Comparative effectiveness of defocus lenses, atropine, and their combined use for myopia control in children: A systematic review

To compare the effectiveness of defocus incorporated multiple segments (DIMS) lenses, atropine monotherapies, and their combination for myopia management in children. A systematic review was conducted following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Multiple electronic databases were searched to identify relevant, comparative studies. The primary outcome was the change in spherical equivalent refraction (SER) in diopters and axial length (AL) in millimeters at the latest patient follow-up, with a minimum follow-up period of 6 months. The secondary outcomes included adverse effects, changes in visual acuity and compliance related to the interventions. A total of 1460 participants from eight studies were included. Three studies compared DIMS lenses and atropine monotherapy; there was no statistically significant difference in SER reduction except with one study that reported significant reduction with atropine. However, two studies reported a significant decrease in AL with DIMS lenses, while one did not. Four studies compared the combination therapy versus DIMS monotherapy; three reported a significant reduction in SER with the combination. Regarding AL, all studies favored combination therapy, with three showing statistically significant results. Three studies compared combination therapy with atropine monotherapy; all demonstrated reductions in SER and AL, with two studies showing statistical significance for each. The evidence suggests that both DIMS lenses and atropine monotherapy are effective in managing myopia, with DIMS lenses being preferred due to fewer adverse effects. However, combining these therapies offers greater effectiveness than either therapy alone.