Orthokeratology and myopia control: A comprehensive meta-analysis of axial growth in children and adolescents

IF 2.8 3区医学 Q1 OPHTHALMOLOGY Acta Ophthalmologica Pub Date : 2025-01-19 DOI:10.1111/aos.17279

António Queirós, Inês Mota-Silva, Ana Filipa Pereira-da-Mota

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Abstract

Aims/Purpose: The aim of this study was to evaluate the longitudinal effect on axial eye length in myopic children and adolescents treated with orthokeratology (OK) lenses compared to spectacles (GL), through a systematic review and meta-analysis

Methods: We conducted a systematic search of PubMed and Google Scholar databases for randomized controlled trials and cohort studies investigated the effects of longitudinal axial length difference, using the keyword “Axial Length” AND “orthokeratology” AND “spectacles”. From the initial 91 studies, we excluded 13 review studies, 10 meta-analysis studies, 7 systematic reviews and 37 studies that did not meet the inclusion criteria. Of the 24 selected studies, detailed information was available at 24, 18, 12, 6, 3 and 1 month, with 10, 8, 19, 17, 2 and 3 studies respectively, allowing for the comparison between 2172 eyes treated with orthokeratology and 2095 eyes with glasses.

Results: The analysis of the 24 studies (which included 59 comparisons from 1 month to 24 months) showed no statistically significant differences in initial axial length [AL(GL) = 24.39 ± 0.34 mm; AL(OK) = 24.44 ± 0.38 mm] and initial refractive error [M(GL) = -2.59 ± 0.70 D; M(OK) = -2.53 ± 0.44 D] between the two treatment groups (p > 0.565, independent samples t-test) and for the evolution time intervals (p > 0.591, ANOVA). This analysis encompassed 4267 eyes with a mean age of 10.23 ± 1.21 years. Forest plot provided in an overall effect size of myopic defocus AL = -0.16 com IC 95% -0.19 a -0.14, Z = 12.71 p < 0.001. A random effects model was used considering the heterogeneity observed (I² = 97%; p < 0.001, df = 58). There was a greater myopia control effect at 24 months (AL = -0.26, 95% IC -0.29 to -0.22, Z = 13.71 p < 0.001; I² = 0%; p = 0.95) than to treatments of less than 3 months (AL = -0.04, 95% IC -0.06 to -0.01, Z = 2.60 p = < 0.009; I² = 86%; p < 0.001).

Conclusions: While the treatment at 24 months shows an homogeneous behaviour among studies, shorter follow-up times renders a larger heterogeneity and for that reason, longer follow-up periods should be preferred to estimate a more solid effect size. Orthokeratology treatment has been shown to be effective in myopia control progression for short or longer longitudinal treatments in children and young people with spectacles comparison.

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角膜塑形镜与近视控制：儿童和青少年眼轴生长的综合meta分析

目的/宗旨：本研究旨在通过系统综述和荟萃分析，评估与眼镜（GL）相比，矫形角膜塑形镜（OK）对近视儿童和青少年眼轴长度的纵向影响：我们使用关键词 "轴向长度"、"角膜矫形 "和 "眼镜"，在 PubMed 和 Google Scholar 数据库中对调查纵向轴向长度差异影响的随机对照试验和队列研究进行了系统检索。在最初的 91 项研究中，我们排除了 13 项综述研究、10 项荟萃分析研究、7 项系统综述和 37 项不符合纳入标准的研究。在入选的 24 项研究中，分别有 10 项、8 项、19 项、17 项、2 项和 3 项研究提供了 24 个月、18 个月、12 个月、6 个月、3 个月和 1 个月的详细信息，从而可以对 2172 只接受角膜矫形术治疗的眼睛和 2095 只佩戴眼镜的眼睛进行比较。研究结果对 24 项研究（包括 59 项从 1 个月到 24 个月的比较）的分析表明，初始轴长[AL(GL) = 24.39 ± 0.34 mm；AL(OK) = 24.44 ± 0.38 mm]和初始屈光度[AL(GL) = 24.39 ± 0.34 mm]在统计学上没有显著差异。38 mm]和初始屈光不正[M(GL) = -2.59 ± 0.70 D; M(OK) = -2.53 ± 0.44 D]在两个治疗组之间（p > 0.565，独立样本 t 检验）和演变时间间隔之间（p > 0.591，方差分析）没有统计学差异。该分析包括 4267 只眼睛，平均年龄为 10.23 ± 1.21 岁。森林图显示，近视离焦的总体效应大小为 AL = -0.16 com IC 95% -0.19 a -0.14，Z = 12.71 p < 0.001。考虑到观察到的异质性，采用了随机效应模型（I2 = 97%; p < 0.001, df = 58）。24个月的近视控制效果（AL = -0.26，95% IC -0.29至-0.22，Z = 13.71 p <；0.001；I2 = 0%；p = 0.95）大于3个月以下的治疗效果（AL = -0.04，95% IC -0.06至-0.01，Z = 2.60 p = <；0.009；I2 = 86%；p <；0.001）。结论虽然 24 个月的治疗在各研究中表现出同质性，但较短的随访时间会导致较大的异质性，因此，应选择较长的随访时间来估算更可靠的效应大小。事实证明，在儿童和青少年中进行短期或长期纵向治疗，角膜塑形镜治疗可有效控制近视度数的加深。

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来源期刊

Acta Ophthalmologica 医学-眼科学

CiteScore

7.60

自引率

5.90%

发文量

433

审稿时长

6 months

期刊介绍： Acta Ophthalmologica is published on behalf of the Acta Ophthalmologica Scandinavica Foundation and is the official scientific publication of the following societies: The Danish Ophthalmological Society, The Finnish Ophthalmological Society, The Icelandic Ophthalmological Society, The Norwegian Ophthalmological Society and The Swedish Ophthalmological Society, and also the European Association for Vision and Eye Research (EVER). Acta Ophthalmologica publishes clinical and experimental original articles, reviews, editorials, educational photo essays (Diagnosis and Therapy in Ophthalmology), case reports and case series, letters to the editor and doctoral theses.