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Advisor(s)
Abstract(s)
Existem diversas condições que podem afetar a visão e causar algum grau de deficiência visual,
sendo uma das mais comuns o erro refrativo não corrigido. A miopia é o erro refrativo que mais
alarme tem causado na comunidade científica, com uma estimativa de 2,5 a 2,6 biliões de
pessoas com esta condição até ao final da década de 2010, com um aumento da sua prevalência
ao longo dos últimos anos, sendo estimada em 49,8% na população mundial para 2050. Com a
crescente preocupação em torno deste erro refrativo, ao longo dos últimos 30 anos, o número de
estudos e publicações sobre a miopia tem aumentado. Assim sendo, o objetivo principal deste
trabalho consiste em averiguar a eficácia das várias abordagens não farmacológicas no controlo
da progressão da miopia, na população com idades entre os 6 e 18 anos através da realização de
uma revisão sistemática da literatura.
Foi conduzida uma pesquisa em 3 bases de dados (PubMed, Scopus e Web of Science) e
realizada uma revisão sistemática da literatura, seguindo a linha orientadora PRISMA. Foram
incluídos ensaios clínicos randomizados, publicados ou a aguardar publicação até julho de 2022,
que estudaram o efeito das técnicas não farmacológicas no controlo da progressão da miopia,
com participantes de idades compreendidas entre os 6 e os 18 anos e um período de seguimento
mínimo de 12 meses.
Foram incluídos 28 estudos publicados entre 1988 e 2022, com um total de 4653 participantes,
em que foram realizadas intervenções com lentes oftálmicas monofocais, bifocais, progressivas e
de desenho específico para controlo de miopia, lentes de contacto monofocais, multifocais e de
desenho específico, lentes rígidas permeáveis aos gases e ortoqueratologia. As lentes oftálmicas
monofocais, com correção para visão de longe, mostraram não retardar a progressão da miopia
em crianças de idade escolar, sendo que utilização de lentes bifocais e progressivas também não
revelou significância clínica no controlo da miopia, com uma taxa de redução na progressão
entre 14% e 20% e maior efeito nos primeiros 12 meses de intervenção. A ortoqueratologia
revelou uma redução de progressão da miopia entre 43% a 63%. O uso de lentes de contacto
causou uma redução no aumento do erro refrativo de 20,5-59% e 10,5-52% no crescimento do
comprimento axial. Por fim, a utilização de lentes oftálmicas de desenho específico para
controlo de miopia mostrou resultados promissores com uma redução na progressão da miopia
de 52% e 62%, quando avaliada em termos de erro refrativo e comprimento axial,
respetivamente.
As lentes de contacto MiSight e as lentes oftálmicas de desfocagem com segmentos múltiplos
mostraram uma maior eficácia no controlo da progressão da miopia. No entanto alguns eventos
adversos podem surgir, como o desconforto e a falta de motivação, que são os principais motivos
de desistência da utilização das lentes de contacto, sendo as lentes de desfocagem com
segmentos múltiplos menos invasivas e de utilização idêntica a lentes oftálmicas convencionais. Os resultados reforçam que o controlo do desfoque periférico da retina tem um papel relevante
na progressão da miopia, que mostrou ser importante para travar o crescimento desta condição.
No entanto, são necessários mais estudos para perceber o mecanismo exato de atuação deste
último fator na progressão da miopia.
There are several conditions that can affect vision and cause some degree of visual impairment, one of the most common being uncorrected refractive error. Myopia is the refractive error that has caused the most alarm in the scientific community, with an estimated 2.5 to 2.6 billion people with this condition by the end of 2010, with its prevalence increasing over the last few years, and estimated to be 49.8% in the world population by 2050. With the growing concern surrounding this refractive error, over the past 30 years, the number of studies and publications on myopia has increased. Therefore, the main objective of this study is to investigate the efficacy of various non-pharmacological approaches to control the progression of myopia in the population aged between 6 and 18 years through a systematic review of the literature. A search was made in 3 databases (PubMed, Scopus, and Web of Science) and a systematic review of the literature was performed, following the PRISMA guideline. Randomized clinical trials, published, or awaiting publication until July 2022, that studied the effect of nonpharmacological techniques on the control of myopia progression were included, with participants aged 6 to 18 years and a minimum follow-up period of 12 months. A total of 28 studies published between 1988 and 2022 were included, with a total of 4653 participants, in which interventions were performed with monofocal, bifocal, progressive and specifically designed ophthalmic lenses for myopia control, monofocal, multifocal and specifically designed contact lenses, rigid gas permeable lenses and orthokeratology. Monofocal ophthalmic lenses, with correction for far vision, were shown not to slow the progression of myopia in school-aged children, and the use of bifocal and progressive lenses also showed no clinical significance in controlling myopia, with a reduction in progression between 14% and 20% and the greatest effect in the first 12 months of intervention. Orthokeratology revealed a reduction in myopia progression between 43% and 63%. Contact lens use caused a 20.5-59% reduction in refractive error increase and a 10.5-52% reduction in axial length growth. Finally, the use of ophthalmic lenses of specific design for myopia control showed promising results with a reduction in myopia progression of 52% and 62% when evaluated in terms of refractive error and axial length, respectively. MiSight contact lenses and defocus incorporated multiple segments ophthalmic lenses have shown greater efficacy in controlling myopia progression. However, some adverse events may arise, such as discomfort and lack of motivation, which are the main reasons for giving up contact lenses, defocus incorporated multiple segments lenses are less invasive and of identical use to conventional ophthalmic lenses. The results reinforce that controlling peripheral retinal blur plays a relevant role in the progression of myopia, which has been shown to be important in halting the growth of this condition. However, further studies are needed to understand the exact mechanism of action of the latter factor in the progression of myopia.
There are several conditions that can affect vision and cause some degree of visual impairment, one of the most common being uncorrected refractive error. Myopia is the refractive error that has caused the most alarm in the scientific community, with an estimated 2.5 to 2.6 billion people with this condition by the end of 2010, with its prevalence increasing over the last few years, and estimated to be 49.8% in the world population by 2050. With the growing concern surrounding this refractive error, over the past 30 years, the number of studies and publications on myopia has increased. Therefore, the main objective of this study is to investigate the efficacy of various non-pharmacological approaches to control the progression of myopia in the population aged between 6 and 18 years through a systematic review of the literature. A search was made in 3 databases (PubMed, Scopus, and Web of Science) and a systematic review of the literature was performed, following the PRISMA guideline. Randomized clinical trials, published, or awaiting publication until July 2022, that studied the effect of nonpharmacological techniques on the control of myopia progression were included, with participants aged 6 to 18 years and a minimum follow-up period of 12 months. A total of 28 studies published between 1988 and 2022 were included, with a total of 4653 participants, in which interventions were performed with monofocal, bifocal, progressive and specifically designed ophthalmic lenses for myopia control, monofocal, multifocal and specifically designed contact lenses, rigid gas permeable lenses and orthokeratology. Monofocal ophthalmic lenses, with correction for far vision, were shown not to slow the progression of myopia in school-aged children, and the use of bifocal and progressive lenses also showed no clinical significance in controlling myopia, with a reduction in progression between 14% and 20% and the greatest effect in the first 12 months of intervention. Orthokeratology revealed a reduction in myopia progression between 43% and 63%. Contact lens use caused a 20.5-59% reduction in refractive error increase and a 10.5-52% reduction in axial length growth. Finally, the use of ophthalmic lenses of specific design for myopia control showed promising results with a reduction in myopia progression of 52% and 62% when evaluated in terms of refractive error and axial length, respectively. MiSight contact lenses and defocus incorporated multiple segments ophthalmic lenses have shown greater efficacy in controlling myopia progression. However, some adverse events may arise, such as discomfort and lack of motivation, which are the main reasons for giving up contact lenses, defocus incorporated multiple segments lenses are less invasive and of identical use to conventional ophthalmic lenses. The results reinforce that controlling peripheral retinal blur plays a relevant role in the progression of myopia, which has been shown to be important in halting the growth of this condition. However, further studies are needed to understand the exact mechanism of action of the latter factor in the progression of myopia.
Description
Keywords
Controlo de Miopia Lentes de Contacto Lentes Oftálmicas Miopia Ortoqueratologia Progressão da Miopia Revisão Sistemática