{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T16:01:02Z","timestamp":1783612862728,"version":"3.55.0"},"reference-count":56,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2025,2,28]],"date-time":"2025-02-28T00:00:00Z","timestamp":1740700800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>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\u20130.59 D; MD: 0.33 D, 95% CI: 0.23\u20130.43 D) and axial elongation (MD: \u22120.23 mm, 95% CI: \u22120.27 to \u22120.19 mm; MD: \u22120.12 mm, 95% CI: \u22120.16 to \u22120.08 mm). In addition, both significantly lowered myopia incidence (RR: 0.59, 95% CI: 0.45\u20130.79; RR: 0.55, 95% CI: 0.41\u20130.75). 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.<\/jats:p>","DOI":"10.3390\/jcm14051665","type":"journal-article","created":{"date-parts":[[2025,2,28]],"date-time":"2025-02-28T10:12:33Z","timestamp":1740737553000},"page":"1665","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Efficacy of Myopia Prevention in At-Risk Children: A Systematic Review and Network Meta-Analysis"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-2916-6741","authenticated-orcid":false,"given":"Ssu-Hsien","family":"Lee","sequence":"first","affiliation":[{"name":"School of Medicine, Tzu Chi University, Hualien 970, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bor-Yuan","family":"Tseng","sequence":"additional","affiliation":[{"name":"School of Medicine, Tzu Chi University, Hualien 970, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8005-9958","authenticated-orcid":false,"given":"Jen-Hung","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Medical Research, Buddhist Tzu Chi General Hospital, Hualien 970, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheng-Jen","family":"Chiu","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology and Visual Science, Tzu Chi University, Hualien 970, Taiwan"},{"name":"Department of Ophthalmology, Hualien Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, 707, Section 3, Zhongyang Rd, Hualien 970, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,2,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1036","DOI":"10.1016\/j.ophtha.2016.01.006","article-title":"Global Prevalence of Myopia and High Myopia and Temporal Trends from 2000 through 2050","volume":"123","author":"Holden","year":"2016","journal-title":"Ophthalmology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1038\/519276a","article-title":"The myopia boom","volume":"519","author":"Dolgin","year":"2015","journal-title":"Nature"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1355","DOI":"10.1001\/jamaophthalmol.2016.4009","article-title":"Association of Axial Length With Risk of Uncorrectable Visual Impairment for Europeans With Myopia","volume":"134","author":"Tideman","year":"2016","journal-title":"JAMA Ophthalmol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"4603","DOI":"10.1167\/iovs.18-24032","article-title":"Prevalence, Risk Factors, and Impact of Myopic Macular Degeneration on Visual Impairment and Functioning Among Adults in Singapore","volume":"59","author":"Wong","year":"2018","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1021","DOI":"10.1016\/j.ajo.2013.06.005","article-title":"Myopia and age-related cataract: A systematic review and meta-analysis","volume":"156","author":"Pan","year":"2013","journal-title":"Am. J. Ophthalmol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1989","DOI":"10.1016\/j.ophtha.2011.03.012","article-title":"Myopia as a risk factor for open-angle glaucoma: A systematic review and meta-analysis","volume":"118","author":"Marcus","year":"2011","journal-title":"Ophthalmology"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1167\/iovs.64.6.7","article-title":"IMI 2023 Digest","volume":"64","author":"Sankaridurg","year":"2023","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_8","first-page":"Cd014758","article-title":"Interventions for myopia control in children: A living systematic review and network meta-analysis","volume":"2023","author":"Lawrenson","year":"2023","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1167\/iovs.62.5.6","article-title":"IMI Prevention of Myopia and Its Progression","volume":"62","author":"Jonas","year":"2021","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"472","DOI":"10.1001\/jama.2022.24162","article-title":"Effect of Low-Concentration Atropine Eyedrops vs Placebo on Myopia Incidence in Children: The LAMP2 Randomized Clinical Trial","volume":"329","author":"Yam","year":"2023","journal-title":"JAMA"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1016\/j.ophtha.2022.08.024","article-title":"Myopia Control Effect of Repeated Low-Level Red-Light Therapy in Chinese Children: A Randomized, Double-Blind, Controlled Clinical Trial","volume":"130","author":"Dong","year":"2023","journal-title":"Ophthalmology"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1136\/bjophthalmol-2021-319306","article-title":"Interventions recommended for myopia prevention and control among children and adolescents in China: A systematic review","volume":"107","author":"Zhu","year":"2023","journal-title":"Br. J. Ophthalmol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1016\/j.preteyeres.2017.09.004","article-title":"The epidemics of myopia: Aetiology and prevention","volume":"62","author":"Morgan","year":"2018","journal-title":"Prog. Retin. Eye Res."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1239","DOI":"10.1016\/j.ophtha.2017.12.011","article-title":"Myopia Prevention and Outdoor Light Intensity in a School-Based Cluster Randomized Trial","volume":"125","author":"Wu","year":"2018","journal-title":"Ophthalmology"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1077","DOI":"10.1001\/jamapediatrics.2022.3542","article-title":"Effect of Text Messaging Parents of School-Aged Children on Outdoor Time to Control Myopia: A Randomized Clinical Trial","volume":"176","author":"Li","year":"2022","journal-title":"JAMA Pediatr."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Liao, S., Li, X., Bai, N., Wu, D., Yang, W., Wang, F., and Ji, H.Z. (2023). An empirical study on the effect of outdoor illumination and exercise intervention on Children\u2019s vision. Front. Public Health, 11.","DOI":"10.3389\/fpubh.2023.1270826"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"777","DOI":"10.7326\/M14-2385","article-title":"The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: Checklist and explanations","volume":"162","author":"Hutton","year":"2015","journal-title":"Ann. Intern. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"l4898","DOI":"10.1136\/bmj.l4898","article-title":"RoB 2: A revised tool for assessing risk of bias in randomised trials","volume":"366","author":"Sterne","year":"2019","journal-title":"BMJ"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1002\/jrsm.1045","article-title":"Consistency and inconsistency in network meta-analysis: Model estimation using multivariate meta-regression","volume":"3","author":"White","year":"2012","journal-title":"Res. Synth. Methods"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1002\/jrsm.1044","article-title":"Consistency and inconsistency in network meta-analysis: Concepts and models for multi-arm studies","volume":"3","author":"Higgins","year":"2012","journal-title":"Res. Synth. Methods"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"560","DOI":"10.1001\/jamaophthalmol.2024.0801","article-title":"Daily Low-Level Red Light for Spherical Equivalent Error and Axial Length in Children With Myopia: A Randomized Clinical Trial","volume":"142","author":"Cao","year":"2024","journal-title":"JAMA Ophthalmol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1141","DOI":"10.1001\/jamapediatrics.2023.3615","article-title":"Effect of Extracurricular After-School Physical Activities on Academic Performance of Schoolchildren: A Cluster Randomized Clinical Trial","volume":"177","author":"Wang","year":"2023","journal-title":"JAMA Pediatr."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1299","DOI":"10.1136\/bjo-2023-324260","article-title":"Effectiveness of repeated low-level red light in myopia prevention and myopia control","volume":"108","author":"Liu","year":"2024","journal-title":"Br. J. Ophthalmol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1142","DOI":"10.1001\/jama.2015.10803","article-title":"Effect of Time Spent Outdoors at School on the Development of Myopia Among Children in China: A Randomized Clinical Trial","volume":"314","author":"He","year":"2015","journal-title":"JAMA"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1245","DOI":"10.1016\/j.ophtha.2022.06.024","article-title":"Time Outdoors in Reducing Myopia: A School-Based Cluster Randomized Trial with Objective Monitoring of Outdoor Time and Light Intensity","volume":"129","author":"He","year":"2022","journal-title":"Ophthalmology"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e239612","DOI":"10.1001\/jamanetworkopen.2023.9612","article-title":"Effect of Repeated Low-level Red Light on Myopia Prevention Among Children in China With Premyopia: A Randomized Clinical Trial","volume":"6","author":"He","year":"2023","journal-title":"JAMA Netw. Open"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1111\/opo.12207","article-title":"Elevated light levels in schools have a protective effect on myopia","volume":"35","author":"Hua","year":"2015","journal-title":"Ophthalmic Physiol. Opt."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"238","DOI":"10.4103\/ijo.IJO_1462_21","article-title":"Efficacy of low-concentration atropine (0.01%) eye drops for prevention of axial myopic progression in premyopes","volume":"70","author":"Jethani","year":"2022","journal-title":"Indian J. Ophthalmol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1165","DOI":"10.1001\/jamaophthalmol.2021.3695","article-title":"Effect of School-Based Family Health Education via Social Media on Children\u2019s Myopia and Parents\u2019 Awareness: A Randomized Clinical Trial","volume":"139","author":"Li","year":"2021","journal-title":"JAMA Ophthalmol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1167\/tvst.13.6.23","article-title":"Comparison of Changes in Retinal Vascular Density and Thickness After Using Low-Level Red Light and 0.01% Atropine in Premyopic Children","volume":"13","author":"Shang","year":"2024","journal-title":"Transl. Vis. Sci. Technol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1080\/08164622.2023.2251975","article-title":"Temporal effects of an original myopia song on school children\u2019s myopia and awareness: A 3-year prospective study","volume":"107","author":"Tong","year":"2024","journal-title":"Clin. Exp. Optom."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"2597","DOI":"10.1007\/s00431-023-04921-5","article-title":"Prevention of myopia shift and myopia onset using 0.01% atropine in premyopic children\u2014A prospective, randomized, double-masked, and crossover trial","volume":"182","author":"Wang","year":"2023","journal-title":"Eur. J. Pediatr."},{"key":"ref_33","first-page":"533","article-title":"Effects of 0.01% atropine eye drops on the prevention of myopia onset among schoolchildren: A randomized, double-blind, controlled trial","volume":"40","author":"Yu","year":"2022","journal-title":"Chin. J. Exp. Ophthalmol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"739","DOI":"10.1007\/s40123-023-00875-x","article-title":"The Effects of Repeated Low-Level Red-Light Therapy on the Structure and Vasculature of the Choroid and Retina in Children with Premyopia","volume":"13","author":"Liu","year":"2024","journal-title":"Ophthalmol. Ther."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1080\/08164622.2023.2216840","article-title":"Effects of online family health education on myopia prevention in children by parental myopia: A randomized clinical trial","volume":"107","author":"Zhang","year":"2024","journal-title":"Clin. Exp. Optom."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1167\/iovs.62.1.28","article-title":"Ambient Light Regulates Retinal Dopamine Signaling and Myopia Susceptibility","volume":"62","author":"Landis","year":"2021","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"622","DOI":"10.1016\/j.preteyeres.2012.06.004","article-title":"The complex interactions of retinal, optical and environmental factors in myopia aetiology","volume":"31","author":"Flitcroft","year":"2012","journal-title":"Prog. Retin. Eye Res."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1462","DOI":"10.1016\/j.ophtha.2020.01.054","article-title":"Increased Time Outdoors Is Followed by Reversal of the Long-Term Trend to Reduced Visual Acuity in Taiwan Primary School Students","volume":"127","author":"Wu","year":"2020","journal-title":"Ophthalmology"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"989","DOI":"10.1038\/d41586-024-01518-2","article-title":"A myopia epidemic is sweeping the globe. Here\u2019s how to stop it","volume":"629","author":"Dolgin","year":"2024","journal-title":"Nature"},{"key":"ref_40","first-page":"129","article-title":"Effect of Outdoor Scene Classrooms on Myopia Prevention and Control: One-year Result from a Randomized Clinical Trial","volume":"65","author":"Lan","year":"2024","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"880","DOI":"10.1016\/j.ophtha.2022.03.017","article-title":"Premyopia at Preschool Age: Population-based Evidence of Prevalence and Risk Factors from a Serial Survey in Taiwan","volume":"129","author":"Wang","year":"2022","journal-title":"Ophthalmology"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1167\/iovs.62.5.3","article-title":"IMI Risk Factors for Myopia","volume":"62","author":"Morgan","year":"2021","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1001\/jamaophthalmol.2020.0412","article-title":"Association of Parental Myopia With Higher Risk of Myopia Among Multiethnic Children Before School Age","volume":"138","author":"Jiang","year":"2020","journal-title":"JAMA Ophthalmol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1089\/jop.2009.0135","article-title":"Prevention of myopia onset with 0.025% atropine in premyopic children","volume":"26","author":"Fang","year":"2010","journal-title":"J. Ocul. Pharmacol. Ther."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"M1","DOI":"10.1167\/iovs.18-25980","article-title":"IMI\u2014Myopia Control Reports Overview and Introduction","volume":"60","author":"Wolffsohn","year":"2019","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"108402","DOI":"10.1016\/j.visres.2024.108402","article-title":"Mechanisms of emmetropization and what might go wrong in myopia","volume":"220","author":"Schaeffel","year":"2024","journal-title":"Vis. Res."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1097\/OPX.0000000000002119","article-title":"Myopia control: Seeing beyond efficacy","volume":"101","author":"Bullimore","year":"2024","journal-title":"Optom. Vis. Sci."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1016\/j.ophtha.2021.11.023","article-title":"Effect of Repeated Low-Level Red-Light Therapy for Myopia Control in Children: A Multicenter Randomized Controlled Trial","volume":"129","author":"Jiang","year":"2022","journal-title":"Ophthalmology"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1016\/j.ophtha.2015.07.004","article-title":"Five-Year Clinical Trial on Atropine for the Treatment of Myopia 2: Myopia Control with Atropine 0.01% Eyedrops","volume":"123","author":"Chia","year":"2016","journal-title":"Ophthalmology"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"998","DOI":"10.1038\/eye.2016.78","article-title":"Effectiveness study of atropine for progressive myopia in Europeans","volume":"30","author":"Polling","year":"2016","journal-title":"Eye"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"e2424595","DOI":"10.1001\/jamanetworkopen.2024.24595","article-title":"Smartwatch Measures of Outdoor Exposure and Myopia in Children","volume":"7","author":"Chen","year":"2024","journal-title":"JAMA Netw. Open"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"102283","DOI":"10.1016\/j.clae.2024.102283","article-title":"Shared decision-making, treatment decision regret, and vision-related quality of life among parents of children with myopia: An online survey in Taiwan","volume":"47","author":"Chang","year":"2024","journal-title":"Cont. Lens Anterior Eye"},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Lee, S.H., Tsai, P.C., Chiu, Y.C., Wang, J.H., and Chiu, C.J. (2024). Myopia progression after cessation of atropine in children: A systematic review and meta-analysis. Front. Pharmacol., 15.","DOI":"10.3389\/fphar.2024.1343698"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1013","DOI":"10.1111\/ceo.14149","article-title":"Sustained and rebound effect of repeated low-level red-light therapy on myopia control: A 2-year post-trial follow-up study","volume":"50","author":"Xiong","year":"2022","journal-title":"Clin. Exp. Ophthalmol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1167\/tvst.8.3.2","article-title":"Outdoor Jogging and Myopia Progression in School Children From Rural Beijing: The Beijing Children Eye Study","volume":"8","author":"Guo","year":"2019","journal-title":"Transl. Vis. Sci. Technol."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"142","DOI":"10.4103\/tjo.TJO-D-23-00032","article-title":"Artificial intelligence and digital solutions for myopia","volume":"13","author":"Li","year":"2023","journal-title":"Taiwan J. Ophthalmol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/5\/1665\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T16:44:54Z","timestamp":1760028294000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/5\/1665"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,28]]},"references-count":56,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2025,3]]}},"alternative-id":["jcm14051665"],"URL":"https:\/\/doi.org\/10.3390\/jcm14051665","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,28]]}}}