Results of osteopathic correction of myopia and accommodation spasm in children: systematic review using meta-analysis

Introduction. The incidence of myopia tends to grow steadily, and therefore, it can be characterized as a disease of the 21st century. Even with complex ophthalmological treatment, refractive indices do not improve, and only in 18 % of cases these indices are stabilized. The effect of osteopathic correction (OC) on visual acuity is insufficiently studied. A comprehensive review of the evidence on this issue may help estimate the use of OC in existing health care programs for myopia and accommodative spasm in children.The goal of research — to study, according to the literature, the effect of osteopathic correction of somatic dysfunctions in children of different ages on the state of refraction in myopia, spasm of accommodation. Materials and methods. The selection of scientific papers according to the following criteria. Inclusion criteria: children aged 5 to 18 years with a history of diagnosis: myopia of varying degrees, spasm of accommodation; the dividing patients into 2 groups: in the experimental group — osteopathic and ophthalmological treatment, in the control group — standard ophthalmological treatment; the results of an ophthalmological examination are described; the duration of observations is from 3 to 6 months. Exclusion criteria: description of a single clinical case; the diseases are not associated with disorders of the visual apparatus; the study sample is less than 30 patients. The Jamovi statistical analysis software was used to perform the meta-analysis. The Newcastle-Ottawa scale was used to assess the risk of bias in cohort studies.Results. There were selected 3 scientific works studying the influence of osteopathic correction on the state of refraction in myopia, spasm of accommodation in children. On the Newcastle-Ottawa scale, all three studies had a total score of 8, indicating a low risk of bias. The odds ratio was 20.884, which is a high indicator revealing the effectiveness of the OC together with ophthalmological treatment of myopia, accommodation spasm in children of different ages. Thus, we can say that when similar studies will be repeated, the achievement of a positive effect when using OC as part of a complex treatment in 95 % of cases will be higher than the use of only ophthalmological treatment of children with myopia, accommodation spasm.Conclusion. Based on the studied literature and the conducted meta-analysis, we can make a preliminary conclusion that the inclusion of osteopathic correction in the complex treatment can give an additional advantage over standard treatment in children with refractive disorders.

Cost-benefit analysis of accommodation spasm prevention programs for schoolchildren

Annotation. The relevance of the study is due to the prevalence of accommodation spasm in schoolchildren and the uncertainty regarding the clinical and economic effectiveness of prevention programs. The aim of the study was to develop a new approach to cost-benefit analysis to evaluate the effectiveness of programs for the prevention of spasm accommodation in schoolchildren. The proposed methodology is based on the economic theory of moral hazard and included analytical optimization with the derivation of the equilibrium model. The data are organized into a dynamic sample of schoolchildren with a panel design with replenishment with first-graders during 2012–2015, followed by observation until 2017 with sample size of 1115. It has been established that from a cost-benefit perspective, additional measures of an expanded prevention program, aimed primarily at improving compliance and improving the management of a standard program, provide a net profit in 42.45% of students (430 out of 1013). It has been established that the benefits of an expanded program increase in terms of cost-benefit compared to the existing one: in the schoolchildren with tonsillitis, burdened heredity, daily continuous computer work for more than 2 hours, the presence of stressful situations, a history of eclipses in the eyes. To evaluate preventive programs, future gains should be considered, since this problem is even more clearly related to the prevention of myopia. This will lead to greater efficiency of the expanded program due to better clinical efficacy (not shown in the article).