/year) and mean annual change in axial length (millimeters/year).
  
  
  RESULTS
  Thirty RCTs (involving 5422 eyes) were identified. Network meta-analysis showed that in comparison with placebo or single vision spectacle lenses, high-dose atropine (refraction change: 0.68 [0.52-0.84]; axial length change: -0.21 [-0.28 to -0.16]), moderate-dose atropine (refraction change: 0.53 [0.28-0.77]; axial length change: -0.21 [-0.32 to -0.12]), and low-dose atropine (refraction change: 0.53 [0.21-0.85]; axial length change: -0.15 [-0.25 to -0.05]) markedly slowed myopia progression. Pirenzepine (refraction change: 0.29 [0.05-0.52]; axial length change: -0.09 [-0.17 to -0.01]), orthokeratology (axial length change: -0.15 [-0.22 to -0.08]), and peripheral defocus modifying contact lenses (axial length change: -0.11 [-0.20 to -0.03]) showed moderate effects. Progressive addition spectacle lenses (refraction change: 0.14 [0.02-0.26]; axial length change: -0.04 [-0.09 to -0.01]) showed slight effects.
  
  
  CONCLUSIONS
  This network analysis indicates that a range of interventions can significantly reduce myopia progression when compared with single vision spectacle lenses or placebo. In terms of refraction, atropine, pirenzepine, and progressive addition spectacle lenses were effective. In terms of axial length, atropine, orthokeratology, peripheral defocus modifying contact lenses, pirenzepine, and progressive addition spectacle lenses were effective. The most effective interventions were pharmacologic, that is, muscarinic antagonists such as atropine and pirenzepine. Certain specially designed contact lenses, including orthokeratology and peripheral defocus modifying contact lenses, had moderate effects, whereas specially designed spectacle lenses showed minimal effect.
authors.affiliation: School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China; Key Laboratory of Vision Science, Ministry of Health P.R. China, Wenzhou, Zhejiang, China.
authors.forename: Jinhai
authors.initials: J
authors.lastname: Huang
authors.affiliation: School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China; Department of Ophthalmology, No.180 Hospital of Chinese PLA, Quanzhou, Fujian.
authors.forename: Daizong
authors.initials: D
authors.lastname: Wen
authors.affiliation: School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China; Key Laboratory of Vision Science, Ministry of Health P.R. China, Wenzhou, Zhejiang, China.
authors.forename: Qinmei
authors.initials: Q
authors.lastname: Wang
authors.affiliation: School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China; ABM University Health Board, Swansea, United Kingdom; Flinders University, Adelaide, South Australia, Australia.
authors.forename: Colm
authors.initials: C
authors.lastname: McAlinden
authors.affiliation: Department of Ophthalmology, Children's University Hospital, Dublin, Ireland.
authors.forename: Ian
authors.initials: I
authors.lastname: Flitcroft
authors.affiliation: School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China; Key Laboratory of Vision Science, Ministry of Health P.R. China, Wenzhou, Zhejiang, China.
authors.forename: Haisi
authors.initials: H
authors.lastname: Chen
authors.affiliation: Department of Epidemiology and Public Health, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
authors.forename: Seang Mei
authors.initials: SM
authors.lastname: Saw
authors.affiliation: School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China.
authors.forename: Hao
authors.initials: H
authors.lastname: Chen
authors.affiliation: School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China; Key Laboratory of Vision Science, Ministry of Health P.R. China, Wenzhou, Zhejiang, China.
authors.forename: Fangjun
authors.initials: F
authors.lastname: Bao
authors.affiliation: School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China; Key Laboratory of Vision Science, Ministry of Health P.R. China, Wenzhou, Zhejiang, China.
authors.forename: Yune
authors.initials: Y
authors.lastname: Zhao
authors.affiliation: School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China; Key Laboratory of Vision Science, Ministry of Health P.R. China, Wenzhou, Zhejiang, China.
authors.forename: Liang
authors.initials: L
authors.lastname: Hu
authors.affiliation: Department of Ophthalmology, No.180 Hospital of Chinese PLA, Quanzhou, Fujian.
authors.forename: Xuexi
authors.initials: X
authors.lastname: Li
authors.affiliation: School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China; Key Laboratory of Vision Science, Ministry of Health P.R. China, Wenzhou, Zhejiang, China.
authors.forename: Rongrong
authors.initials: R
authors.lastname: Gao
authors.affiliation: School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China; Key Laboratory of Vision Science, Ministry of Health P.R. China, Wenzhou, Zhejiang, China.
authors.forename: Weicong
authors.initials: W
authors.lastname: Lu
authors.affiliation: School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China.
authors.forename: Yaoqiang
authors.initials: Y
authors.lastname: Du
authors.affiliation: Department of Ophthalmology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China.
authors.forename: Zhengxuan
authors.initials: Z
authors.lastname: Jinag
authors.affiliation: School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China; Key Laboratory of Vision Science, Ministry of Health P.R. China, Wenzhou, Zhejiang, China.
authors.forename: Ayong
authors.initials: A
authors.lastname: Yu
authors.affiliation: Department of Biological Statistics, Eye hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
authors.forename: Hengli
authors.initials: H
authors.lastname: Lian
authors.affiliation: School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China; Key Laboratory of Vision Science, Ministry of Health P.R. China, Wenzhou, Zhejiang, China.
authors.forename: Qiuruo
authors.initials: Q
authors.lastname: Jiang
authors.affiliation: School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China; Key Laboratory of Vision Science, Ministry of Health P.R. China, Wenzhou, Zhejiang, China.
authors.forename: Ye
authors.initials: Y
authors.lastname: Yu
authors.affiliation: School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China; Key Laboratory of Vision Science, Ministry of Health P.R. China, Wenzhou, Zhejiang, China. Electronic address: jia.qu@mail.eye.ac.cn.
authors.forename: Jia
authors.initials: J
authors.lastname: Qu
mesh_terms: D001285:Atropine / Q000008:administration & dosage*; D058452:Axial Length, Eye / Q000502:physiology; D016208:Databases, Factual; D005139:Eyeglasses; D006801:Humans; D009184:Mydriatics / Q000008:administration & dosage*; D009216:Myopia / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic; D012029:Refraction, Ocular / Q000502:physiology; D016896:Treatment Outcome
chemical_list: D009184:Mydriatics; D001285:Atropine