A Meta-Analysis Assessing Change in Pupillary Diameter, Accommodative Amplitude, and Efficacy of Atropine for Myopia Control

AbstractObjectiveThe rates of myopia (−0.50 diopter), and high myopia (≥ −6.0 diopter) have been increasing in East Asian populations; the reasons for which may include the combinations of genetic, environment and behavioural factors. The most affected demography point to the young elite population of intellectuals produced from universities. Of the several recommendations to address the myopia epidemic, the influence of Chinese eye exercises (CEE) have been examined. However, reports have been inconsistent, prompting a meta-analysis to obtain more precise estimates.MethodsEight articles were included in the meta-analysis where we operated on the hypothesis that CEE either increased or reduced myopia control. We compared the subjects that performed CEE against those that did not. We used and estimated odds ratios [ORs] and 95% confidence intervals (CIs) using the generic inverse variance method. Subgroup analysis involved quality (high/serious and low/non-serious) and frequency (> 5 times/week) of performing CEE comprised. Heterogeneity was subjected to outlier treatment which split the findings into pre- (PRO) and post- (PSO) outlier. The strength of evidence in our findings were based on high significance (Pa < 10−5), surviving the Bonferroni correction and homogeneity (I2 = 0%). Outcomes with these features comprised our core findings.ResultsOur core findings were found in the PSO overall indicating elevated myopia control (OR 0.72, 95% CI 0.61-0.86, Pa = 0.0002) and CEE subgroups (Serious: OR 0.75, 95% CI 0.68-0.84, Pa < 10−5; Frequent: OR 0.55, 95% CI 0.45-0.68, Pa < 10−5). The low quality subgroup outcome was null in PRO (OR 0.97, 95% CI 0.50-1.86, Pa = 0.92) but conveyed significantly less myopia control in PSO (OR1.57, 95% CI 1.24-2.01, Pa = 0.0002).ConclusionsThis meta-analysis found that CEE afforded 28% greater control of myopia. Enabled by outlier treatment, this finding was homogeneous and consistent. Subgroup effects elevated myopia control to 62% when CEE was done up to 5 times a week. Improper CEE performance implied reduced myopia control of up to 57%.

Download Full-text

Is 0.01% Atropine an Effective and Safe Treatment for Myopic Children? A Systemic Review and Meta-Analysis

Journal of Clinical Medicine ◽

10.3390/jcm10173766 ◽

2021 ◽

Vol 10 (17) ◽

pp. 3766

Author(s):

Hou-Ren Tsai ◽

Tai-Li Chen ◽

Jen-Hung Wang ◽

Huei-Kai Huang ◽

Cheng-Jen Chiu

Keyword(s):

Pupil Diameter ◽

Weighted Mean Difference ◽

Meta Analysis ◽

Systemic Review ◽

Weighted Mean ◽

Axial Elongation ◽

Lower Baseline ◽

Atropine Treatment ◽

The Mean ◽

Accommodative Amplitude

Several conflicting results regarding the efficacy of 0.01% atropine in slowing axial elongation remain in doubt. To solve this issue and evaluate the safety of 0.01% atropine, we conducted a systematic review and meta-analysis with the latest evidence. The review included a total of 1178 participants (myopic children). The efficacy outcomes were the mean annual progression in standardized equivalent refraction (SER) and axial length (AL). The safety outcomes included mean annual change in accommodative amplitude, photopic and mesopic pupil diameter. The results demonstrated that 0.01% atropine significantly retarded SER progression compared with the controls (weighted mean difference [WMD], 0.28 diopter (D) per year; 95% confidence interval (CI) = 0.17, 0.38; p < 0.01), and axial elongation (WMD, −0.06 mm; 95% CI = −0.09, −0.03; p < 0.01) during the 1-year period. Patients receiving 0.01% atropine showed no significant changes in accommodative amplitude (WMD, −0.45 D; 95% CI = −1.80, 0.90; p = 0.51) but showed dilated photopic pupil diameter (WMD, 0.35 mm; 95% CI = 0.02, 0.68; p = 0.04) and mesopic pupil diameter (WMD, 0.20 mm; 95% CI = 0.08, 0.32; p < 0.01). In the subgroup analysis of SER progression, myopic children with lower baseline refraction (>−3 D) and older age (>10-year-old) obtained better responses with 0.01% atropine treatment. Furthermore, the European and multi-ethnicity groups showed greater effect than the Asian groups. In conclusion, 0.01% atropine had favorable efficacy and adequate safety for childhood myopia over a 1-year period.

Download Full-text

Scientometric analysis of publications on orthokeratology over half a century

The Eye ◽

10.33791/2222-4408-2019-2-6-12 ◽

2019 ◽

Vol 126 (2019-2) ◽

Author(s):

Andrey Shmakov ◽

Polina Asitinskaya ◽

Aslan Khurai ◽

Alla Shamakova ◽

Dmitry Mirsayafov

Keyword(s):

Semantic Analysis ◽

Meta Analysis ◽

Scientometric Analysis ◽

Myopia Progression ◽

Clear Trend ◽

Number Of Publications ◽

The One ◽

The Individual ◽

Study Designs ◽

Myopia Control

This research is aimed at elucidation of the current state and prospects of orthokeratology (OK-therapy, Ortho-K) development with the aid of scientometric analysis of publications from 1968 to 2018 inclusive. Two periods were characterized: “old orthokeratology” period from 1968 to 1993 and the period of “new orthokeratology” from 1994 to 2018. The first period is characterized by the absence of a clear trend in the dynamics of publicationscontaining “orthokeratology” term. However, publications growth during the second period is well approximated with exponential function. It points to the relevance and good prospects for the orthokeratology scientific area and the development of this method. Noteworthy, the growth in the number of publications containing the terms “orthokeratology” and “myopia” is 1.5 times higher than the one of publications, when searched only for the “orthokeratology” term. It indicates the elevated interest of researchers and clinicians in myopia and opportunities for myopia control with Ortho-K. The latter is confirmed by clinical trials and meta-analysis results, which demonstrate significant retardation of the eye’s axial length growth due to the use of Ortho-K lenses as well as safety of this method. The need to combine the scientometric approach with meticulous semantic analysis of the individual publications is highlighted. Clinical study designs, opportunities to increase the efficacy of Ortho-K and place of orthokeratology among other methods of myopia control are briefly discussed. Considering the fact that orthokeratology not only controls myopia progression and is being a good option for combination with other methods of myopia treatment, but also ensures the required visual acuity and freedom of various outdoor activities, the choice of practitioners in favor of administering Ortho-K is factually justified.

Download Full-text

Bayesian Meta-Analysis of Myopia Control with Multifocal Lenses

Journal of Clinical Medicine ◽

10.3390/jcm10040730 ◽

2021 ◽

Vol 10 (4) ◽

pp. 730

Author(s):

Saulius Varnas ◽

Xiaomeng Gu ◽

Andrew Metcalfe

Keyword(s):

Contact Lenses ◽

Meta Analysis ◽

Credibility Interval ◽

Slowing Down ◽

Separate Model ◽

The Mean ◽

Randomised Controlled ◽

Meta Analyses ◽

Myopia Control

The aim of this study is to provide reliable guidelines for the mean percentage efficacy together with the 95% credibility interval in slowing down progression of myopia by a specific intervention over defined time periods, derived from a substantial number of randomised controlled clinical trials (RCTs) with consistent outcomes. Multifocal spectacles and contact lenses represent interventions with the largest number of RCTs carried out. Our meta-analyses considered 10 RCTs involving 1662 children which have tested the efficacy of progressive addition spectacle lenses (PALs). In a separate model for comparison purposes nine RCTs with 982 children trialling soft multifocal contact lenses (MFCLs) were analysed. Bayesian random-effects hierarchical models were fitted. The highest efficacy in retarding progression of the scaled sphere equivalent refraction was achieved after 12 M follow-up with the mean 28% reduction in progression and the 95% credibility interval between 21% and 35%. For comparison, the 95% credibility interval for the mean efficacy of soft MFCLs at 12 M follow up is 21% to 37%. We conclude that both multifocal spectacle and contact lenses moderately slow down progression of myopia, relative to single-vision spectacle lenses (SVLs) in the first 12 months after intervention. The relative efficacy of PALs tends to weaken after the first 12 months.

Download Full-text

The Effect of Atropine Alone or Combined with Orthokeratology for Children with Myopia: A Meta-Analysis

10.21203/rs.3.rs-730221/v1 ◽

2021 ◽

Author(s):

zengying wang ◽

yifei meng ◽

sufang qie ◽

zhipeng yan

Keyword(s):

Weighted Mean Difference ◽

Meta Analysis ◽

Cochrane Library ◽

Moderate Degree ◽

Axial Elongation ◽

Low Degree ◽

Significant Difference ◽

The Mean ◽

Analysis System ◽

Myopia Control

Abstract Objective: To evaluate the effect of atropine alone or combined with orthokeratology on myopia control by meta-analysis system.Methods: The current study searched PubMed, Cochrane Library, EMBASE, MEDLINE, Web of science, Ovid to collect eligible studies. The Weighted mean difference (WMD) of mean changes in axial elongation between the atropine alone or combined with orthokeratology group and the orthokeratology (ortho-k) group was used as evaluation index. Results: Twelve studies were eventually included, involving 671 children in the atropine alone and 547 children in the atropine combined with orthokeratology（AOK） group. This meta-analysis showed that the mean axial elongation of atropine alone was faster than that of ortho-k alone. [WMD=0.06mm, 95％CI(0.02~0.10), p＜0.007]. The function of AOK for slowing axial elongation was affected by the baseline diopter of children. The WMD in -1~-3D subgroup was -0.10 mm(95％CI,-0.14~-0.05,P＜0.00001),which mens that the AOK was more effective than OK alone in retarding axial elongation. In -3~-6D, WMD is -0.04mm (95% Cl, -0.11~0.03), and there is not statistically significant between two groups (P<0.30).Conclusion: This study suggested that ortho-k monotherapy is better in slowing axial elongation than atropine monotherapy in children with myopia. For children with low degree of myopia, the combination of ortho-k and 0.01% atropine is more effective than ortho-k monotherapy in slowing axial elongation in children. But there is no significant difference between two treatments in children with moderate degree of myopia.

Download Full-text

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

Cochrane Database of Systematic Reviews ◽

10.1002/14651858.cd014758 ◽

2021 ◽

Author(s):

John G Lawrenson ◽

Rohit Dhakal ◽

Pavan K Verkicharla ◽

Rakhee Shah ◽

Byki Huntjens ◽

...

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Myopia Control

Download Full-text

Efficacy and Safety of 8 Atropine Concentrations for Myopia Control in Children: A Network Meta-Analysis

Ophthalmology ◽

10.1016/j.ophtha.2021.10.016 ◽

2021 ◽

Author(s):

Ahnul Ha ◽

Seong Joon Kim ◽

Sung Ryul Shim ◽

Young Kook Kim ◽

Jae Ho Jung

Keyword(s):

Meta Analysis ◽

Efficacy And Safety ◽

Myopia Control

Download Full-text

The Role of Back Optic Zone Diameter in Myopia Control with Orthokeratology Lenses

Journal of Clinical Medicine ◽

10.3390/jcm10020336 ◽

2021 ◽

Vol 10 (2) ◽

pp. 336

Author(s):

Jaume Pauné ◽

Silvia Fonts ◽

Lina Rodríguez ◽

Antonio Queirós

Keyword(s):

Pupillary Diameter ◽

Myopia Progression ◽

Zone Diameter ◽

Power Change ◽

Ring Diameter ◽

The Mean ◽

Two Parameters ◽

Better Than ◽

Myopia Control

We compared the efficacy of controlling the annual increase in axial length (AL) in myopic Caucasian children based on two parameters: the back optic zone diameter (BOZD) of the orthokeratology (OK) lens and plus power ring diameter (PPRD) or mid-peripheral annular ring of corneal steepening. Data from 71 myopic patients (mean age, 13.34 ± 1.38 years; range, 10–15 years; 64% male) corrected with different BOZD OK lenses (DRL, Precilens) were collected retrospectively from a Spanish optometric clinic. The sample was divided into groups with BOZDs above or below 5.00 mm and the induced PPRD above or below 4.5 mm, and the relation to AL and refractive progression at 12 months was analyzed. Three subgroups were analyzed, i.e., plus power ring (PPR) inside, outside, or matching the pupil. The mean baseline myopia was −3.11 ± 1.46 D and the AL 24.65 ± 0.88 mm. Significant (p < 0.001) differences were found after 12 months of treatment in the refractive error and AL for the BOZD and PPRD. AL changes in subjects with smaller BOZDs decreased significantly regarding larger diameters (0.09 ± 0.12 and 0.15 ± 0.11 mm, respectively); in subjects with a horizontal sector of PPRD falling inside the pupil, the AL increased less (p = 0.035) than matching or outside the pupil groups by 0.04 ± 0.10 mm, 0.10 ± 0.11 mm, and 0.17 ± 0.12 mm, respectively. This means a 76% lesser AL growth or 0.13 mm/year in absolute reduction. OK corneal parameters can be modified by changing the OK lens designs, which affects myopia progression and AL elongation. Smaller BOZD induces a reduced PPRDs that slows AL elongation better than standard OK lenses. Further investigations should elucidate the effect of pupillary diameter, PPRD, and power change on myopia control.

Download Full-text

Appendix 3. Meta-analysis Methods

Issues in Toxicology - Formaldehyde ◽

10.1039/9781788010269-00357 ◽

2018 ◽

pp. 357-368

Keyword(s):

Meta Analysis ◽

Analysis Methods

Download Full-text

The effects of low-ratio n-6/n-3 PUFA on biomarkers of inflammation: a systematic review and meta-analysis

Food & Function ◽

10.1039/d0fo01976c ◽

2021 ◽

Author(s):

Yali Wei ◽

Yan Meng ◽

Na Li ◽

Qian Wang ◽

Liyong Chen

Keyword(s):

Systematic Review ◽

Fatty Acid ◽

Polyunsaturated Fatty Acid ◽

Meta Analysis ◽

Chain Polyunsaturated Fatty Acid ◽

Inflammation Markers ◽

Pufa Supplementation ◽

Long Chain

The purpose of the systematic review and meta-analysis was to determine if low-ratio n-6/n-3 long-chain polyunsaturated fatty acid (PUFA) supplementation affects serum inflammation markers based on current studies.

Download Full-text