Network Meta-Analysis of Pharmacological and Optical Interventions for Myopia Control in Children: A 1-Year and 2-Year Comparative Analysis
This network meta-analysis of 11 randomized trials involving 1,522 children found that higher-concentration atropine (0.04–0.05%) and specific optical interventions (DIMS lenses and ortho-K combined with low-dose atropine) are the most effective treatments for controlling myopia progression over 1 to 2 years, with atropine 0.04% offering a particularly promising balance of efficacy and tolerability for 2-year treatment.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
The eyes of children are not static; they are growing organs that can sometimes grow too long. When the eyeball stretches beyond its ideal length, light entering the eye focuses in front of the retina rather than directly on it, creating a blurry world known as nearsightedness, or myopia. This condition is becoming a global health challenge, with millions of young people affected, particularly in East Asia. If left unchecked, severe nearsightedness can lead to serious vision problems later in life, such as retinal detachment or glaucoma. To stop this stretching, doctors have developed various tools. Some are liquid drops placed in the eye, while others are special contact lenses worn overnight or glasses with unique lens designs. For years, researchers have known these methods work better than doing nothing, but they have struggled to answer a crucial question: which specific treatment works best, and does the answer change depending on how long a child is treated?
A team of researchers from Kunming Medical University in China set out to solve this puzzle by gathering and comparing data from eleven different clinical trials involving over 1,500 children. Instead of looking at each study in isolation, they used a sophisticated method to weave all the results together, creating a single, comprehensive picture of how these treatments stack up against one another. They focused on two specific checkpoints: one year into treatment and two years into treatment. Their goal was to measure the actual physical change in the length of the eyeball, which is the most reliable way to see if a treatment is successfully slowing down the progression of nearsightedness.
The researchers found that almost every active treatment they studied was better than no treatment at all, but the degree of success varied significantly. After one year, the most effective treatment was a specific concentration of atropine drops, a medication that relaxes the eye muscles. This particular strength of drops, at 0.05 percent, slowed the growth of the eye by an average of 0.21 millimeters compared to children who received no treatment. This was followed closely by a combination of special contact lenses worn overnight and a very low dose of the same drops. Interestingly, a slightly lower concentration of the drops, known as 0.04 percent, also performed very well, ranking third in effectiveness.
When the researchers looked at the two-year mark, the landscape of effectiveness shifted slightly, though the top contenders remained strong. The highest concentration of atropine drops, at 1 percent, emerged as the most powerful single agent, reducing eye growth by 0.40 millimeters over two years. However, this high strength is often difficult for children to tolerate due to side effects like sensitivity to light and blurry vision. In the middle tier of effectiveness, a new type of spectacle lens designed to create a specific visual signal to slow eye growth, known as DIMS lenses, performed exceptionally well, reducing growth by 0.34 millimeters. The 0.05 percent and 0.04 percent concentrations of atropine drops also held their ground, showing they could achieve nearly the same results as the stronger 1 percent drops but with a much better chance of being comfortable for the child to use every day.
One of the most valuable contributions of this study was its ability to connect treatments that had rarely been compared directly. By including a recent trial that tested the 0.04 percent concentration, the researchers were able to link the world of contact lenses with the world of eye drops in their analysis for the first time. This allowed them to see that while the strongest drops are the most potent, the 0.04 percent concentration offers a compelling balance. It provides a level of protection against eye growth that is very close to the strongest options, yet it is likely to be easier for older children and teenagers to stick with over the long term. The study suggests that for many families, this middle-ground option might be the most practical choice, offering strong results without the heavy side effects of the highest doses.
The researchers were careful to note that while their findings are robust, the number of studies available for some specific comparisons was still limited. They observed that the treatments generally worked consistently over time, with the rankings of the most effective options staying relatively stable between the one-year and two-year marks. The study confirms that there is no single "magic bullet" that works perfectly for every child, but it does provide a clear hierarchy of options. Doctors and parents can now look at the evidence and understand that higher concentrations of atropine and advanced optical lenses are the most powerful tools available, with the 0.04 percent drop concentration standing out as a particularly promising solution for balancing effectiveness with daily comfort.
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