ABSTRACT
Objective:To evaluate the effect of peripheral defocus soft contact lenses (PDSCLs), single-vision spectacles and single-vision contact lenses (SVCLs) on the progression of myopia in children and adolescents.Methods:A meta-analysis was conducted.To collect relevant studies on the myopia control effect of PDSCLs in children, English databases including PubMed, Medline, Embase and Cochrane library were searched with myopia, contact lens, children, adolescents, myopia progression, axial length, refractive error and relevant free English terms as key words.Chinese databases including CNKI, Wanfang and VIP were searched with corresponding Chinese phrases and relevant free Chinese terms as key words.Randomized controlled trials (RCTs) on the myopia control effect in children and adolescents, with PDSCLs wearer as experimental group and single-vision spectacles or SVCLs wearer as control group, were independently collected by two researchers.Quality of included studies was evaluated with the Cochrane tool to assess risk of bias for RCTs.Combined effects of change in refraction and axial length between experimental and control groups was calculated by weighted mean difference (WMD) and 95%confidence interval ( CI). The heterogeneity of included studies was evaluated by I2 statistic.The refraction and axial length of experimental and control groups were compared by Z test.Myopia control effect of different PDSCLs add powers was analyzed by subgroup analysis.The experimental data with add power ≤+ 2.00 D, low aberration and low depth of focus were assigned to low-medium add power subgroup, and the experimental data with add power >+ 2.00 D, high aberration and high depth of focus were assigned to high add power subgroup. Results:A total of 378 publications were retrieved.Finally, 10 high-quality RCTs and 14 groups of data were included in this meta-analysis.In these studies, 1 645 myopic children aged from 6 to 18 years were enrolled, including 808 cases in experimental group and 837 in control group.The follow-up ranged from 10 to 36 months.Among the 10 studies, there were two crossover trials without a washout period, so only the first intervention results were included.According to the meta-analysis, the change in refraction in experimental group was significantly less than that in control group (WMD=0.22 D, 95% CI: 0.15-0.30, Z=5.65; P<0.05). The change in axial elongation was significantly less in experimental group than control group (WMD=-0.10 mm, 95% CI: -0.12--0.09, Z=12.28; P<0.05). Subgroup analysis showed that the WMD of refraction change and axial elongation between experimental and control groups were 0.21 D (95% CI: 0.10-0.31) and-0.10 mm (95% CI: -0.13-0.08) in the low-medium add power subgroup, respectively, and were 0.26 D (95% CI: 0.13-0.38) and -0.13 mm (95% CI: -0.15--0.10) in the high add power subgroup, respectively. Conclusions:PDSCLs have better myopia control effect than single-vision spectacles and SVCLs in children and adolescents.When the add power is higher, PDSCLs can slow the progression of myopia more effectively.