Efficacy comparison of atropine, orthokeratology and repeated low-level red-light therapy for myopia control in children: a systematic review and network meta-analysis.

Objectives: This study aimed to compare the efficacy of different interventions for myopia control in children, including 0.01% atropine (AP), orthokeratology (Ortho-k), and repeated low-level red-light therapy (RLRL), and their combinations by conducting a network meta-analysis.

Methods: We searched for randomised controlled trials (RCTs) in PubMed, Web of Science and Embase. The primary outcomes were the mean changes in the cycloplegic spherical equivalent (SE) and axial length (AL) at the 12-month follow-up. A Bayesian random-effects network meta-analysis was performed to estimate pooled weighted mean differences and 95% credible intervals.

Results: The analysis included 41 RCTs with 6434 eyes. Compared with the control group, all interventions were found to be effective at slowing myopia progression, combining direct and indirect evidence at the 12-month follow-up: RLRL therapy (AL -0.31 (0.39, 0.24), p<0.05; SE 0.76 (0.54, 0.98), p<0.05), 0.01% atropine (AL -0.13 (-0.20, 0.07), p<0.05; SE 0.25 (0.08, 0.42), p<0.05), Ortho-k therapy (AL -0.16 (-0.26, 0.06), p<0.05; SE 0.58 (0.05, 1.13), p<0.05) and 0.01% atropine+Ortho-k therapy (AL -0.27 (-0.38, 0.16), p<0.05; SE 0.76 (0.23, 1.31), p<0.05). The cumulative probability ranking suggested that RLRL therapy was the most effective intervention in slowing AL, followed by 0.01% atropine+Ortho-k, Ortho-k and 0.01% atropine.

Conclusions: This network meta-analysis provides evidence that RLRL, 0.01% atropine, Ortho-k and 0.01% atropine+Ortho-k are all effective in suppressing myopia progress. In terms of long-term treatment efficacy in slowing AL and SE procession, RLRL was the most effective intervention.