Non-Pharmacological and Non-Optical Interventions for Myopia Prevention and Control in Children: A Systematic Review and Meta-Analysis.

BACKGROUND

Myopia is projected to affect 50% of the global population by 2050. Its progression increases the risk of severe ocular pathologies, making it imperative to validate safe and effective non-pharmacological prevention interventions.

AIM: To evaluate the clinical efficacy of low-level red-light therapy (RLRL) and nutritional supplementation in preventing and controlling myopia progression in children and adolescents.

METHODS

This systematic review and meta-analysis followed PRISMA guidelines and was registered in PROSPERO (CRD420261301596). Randomized clinical trials in pediatric populations (aged 0-18 years) were included. The primary quantitative outcome measures for myopia were axial length (AL) and spherical equivalent (SE). Risk of bias (RoB 2) and heterogeneity (I2) were assessed.

RESULTS

18 articles were included (n = 2438). RLRL demonstrated a significant reduction in axial elongation (mean difference (MD): -0.26 mm; 95% CI: -0.34 to -0.18) and a protective effect on refractive progression (MD: +0.60 D; 95% CI: 0.42 to 0.78), although with high heterogeneity (I2 > 97%). Nutritional supplementation exhibited a modest, non-significant effect on axial length (-0.22 mm; 95% CI: -0.44 to 0.00), acting primarily as functional support.

CONCLUSIONS

RLRL slows ocular elongation and myopia progression. Recent studies provide reassuring evidence regarding its long-term safety when recommended treatment protocols are followed. However, the high heterogeneity among studies, the need for standardized treatment discontinuation strategies, and the limited long-term evidence in geographically and ethnically diverse pediatric populations warrant further investigation. Current evidence is insufficient to demonstrate a consistent clinically meaningful effect of nutritional supplementation on axial elongation.