Chen Meilan, Xu Lu, Li Hongyang, Cai Fengping, Wang Hao, Hu Chun, Wu Yi
Department of Ophthalmology, Guangdong Second Provincial General Hospital, Guangzhou, China.
Institute for Brain Science and Rehabilitation, South China Normal University, Guangzhou, China.
Front Pediatr. 2022 Jun 20;10:889243. doi: 10.3389/fped.2022.889243. eCollection 2022.
Myopia is one of the most common eye diseases in school-aged children. Multifocal lens (MFL) is one of the interventions that has being widely applied to control the progress of myopia. However, the treatment effects of MFLs in school-aged children require to be systematically evaluated.
A systematic analysis on qualified randomized controlled trials (RCTs) in which MFLs were prescribed as the intervention and single-vision lenses (SVLs) as the control was conducted. The treatment effects referring to the mean differences in spherical equivalent refraction (SER) and axial length (AL) between MFLs and SVLs groups were analyzed.
With annual visit (3-years follow-up), the weighted mean differences (WMDs) in SER between MFLs and SVLs were 0.29 D (95% CI, 0.21 ∼ 0.37, < 0.00001), 0.46 D (95% CI, 0.32 ∼ 0.60, < 0.00001), and 0.64 D (95% CI, 0.40 ∼ 0.88, < 0.00001) at the first, second, and third year; in AL were -0.12 mm (95% CI, -0.14 ∼-0.11, < 0.00001), -0.19 mm (95% CI, -0.22 ∼-0.16, < 0.00001), and -0.26 mm (95% CI, -0.31 ∼-0.21, < 0.00001) at the first, second, and third year. With 6-months interval trials (2-years follow-up), the WMDs in SER from MFLs were 0.14 D (95% CI, 0.08 ∼ 0.20, < 0.0001), 0.19 D (95% CI, 0.11 ∼ 0.28, < 0.0001), 0.24 D (95% CI, 0.16 ∼ 0.33, < 0.0001), 0.31 D (95% CI, 0.18 ∼ 0.44, < 0.0001) and in AL from MFLs were -0.08 mm (95% CI, -0.09 ∼-0.07, < 0.00001), -0.10 mm (95% CI, -0.12 ∼-0.09, < 0.00001), -0.14 mm (95% CI, -0.17 ∼-0.11, < 0.00001), and -0.18 mm (95% CI, -0.22 ∼-0.14, < 0.00001) slower comparing with SVLs at follow up of 6, 12, 18, and 24 months, respectively.
The treatment effects of MFLs to slow down the myopic progress are positive in both 6-months and annual-visit trials and which could be sustained till 36 months. While a slight weaker treatment effect was observed after the first visit in 6-months visit, a slight rebound was observed at the following visit points. Furthermore, the treatment effects in annual visit are more profound than 6-months visit at almost all stages especially in SER. Our analysis encourages the MFLs users to maintain a long-term treatment with annual visit.
近视是学龄儿童中最常见的眼部疾病之一。多焦点镜片（MFL）是广泛应用于控制近视进展的干预措施之一。然而，MFLs对学龄儿童的治疗效果需要进行系统评估。
对合格的随机对照试验（RCTs）进行系统分析，其中将MFLs作为干预措施，单焦点镜片（SVLs）作为对照。分析了MFLs组和SVLs组之间球镜等效屈光度（SER）和眼轴长度（AL）的平均差异的治疗效果。
在每年随访（3年随访）时，MFLs和SVLs之间SER的加权平均差异（WMDs）在第一年、第二年和第三年分别为0.29 D（95%CI，0.21～0.37，P<0.00001）、0.46 D（95%CI，0.32～0.60，P<0.00001）和0.64 D（95%CI，0.40～0.88，P<0.00001）；AL在第一年、第二年和第三年分别为-0.12 mm（95%CI，-0.14～-0.11，P<0.00001）、-0.19 mm（95%CI，-0.22～-0.16，P<0.00001）和-0.26 mm（95%CI，-0.31～-0.21，P<0.00001）。在间隔6个月的试验（2年随访）中，与SVLs相比，MFLs在随访6、12、18和24个月时SER的WMDs分别为0.14 D（95%CI，0.08～0.20，P<0.0001）、0.19 D（95%CI，0.11～0.28，P<0.0001）、0.24 D（95%CI，0.16～0.33，P<0.0001）、0.31 D（95%CI，0.18～0.44，P<0.0001），MFLs的AL分别为-0.08 mm（95%CI，-0.09～-0.07，P<0.00001）、-0.10 mm（95%CI，-0.12～-0.09，P<0.00001）、-0.14 mm（95%CI，-0.17～-0.11，P<0.00001）和-0.18 mm（95%CI，-0.22～-0.14，P<0.00001）增长较慢。
MFLs减缓近视进展的治疗效果在6个月和每年随访试验中均为阳性，且可持续至36个月。虽然在6个月随访的首次随访后观察到治疗效果略有减弱，但在随后的随访点观察到略有反弹。此外，几乎在所有阶段，每年随访的治疗效果比6个月随访更显著，尤其是在SER方面。我们的分析鼓励MFLs使用者进行每年随访的长期治疗。
