Myopia control strategies: A systematic review and meta‐meta‐analysis

Abstract Purpose To summarise pooled estimates of the efficacies of various myopia control interventions, as drawn from published meta‐analyses. Method PubMed, SCOPUS and Web of Science were searched from inception to February 2024 for systematic reviews and meta‐analyses reporting treatment effects of various myopia control strategies. The qualities of the included meta‐analyses were assessed using the 16‐item A MeaSurement Tool to Assess systematic Reviews ( AMSTAR ) 2. An intervention was defined as having a clinically significant effect if it resulted in a change in spherical equivalent refraction (SER) of ≥0.50 D/year or axial length (AL) change of ≤−0.18 mm/year. Results A total of 38 studies were identified. The overall respective changes in SER and AL, mean difference (95% CI) were high‐concentration (≥0.5%) atropine 0.67 D (0.58–0.77) and −0.24 mm (−0.36 to −0.11); moderate‐concentration (>0.05% to <0.5%) atropine 0.48 D (0.34–0.62) and −0.23 mm (−0.27 to −0.19); low‐concentration (0.01%, 0.025%, 0.05%) atropine 0.33 D (0.23–0.43) and −0.14 mm (−0.19 to −0.09); orthokeratology −0.47 mm (−0.66 to −0.28); peripheral plus soft contact lenses 0.30 D (0.18–0.42) and −0.35 mm (−0.62 to −0.08); peripheral plus spectacles 0.77 D (0.40–1.14) and −0.43 mm (−0.78 to −0.08); multifocal spectacles 0.21 D (0.11–0.31); repeated low‐level red light therapy 0.55 D (0.46–0.65) and −0.25 mm (−0.29 to −0.20); outdoor time 0.17 D (0.16–0.18) and −0.04 mm (−0.06 to −0.01). Conclusion High and moderate concentrations of atropine, orthokeratology, peripheral plus spectacles and repeated low‐level red light demonstrated clinically significant effects on slowing AL elongation, while high and moderate concentrations of atropine, peripheral plus spectacles and repeated low‐level red light demonstrated clinically significant effects on slowing SER progression.