Efficacy of Tuina for Myopia in Children: Protocol for a Randomized Controlled Trial.

Purpose A safe and effective treatment that can control or slow the progression of myopia, which typically occurs during childhood, would be a significant advance in the management of myopia. The findings of recent clinical trials evaluating the use of antimuscarinic agents atropine and pirenzepine as well as optical modalities such as progressive addition lenses for controlling the progression of myopia in children are reported. Methods Randomized controlled trials with comparisons of the effectiveness of interventions such as atropine, pirenzepine and progressive addition lenses to decrease myopia progression in myopic children were reviewed. Results Topical atropine was well tolerated and effective in slowing the progression of low and moderate myopia and ocular axial elongation in children. Pirenzepine gel was also effective and relatively safe in slowing myopia progression during a 1‐year treatment period. Progressive addition lenses did not, or at best marginally slowed the increase of myopia and axial elongation. Conclusion Trials of progressive addition lenses on myopia progression have yielded disappointing results. To date, only pharmacological intervention with atropine and pirenzepine appear to have some consistent effect on reducing the progression of myopia. However, the long‐term safety and efficacy profiles of these drugs are not known. As such, well‐designed clinical trials with longer duration of treatment and follow‐up are required.

BackgroundMyopia has recently emerged as a significant threat to global public health. The high and pathological myopia in children and adolescents could result in irreversible damage to eye tissues and severe impairment of visual function without timely control. Posterior scleral reinforcement (PSR) can effectively control the progression of high myopia by limiting posterior scleral expansion, improving retrobulbar vascular perfusion, thereby stabilizing the axial length and refraction of the eye. Moreover, orthokeratology and low concentrations of atropine are also effective in slowing myopia progression.Case presentationA female child was diagnosed with binocular congenital myopia and amblyopia at the age of 3 and the patient’s vision had never been rectified with spectacles at the first consultation. The patient’s ophthalmological findings suggested, high refractive error with low best corrected visual acuity, longer axial length beyond the standard level of her age, and fundus examination suggesting posterior scleral staphyloma with weakened hemodynamics of the posterior ciliary artery. Thereby, PSR was performed to improve fundus health and the combination of orthokeratology and 0.01% atropine were performed to control the development of myopia. Following up to 8 years of clinical treatment and observations, the progression of myopia could be well controlled and fundus health was stable.ConclusionIn this report, 8-year of clinical observation indicated that PSR could improve choroidal thickness and hemodynamic parameters of the retrobulbar vessels, postoperative orthokeratology combined with 0.01% atropine treatment strategy may be a good choice for myopia control effectively.

To determine the effects of advanced spectacle lens technologies on changes in spherical equivalent of refraction (SER) and axial length (AL) elongation in slowing down the progression of myopia in children and adolescents, by synthesising data from randomised controlled trials (RCTs). A systematic review and meta-analysis was conducted to identify all RCTs up to 27 February 2025 that compared intervention groups with myopia control lenses and control groups with standard single vision lenses (SVLs). Data from eligible studies were extracted into specially-designed data collection forms without changing the original values. Means and SD for continuous outcomes were determined and imported into RevMan. This meta-analysis included 23 RCTs with a total of 13.315 subjects. Compared with SVLs, myopia control lenses significantly reduced AL (-0.15 mm; 95% CI -0.20 to -0.09; p<0.00001) and SER progression (-0.31 D; 95% CI -0.42 to -0.20; p<0.00001). Highly Aspherical Lenslet lenses significantly reduced AL (-0.28 mm; 95% CI -0.37 to -0.19) and SER progression (-0.52 D; 95% CI -0.84 to -0.20). Defocus Incorporated Multiple Segments lenses also significantly reduced SER (-0.45 D; 95% CI -0.65 to -0.26), although only one eligible RCT reported AL data. Other lens types had modest or variable effects. This meta-analysis provides an up-to-date and detailed comparative evaluation of spectacle lens designs for myopia control, based exclusively on RCTs. These findings support the use of specialty lenses as an effective, non-invasive strategy to reduce the risks associated with high-myopia and guide optimal lens selection in clinical practice. CRD420251009898.

This meta‐analysis investigates the effectiveness of outdoor activities in reducing the onset of myopia in children and adolescents by analysing changes in axial elongation and spherical equivalent refractive error. Following PRISMA guidelines and registered in PROSPERO (CRD42024592971), the study included randomized controlled trials (RCTs) and observational studies. The eligibility criteria targeted children and adolescents aged 6 to 18 years with varying levels of outdoor exposure. Primary outcomes were axial elongation and spherical equivalent change. Studies were assessed for quality using GRADE and AMSTAR‐2 tools, and data were analysed using Review Manager 5.4, with random‐effects models applied when heterogeneity was significant. Fifteen studies (9 RCTs and 6 observational) were included, with a total of 16 597 participants. Outdoor activities significantly reduced or delayed the onset of myopia, with a mean axial length difference of −0.08 mm per year (95% CI: −0.09 to −0.07) and a spherical equivalent difference of 0.16 diopters per year (95% CI: 0.07 to 0.25). These differences were observed after 1 year of intervention and sustained for up to 3 years, with daily outdoor exposure ranging from 40 to 120 min. Heterogeneity was moderate to high, but sensitivity analyses confirmed the robustness of the results. While higher outdoor exposure appeared more effective in reducing myopia progression, the certainty of this evidence was rated as low due to suspected publication bias, as indicated by the GRADE analysis. Outdoor activities, especially with prolonged exposure to intense light, effectively reduce or delay the onset of myopia in children and adolescents. This study emphasizes the importance of light intensity in maximizing the benefits of outdoor interventions and highlights regional differences in effectiveness, suggesting that environmental factors play a significant role in the outcomes.

Auricular acupressure for myopia in children and adolescents: A systematic review

To evaluate the impact of Compound Tropicamide (Trop) Eye Drops on the visual quality in juvenile pseudomyopia patients. Data from 111 juvenile pseudomyopia patients treated between September 2019 and September 2022 were reviewed in this retrospective study, including 50 cases treated with Atropine Sulfate Ophthalmic Gel (control group) and 61 with Compound Trop Eye Drops (research group). Clinical efficacy, amplitude of accommodation (AA), uncorrected visual acuity (UCVA), intraocular pressure (IOP), axial length (AL), symptom improvement, complications, and quality of life were compared. Risk factors for visual quality improvement were analyzed using Logistic regression. The research group demonstrated significantly higher treatment efficacy compared to the control group (P>0.05). Post-treatment, AA, IOP, and AL decreased notably in the research group compared to baseline and the control group (all P<0.05). UCVA and quality of life scores improved significantly in the research group (both P<0.05). Recovery indicators, including resolution of dizziness, alleviation of ocular soreness, and vision recovery, were significantly shorter in the research group (all P<0.05). Both groups had similar complication rates, including dry mouth, facial blushing, conjunctival congestion, and transient tachycardia (P>0.05). The research group reported superior post-treatment quality of life across all domains (all P<0.05). Logistic regression showed that gender, age, disease duration, family history of myopia, education level, AA, UCVA, and treatment method were not significant risk factors for visual quality improvement (all P>0.05). Compound Trop Eye Drops effectively enhances visual function and quality of life in juvenile pseudomyopia patients, with a safety profile comparable to low-dose atropine, offering potential clinical value.

There is a scarcity of literature focusing on sleep's impact on myopia in children despite an epidemic rise of myopia among the age group and the importance of early prevention. As such, this systematic review-meta-analysis aims to evaluate the association between various aspects of sleep and myopia in children and adolescents aged 0-19years. We searched PubMed, EMBASE, and Cochrane Library on 08/12/2022 for studies reporting sleep in relation to myopia among children and adolescents. Myopia was defined as spherical equivalent refraction < -0.5 diopter. The primary outcome was the relationship between sleep duration and myopia prevalence. Secondary outcomes include the effect of sleep quality, bedtime, and waketime on myopia prevalence, incidence, and progression. Odds ratio (OR) was estimated with a 95% confidence interval (95% CI). Eighteen studies (49,277 participants) were included in the review, and six studies (14,116 participants) were included in the meta-analysis for the primary outcome. There was no significant correlation between sleep and myopia prevalence (OR = 0.905, 95% CI = 0.782 to 1.047). Some studies suggested that better sleep quality (2 of 6 studies), earlier bedtime (3 of 5 studies), and later waketimes (2 of 3 studies) had protective effects on myopia. Sleep duration did not affect myopia prevalence in children, while other aspects of sleep had plausible but inconclusive impacts on myopia development and progression. More research with diverse populations and standardized methods of reporting is needed.

This study aimed to evaluate the efficacy and safety of 0.01% atropine eye drops in preventing myopia in children with pre-myopia. In this randomised controlled trial (ChiCTR2200055482), children aged 5-12 years with cycloplegic spherical equivalent (SE) between +0.75D and -0.50D were randomised 1:1 to receive either 0.01% atropine (once nightly) or placebo (once nightly). The primary endpoint was the change in SE after 12 months. Sixty-four subjects (48.4% female) completed the 12-month follow-up (32 per group, mean age, 7.47 ± 1.72 vs. 7.84 ± 1.32 years). After 12 months, the change in SE was significantly smaller in the 0.01% atropine group than in the placebo group (-0.23 ± 0.50D vs. -0.49 ± 0.42D; p = 0.03), representing a 53% reduction in myopia progression. No significant intergroup difference was observed in axial length (AL) change (+0.26 ± 0.16 mm vs. +0.32 ± 0.15 mm; p = 0.13), corresponding to a 19% reduction in AL elongation. The 0.01% atropine group exhibited significantly larger pupil diameters at all time points (all p < 0.05), while safety parameters (e.g., amplitude of accommodation, tear film stability, intraocular pressure) remained comparable between the groups (all p > 0.05). In 5- to 12-year-old pre-myopic children, nightly administration of 0.01% atropine eye drops for 1 year was found to delay myopic shift compared with placebo, and no persistent adverse events were observed. Additionally, the atropine group exhibited less axial elongation than the control group, though this difference was not statistically significant.

To evaluate the impact of amplitude of accommodation on controlling the development of myopia in orthokeratology. Forty-nine children aged 7 to 14 years were enrolled in this prospective clinical study.Orthokeratology was performed to correct the refractive errors of these children after measurement of refraction, corneal topography, amplitude of accommodation and axial length. Axial length (AL) and amplitude of accommodation was measured after treatment. The average amplitude of accommodation was calculated and was used as the cutting point for dividing the cohort into "amplitude of accommodation above average" vs. "amplitude of accommodation below average". Data were analyzed by paired t-test, independent t-test, repeated measures-ANOVAs and Pearson correlation analysis. The AL before and after 1- year and 2-year treatment was (24.98 ± 0.75) mm, (25.13 ± 0.74) mm and (25.32 ± 0.78) mm, respectively. AL increased significantly throughout the observed 24-month period (F = 75.848, P < 0.001) . Amplitude of accommodation increased from (13.68 ± 2.65) D to (16.12 ± 2.41) D in 2 years (t = -6.461, P < 0.001) and amplitude of accommodation significantly affected axial growth (F = 7.395, P = 0.009) . The axial growth of subjects with below average amplitude of accommodation and those with above average amplitude of accommodation was (0.23 ± 0.25) and (0.44 ± 0.30) mm, indicating a statistically difference(t = -2.719, P = 0.009). AL change in subjects with below average amplitude of accommodation was 55.81% that of the subjects with above average amplitude of accommodation. Baseline amplitude of accommodation was positively correlated to axial growth at 24-month visit (r = 0.502, P < 0.001). Linear regression analysis was used between baseline amplitude of accommodation and 2-year axial growth: Axial growth = 0.055· Baseline amplitude of accommodation-0.409(F = 15.806, P < 0.001). The change of amplitude of accommodation for subjects with below average amplitude of accommodation and those with above average amplitude of accommodation after 2-year was (4.04 ± 2.16) D and (0.91 ± 2.15) D, indicating statistically difference (t = 5.084, P < 0.001). Myopic control effect would be more beneficial to lower amplitude of accommodation children than that to higher amplitude of accommodation children in orthokeratology. The enhancement of accommodation provides some basis for slowing myopia progression with orthokeratology.

Introduction and purpose. Early use of contact correction for congenital myopia and astigmatism in children and adolescents contributes to their social rehabilitation. The myopia correction with contact lenses provides sustainability of correction and absence of periods of blurred retinal images, which are experienced with the use of glasses. The purpose of the study was to determine, through long-term follow-up, the extent to which contact lens correction improves uncorrected and maximally corrected visual acuity in school-age children with myopia and myopic astigmatism. Material and methods. We followed up for three years 84 children (168 eyes) aged 6–16 years with myopic manifest refraction and astigmatism, who used soft silicone hydrogel aspherical contact lenses to correct ametropia. In the early and late follow-up, these patients were examined for visual acuity, objective and subjective clinical refraction, axial eye length, corneal thickness and diameter, keratometry, and phorometric data (accommodation, vergence, disparate areas, and oculomotor apparatus and their interaction). Results.In course of long-term monitoring of myopia and myopic astigmatism correction with contact lenses in school-age children, the statistically significant results were recorded after three years of observation, namely: an increase in uncorrected visual acuity by 47% (t=5.2; p&lt;0.01), corrected acuity vision by 8% (t=9.3; p&lt;0.01), the spheroequivalent by 17% (t=3.7; p&lt;0.01), anteroposterior segment of the eye by 4% (t=7,1; p&lt;0.01), amplitude of accommodation by 27% (t=14.6; p&lt;0.01), negative part of relative accommodation by 17% (t=7.3; p&lt;0.01), positive part of relative accommodation by 32% (t=7.1; p&lt;0.01), flexibility of accommodation by 35% (t=14.2; p&lt;0.01), the ratio of accommodation convergence to accommodation by 19% (t=3.4, p&lt;0.01), stereovision acuity by 56% (t=4.1; p&lt;0.01), as well as a decrease in keratometry index in the strong meridian by 2% (t=5.2; p&lt;0.01), delays in accommodative responses by 33% (t=14.2; p &lt;0.01), distance phoria by 16% (t=10.1; p&lt;0.01), near phoria by 16% (t=11.3, p&lt;0.01). Conclusions. The study has shown that the use of contact lenses by school-aged children with myopia and myopic astigmatism can increase uncorrected and maximum corrected visual acuity. The increase of the spheroequivalent and anteroposterior axis (APA) of the eye indicates progression of myopia, but the use of soft contact lenses (SCL) leads to changes of the anterior corneal surface: an increase of the thickness in the central zone, and its flattening. Improvement of accommodation, vergence, disparate parts of the oculomotor apparatus, and their interaction was also observed. The results obtained indicate deceleration of myopia progression.

This review summarizes the experimental evidence that supports the role of dopamine in the regulation of ocular axial growth. The most important functions attributed to dopamine are light adaptation and regulation of the retinal circadian rhythm. An increase of the retinal levels of dopamine activates D1 and D2 dopaminergic receptors present throughout the retina, generating a signal that inhibits axial growth once the eye has reached emmetropization. Researchers induced form-deprivation myopia in animal models in order to assess the different changes of ocular axial growth. Other studies have shown that phenylethylamine is an endogenous precursor-neurotransmitter capable of modulating the activity of dopamine. Considering the role of the dopaminergic system in the development of myopia (in children and adolescents) and the fact that phenylethylamine improves the consequences of a dopamine deficit, it would be interesting to study the effect of phenylethylamine on the regulation of axial growth, which represents the genesis of myopia.

The prevalence of visual impairment (VI) increases with axial length (AL) and spherical equivalent (SE). This study aims to explore the prevalence and associated factors of myopia and AL-related VI in children and adolescents, including analysis of sex-specific differences. This cross-sectional survey included 2595 children and adolescents aged 4–18 years from nine educational institutions in a large municipality. The survey comprised a questionnaire, visual acuity examination, refractive screening and AL measurement. The prevalence of myopia and AL-related VI were 56.53% and 50.98% respectively and increased with age (P < 0.01). The myopia rate was higher in females than in males (60.23% vs. 52.71%, χ2 = 14.93, P < 0.05), with a significant difference observed in those aged 9 years and older. However, there was no sex difference between in the prevalence of AL-related VI (51.37% vs. 50.61%, χ2 = 0.15, P = 0.70). The research showed that older adolescent was a risk factor for both myopia (OR = 2.28, 95%CI = 2.06–2.53) and AL-related VI (OR = 2.49, 95%CI = 2.23–2.77). Having a myopic parent was also significantly associated with myopia (OR = 1.21, 95%CI = 1.12–1.32) and AL-related VI (OR = 1.25, 95%CI = 1.16–1.36). The prevalence of myopia and AL-related VI were high and increased with age in children and adolescents, with sex-specific differences in myopia but not in AL-related VI. Therefore, it is possible to predict the risk of myopia by considering age- and sex-specific factors.

An estimated 49.8% of the world population will be myopic by 2050. Multifocal contact lenses (MFCLs) and orthokeratology (OK) reduce peripheral retinal hyperopic defocus, which animal studies have shown to positively impact eye growth. MFCLs are expected to slow myopic progression by 20 - 50% and OK by 30 - 60%, making them valuable therapeutic tools. In view of the guidelines for myopia management published by the International Myopia Institute in 2019, the aim of this retrospective data analysis of a tertiary care center was to review past experience with OK and MFCLs for myopia control and gain information to update current practice. The contact lens (CL) database of the Eye Clinic of the University Hospital of Basel was searched with the label "myopia progression" between January 2012 - 2020. Patients were included if they gave informed consent, were younger than 19 years old at baseline, and had no ocular comorbidities that could potentially compromise vision. Primary outcomes were progression of spherical equivalent refraction for MFCL patients and progression of axial length (AL) for the OK group, comparing with historical data from OK trials. Secondary outcomes were the presence of risk factors for myopia, age, refractive error at baseline, follow-up duration, and adverse effects during therapy. Twenty-one patients could be included, with a mean age of 12.80 ± 3.32 years (y) at baseline. The majority of patients were older than 12 years and already myopic (- 3.89 ± 2.30 diopters) when control treatment was started. Overall, follow-up ranged from 0.08 to 6.33 years (2.03 ± 1.66 y). In the patients treated with MFCLs, myopia control improved significantly when patients changed from spectacles to MFCLs. In the OK group, 14% dropped out during the first year and 2 patients had multiple AL measurements during therapy, which showed a slower growth of AL when compared to other OK trials and controls with spectacles. There were two cases of non-severe keratitis. Environmental risk factors had not been documented and only 48% of clinical records had a documented family risk assessment. Patients showed a slower myopia progression under MFCLs or OK, which supports their role as a treatment option in myopia management. In this regard, AL measurement is an important additional parameter to be included in the assessment of myopia progression in clinical practice. Identification of children at risk of developing high/pathologic myopia (family history, environmental risk factors) needs to improve so that the first stages of myopic shift can be recognized and targeted. Changes in lifestyle should be actively encouraged, especially when the impact of decreases in outdoor time secondary to COVID-19 is yet to become clear.

Objective To investigate the relationship between the nearwork oculomoter functions and the myopia progression in myopia juveniles. Methods 28 students were followed up and visited for 8 to 19months and their oculomoter functions such as heterophoria,the response AC/A ratio,negative relative accommodation,positive relative accommodation,accommodative lag and accommodative amplitudes were measured and analyzed. Results The response AC/A ratio,accommodative hysteresis and accommodative amplitudes were correlated with the annual myopia progression; and the Pearson's correlation coefficients (-0.416,-0.495 and -0.463 respectively) were significant at the 0.05 level. A scatterplot indicated that there was a linear relationship between the accommodative lag and the annual myopia progression;these variables were still negatively correlated while controlling for the effects of the response AC/A ratio (r=-0.383 ,P <0.05). Conclusion High accommodative lag in the nearwork maybe one of the reasons lead to myopia progression. Key words: myopia; Oculomoter function; response AC/A ratio; accommodative lag; accommodative amplitude ; Nearwork; Follow up

A trend that myopia is becoming gradually more common is shown in studies worldwide. Highest frequencies have been found in East Asian urban populations (96.5%) but also a study in Europe shows that nearly half of the 25-29 year olds has myopia. With the increase in prevalence, high myopia, i.e. a spherical equivalent of -6 or more and an axial length of 26 mm or more is also on the rise. High myopia particularly carries a significant risk of ocular pathology related to the long axial length. This highlights the need for myopia management in children with progressive myopia, in particular progression to high myopia. During the last decade, many intervention studies for myopia progression have emerged. Although lifestyle adjustments are effective, pharmacological and optical interventions have shown the highest efficacy on reduction of eye growth. High concentration atropine (0.5%-1.0%) shows the most reduction in axial length progression, but has drawbacks of light sensitivity and loss of accommodation. Nevertheless, when these side effects are mitigated by multifocal photochromatic glasses, the long-term adherence to high dose atropine is high. Lower concentrations of atropine are less effective, but have less side effects. Studies on optical interventions have reported reduction of progression for Ortho-K and multifocal contact lenses, but are in need for replication in larger studies with longer duration. The field of myopia management is rapidly evolving, and a position on the best approach for daily clinics is desirable. Over the last 10 years, our team of clinical researchers has developed a strategy which involves decision-making based on age, axial length, position on the axial length growth chart, progression rate, risk of high myopia, risk profile based on lifestyle and familial risk, side effects, and individual preference. This personalised approach ensures the most optimal long-term myopia control, and helps fight against visual impairment and blindness in the next generations of elderly.