Efficacy of Myopia Prevention in At-Risk Children: A Systematic Review and Network Meta-Analysis

Objectives: To evaluate the efficacy of myopia prevention methods in children without pre-existing myopia. Methods: A network meta-analysis was conducted following the PRISMA-NMA guidelines. Comprehensive searches were performed in PubMed, Embase, and Cochrane CENTRAL databases. The analysis focused on randomized controlled trials evaluating myopia prevention strategies in children without prior myopia. Primary outcomes included annual changes in refraction and axial length, while secondary outcomes encompassed myopia incidence and adverse events. Effect sizes were reported as risk ratios (RR) or mean differences (MD) with 95% confidence intervals (CIs). Data synthesis utilized a random-effects model under a frequentist framework, with intervention efficacy ranked by P-scores. Study quality was assessed using the Cochrane risk-of-bias tool, and robustness was ensured via sensitivity and consistency analyses. Results: Low-level red light therapy and low-dose atropine were the most effective interventions for reducing refractive progression (MD: 0.48 D, 95% CI: 0.38-0.59 D; MD: 0.33 D, 95% CI: 0.23-0.43 D) and axial elongation (MD: -0.23 mm, 95% CI: -0.27 to -0.19 mm; MD: -0.12 mm, 95% CI: -0.16 to -0.08 mm). In addition, both significantly lowered myopia incidence (RR: 0.59, 95% CI: 0.45-0.79; RR: 0.55, 95% CI: 0.41-0.75). Outdoor activities and myopia awareness programs demonstrated moderate efficacy. Adverse events, including photophobia and dry eyes, were minor and self-limiting, with no serious complications reported. Conclusions: Low-level red light therapy and low-dose atropine are the most effective, generally safe strategies for preventing myopia in at-risk children without myopia, while a non-invasive approach, outdoor activities, provides moderate benefits.