Efficacy of defocus incorporated multiple segments lenses and orthokeratology in controlling myopia progression: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

 SONG Desheng , HE Li , LONG Guangfeng

Department of Ophthalmology, Children’s Hospital of Nanjing Medical University, Nanjing 210008, P. R. China;

Corresponding author：

SONG Desheng, Email: songdesheng123456@163.com

Keywords：

Myopia; Defocus incorporated multiple segments; Orthokeratology; Meta-analysis; Systematic review; Axial length

DOI：

10.7507/1672-2531.202407011

Video：

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Objective To systematically review the efficacy of defocus incorporated multiple segments (DIMS) spectacle lenses and orthokeratology (Ortho-K) in controlling myopia. Methods The PubMed, Embase, Cochrane Library, Web of Science, CBM, WanFang Data and CNKI databases were electronically searched to collect clinical studies related to the objectives from January 2000 to June 2024. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis was then performed by using RevMan 5.3 software. Results A total of 8 RCTs and 7 cohort studies were included. The results of meta-analysis showed that both Ortho-K lens and DIMS had better axial control effects than the single vision control group (MD=−0.18, 95%CI −0.21 to −0.15, P<0.01; MD=−0.21, 95%CI −0.27 to −0.15, P<0.01). The Ortho-K had a smaller one-year growth in axial length compared to the DIMS (MD=−0.06, 95%CI −0.08 to −0.04, P<0.01). Conclusion Current evidence suggests that Ortho-K and DIMS have better myopia control effects than single lens lenses, while Ortho-K has better myopia control effects than DIMS, but the advantages are not significant. Due to the limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.

Citation： SONG Desheng, HE Li, LONG Guangfeng. Efficacy of defocus incorporated multiple segments lenses and orthokeratology in controlling myopia progression: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2025, 25(3): 289-293. doi: 10.7507/1672-2531.202407011 Copy

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6.	Smith EL, Kee CS, Ramamirtham R, et al. Peripheral vision can influence eye growth and refractive development in infant monkeys. Invest Ophthalmol Vis Sci, 2005, 46(11): 3965-3972.
7.	Wildsoet C, Wallman J. Choroidal and scleral mechanisms of compensation for spectacle lenses in chicks. Vision Res, 1995, 35(9): 1175-1194.
8.	Siegwart JT, Norton TT. The susceptible period for deprivation-induced myopia in tree shrew. Vision Res, 1998, 38(22): 3505-3515.
9.	Huang Y, Li X, Ding C, et al. Comparison of peripheral refraction and higher-order aberrations between orthokeratology and multifocal soft contact lens designed with highly addition. Graefes Arch Clin Exp Ophthalmol, 2022, 260(5): 1755-1762.
10.	Tang T, Lu Y, Li X, et al. Comparison of the long-term effects of atropine in combination with orthokeratology and defocus incorporated multiple segment lenses for myopia control in Chinese children and adolescents. Eye (Lond), 2024, 38(9): 1660-1667.
11.	Yang B, Liu L, Cho P. Effectiveness of orthokeratology and myopia control spectacles in a real-world setting in China. Cont Lens Anterior Eye, 2024, 47(3): 102167.
12.	Lam CS, Tang WC, Tse DY, et al. Defocus incorporated soft contact (DISC) lens slows myopia progression in Hong Kong Chinese schoolchildren: a 2-year randomised clinical trial. Br J Ophthalmol, 2014, 98(1): 40-45.
13.	Sarkar S, Khuu S, Kang P. A systematic review and meta-analysis of the efficacy of different optical interventions on the control of myopia in children. Acta Ophthalmol, 2024, 102(3): e229-e244.
14.	Lu W, Ji R, Jiang D, et al. Different efficacy in myopia control: comparison between orthokeratology and defocus-incorporated multiple segment lenses. Cont Lens Anterior Eye, 2024, 47(2): 102122.
15.	Joyce KE, Beyer F, Thomson RG, et al. A systematic review of the effectiveness of treatments in altering the natural history of intermittent exotropia. Br J Ophthalmol, 2015, 99(4): 440-450.
16.	Sterne JAC, Savović J, Page MJ, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ, 2019, 366: l4898.
17.	李秀红, 符爱存, 姫娜, 等. 多区正向设计离焦框架眼镜与角膜塑形镜对儿童近视的延缓效果比较. 中华实验眼科杂志, 2024, 42(4): 339-346.
18.	Lee CY, Yang SF, Chang YL, et al. Comparison of myopic control between orthokeratology contact lenses and defocus incorporated multiple segments spectacle lenses. Int J Med Sci, 2024, 21(7): 1329-1336.
19.	王倩, 王秋轶, 吕刚, 等. 角膜塑形镜和多区正向光学离焦眼镜及单焦框架眼镜的近视控制效果比较. 国际眼科杂志, 2023, 23(11): 1891-1895.
20.	魏丽, 王铭, 于世傲, 等. 离焦设计框架眼镜和角膜塑形镜控制近视儿童眼轴延长的疗效比较. 中华眼视光学与视觉科学杂志, 2023, 25(7): 506-511.
21.	Charm J, Cho P. High myopia-partial reduction ortho-k: a 2-year randomized study. Optom Vis Sci, 2013, 90(6): 530-539.
22.	Cho P, Cheung SW. Retardation of myopia in orthokeratology (ROMIO) study: a 2-year randomized clinical trial. Invest Ophthalmol Vis Sci, 2012, 53(11): 7077-7085.
23.	Jakobsen TM, Møller F. Control of myopia using orthokeratology lenses in scandinavian children aged 6 to 12 years. Eighteen-month data from the danish randomized study: clinical study of near-sightedness; treatment with orthokeratology lenses (CONTROL study). Acta Ophthalmol, 2022, 100(2): 175-182.
24.	Zhang Y, Sun X, Chen Y. Controlling anisomyopia in children by orthokeratology: a one-year randomised clinical trial. Cont Lens Anterior Eye, 2023, 46(1): 101537.
25.	Xu S, Li Z, Zhao W, et al. Effect of atropine, orthokeratology and combined treatments for myopia control: a 2-year stratified randomised clinical trial. Br J Ophthalmol, 2023, 107(12): 1812-1817.
26.	Lam CSY, Tang WC, Tse DY, et al. Defocus incorporated multiple segments (DIMS) spectacle lenses slow myopia progression: a 2-year randomised clinical trial. Br J Ophthalmol, 2020, 104(3): 363-368.
27.	魏士飞, 李仕明, 孙芸芸, 等. 角膜塑形镜对低中度近视儿童眼球生物学参数的影响. 中华眼视光学与视觉科学杂志, 2017, 19(9): 548-553.
28.	边思林, 刘华, 林江. 近视儿童角膜塑形镜与框架眼镜配戴一年临床效果的随机对照研究. 中华实验眼科杂志, 2020, 38(2): 121-127.
29.	Bao J, Huang Y, Li X, et al. Spectacle lenses with aspherical lenslets for myopia control vs single-vision spectacle lenses: a randomized clinical trial. JAMA Ophthalmol, 2022, 140(5): 472-478.
30.	Tsai HR, Wang JH, Huang HK, et al. Efficacy of atropine, orthokeratology, and combined atropine with orthokeratology for childhood myopia: a systematic review and network meta-analysis. J Formos Med Assoc, 2022, 121(12): 2490-2500.
31.	Yang B, Ma X, Liu L, et al. Vision-related quality of life of Chinese children undergoing orthokeratology treatment compared to single vision spectacles. Cont Lens Anterior Eye, 2021, 44(4): 101350.
32.	Zhao F, Zhao G, Zhao Z. Investigation of the effect of orthokeratology lenses on quality of life and behaviors of children. Eye Contact Lens, 2018, 44(5): 335-338.
33.	Liu YM, Xie P. The safety of orthokeratology-a systematic review. Eye Contact Lens, 2016, 42(1): 35-42.
34.	Watt KG, Swarbrick HA. Trends in microbial keratitis associated with orthokeratology. Eye Contact Lens, 2007, 33(6 Pt 2): 373-377.

1. Dolgin E. The myopia boom. Nature, 2015, 519(7543): 276-278.
2. Holden BA, Fricke TR, Wilson DA, et al. Global prevalence of myopia and high myopia and temporal trends from 2000 through 2050. Ophthalmology, 2016, 123(5): 1036-1042.
3. Ikuno Y. Overview of the complications of high myopia. Retina, 2017, 37(12): 2347-2351.
4. Ohno-Matsui K, Lai TY, Lai CC, et al. Updates of pathologic myopia. Prog Retin Eye Res, 2016, 52: 156-187.
5. Smith EL. Prentice award lecture 2010: a case for peripheral optical treatment strategies for myopia. Optom Vis Sci, 2011, 88(9): 1029-1044.
6. Smith EL, Kee CS, Ramamirtham R, et al. Peripheral vision can influence eye growth and refractive development in infant monkeys. Invest Ophthalmol Vis Sci, 2005, 46(11): 3965-3972.
7. Wildsoet C, Wallman J. Choroidal and scleral mechanisms of compensation for spectacle lenses in chicks. Vision Res, 1995, 35(9): 1175-1194.
8. Siegwart JT, Norton TT. The susceptible period for deprivation-induced myopia in tree shrew. Vision Res, 1998, 38(22): 3505-3515.
9. Huang Y, Li X, Ding C, et al. Comparison of peripheral refraction and higher-order aberrations between orthokeratology and multifocal soft contact lens designed with highly addition. Graefes Arch Clin Exp Ophthalmol, 2022, 260(5): 1755-1762.
10. Tang T, Lu Y, Li X, et al. Comparison of the long-term effects of atropine in combination with orthokeratology and defocus incorporated multiple segment lenses for myopia control in Chinese children and adolescents. Eye (Lond), 2024, 38(9): 1660-1667.
11. Yang B, Liu L, Cho P. Effectiveness of orthokeratology and myopia control spectacles in a real-world setting in China. Cont Lens Anterior Eye, 2024, 47(3): 102167.
12. Lam CS, Tang WC, Tse DY, et al. Defocus incorporated soft contact (DISC) lens slows myopia progression in Hong Kong Chinese schoolchildren: a 2-year randomised clinical trial. Br J Ophthalmol, 2014, 98(1): 40-45.
13. Sarkar S, Khuu S, Kang P. A systematic review and meta-analysis of the efficacy of different optical interventions on the control of myopia in children. Acta Ophthalmol, 2024, 102(3): e229-e244.
14. Lu W, Ji R, Jiang D, et al. Different efficacy in myopia control: comparison between orthokeratology and defocus-incorporated multiple segment lenses. Cont Lens Anterior Eye, 2024, 47(2): 102122.
15. Joyce KE, Beyer F, Thomson RG, et al. A systematic review of the effectiveness of treatments in altering the natural history of intermittent exotropia. Br J Ophthalmol, 2015, 99(4): 440-450.
16. Sterne JAC, Savović J, Page MJ, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ, 2019, 366: l4898.
17. 李秀红, 符爱存, 姫娜, 等. 多区正向设计离焦框架眼镜与角膜塑形镜对儿童近视的延缓效果比较. 中华实验眼科杂志, 2024, 42(4): 339-346.
18. Lee CY, Yang SF, Chang YL, et al. Comparison of myopic control between orthokeratology contact lenses and defocus incorporated multiple segments spectacle lenses. Int J Med Sci, 2024, 21(7): 1329-1336.
19. 王倩, 王秋轶, 吕刚, 等. 角膜塑形镜和多区正向光学离焦眼镜及单焦框架眼镜的近视控制效果比较. 国际眼科杂志, 2023, 23(11): 1891-1895.
20. 魏丽, 王铭, 于世傲, 等. 离焦设计框架眼镜和角膜塑形镜控制近视儿童眼轴延长的疗效比较. 中华眼视光学与视觉科学杂志, 2023, 25(7): 506-511.
21. Charm J, Cho P. High myopia-partial reduction ortho-k: a 2-year randomized study. Optom Vis Sci, 2013, 90(6): 530-539.
22. Cho P, Cheung SW. Retardation of myopia in orthokeratology (ROMIO) study: a 2-year randomized clinical trial. Invest Ophthalmol Vis Sci, 2012, 53(11): 7077-7085.
23. Jakobsen TM, Møller F. Control of myopia using orthokeratology lenses in scandinavian children aged 6 to 12 years. Eighteen-month data from the danish randomized study: clinical study of near-sightedness; treatment with orthokeratology lenses (CONTROL study). Acta Ophthalmol, 2022, 100(2): 175-182.
24. Zhang Y, Sun X, Chen Y. Controlling anisomyopia in children by orthokeratology: a one-year randomised clinical trial. Cont Lens Anterior Eye, 2023, 46(1): 101537.
25. Xu S, Li Z, Zhao W, et al. Effect of atropine, orthokeratology and combined treatments for myopia control: a 2-year stratified randomised clinical trial. Br J Ophthalmol, 2023, 107(12): 1812-1817.
26. Lam CSY, Tang WC, Tse DY, et al. Defocus incorporated multiple segments (DIMS) spectacle lenses slow myopia progression: a 2-year randomised clinical trial. Br J Ophthalmol, 2020, 104(3): 363-368.
27. 魏士飞, 李仕明, 孙芸芸, 等. 角膜塑形镜对低中度近视儿童眼球生物学参数的影响. 中华眼视光学与视觉科学杂志, 2017, 19(9): 548-553.
28. 边思林, 刘华, 林江. 近视儿童角膜塑形镜与框架眼镜配戴一年临床效果的随机对照研究. 中华实验眼科杂志, 2020, 38(2): 121-127.
29. Bao J, Huang Y, Li X, et al. Spectacle lenses with aspherical lenslets for myopia control vs single-vision spectacle lenses: a randomized clinical trial. JAMA Ophthalmol, 2022, 140(5): 472-478.
30. Tsai HR, Wang JH, Huang HK, et al. Efficacy of atropine, orthokeratology, and combined atropine with orthokeratology for childhood myopia: a systematic review and network meta-analysis. J Formos Med Assoc, 2022, 121(12): 2490-2500.
31. Yang B, Ma X, Liu L, et al. Vision-related quality of life of Chinese children undergoing orthokeratology treatment compared to single vision spectacles. Cont Lens Anterior Eye, 2021, 44(4): 101350.
32. Zhao F, Zhao G, Zhao Z. Investigation of the effect of orthokeratology lenses on quality of life and behaviors of children. Eye Contact Lens, 2018, 44(5): 335-338.
33. Liu YM, Xie P. The safety of orthokeratology-a systematic review. Eye Contact Lens, 2016, 42(1): 35-42.
34. Watt KG, Swarbrick HA. Trends in microbial keratitis associated with orthokeratology. Eye Contact Lens, 2007, 33(6 Pt 2): 373-377.

Chinese Journal of Evidence-Based Medicine

Efficacy of defocus incorporated multiple segments lenses and orthokeratology in controlling myopia progression: a meta-analysis

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