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Medecine Sciences : M/S 2020Myopia is a refractive anomaly, a global public health issue, mainly due to an increase in axial length of the eyeball. Myopia is increasing worldwide with the... (Review)
Review
Myopia is a refractive anomaly, a global public health issue, mainly due to an increase in axial length of the eyeball. Myopia is increasing worldwide with the appearance of a "myopia global growing epidemic". In children under 6 years old, 20 % have abnormalities, the most common of which are primarily refractive abnormalities, followed by strabismus and amblyopia. Myopia presents a major risk of complications, correlated with its severity, such as retinal detachment, retinal neovascularization, early cataracts and glaucoma. In children with high myopia, syndromic myopia must be explored. Early detection of myopia onset and progression is essential to myopia control strategies. The most promising treatments include outdoor activities, defocusing corrective lenses, defocusing contact lenses, orthokeratology and pharmacological treatments with low-dose atropine.
Topics: Age of Onset; Atropine; Child; Child, Preschool; Contact Lenses; Disease Progression; Exercise; Humans; Infant; Myopia; Parks, Recreational
PubMed: 32821053
DOI: 10.1051/medsci/2020131 -
JAMA Feb 2023Early onset of myopia is associated with high myopia later in life, and myopia is irreversible once developed. (Randomized Controlled Trial)
Randomized Controlled Trial
IMPORTANCE
Early onset of myopia is associated with high myopia later in life, and myopia is irreversible once developed.
OBJECTIVE
To evaluate the efficacy of low-concentration atropine eyedrops at 0.05% and 0.01% concentration for delaying the onset of myopia.
DESIGN, SETTING, AND PARTICIPANTS
This randomized, placebo-controlled, double-masked trial conducted at the Chinese University of Hong Kong Eye Centre enrolled 474 nonmyopic children aged 4 through 9 years with cycloplegic spherical equivalent between +1.00 D to 0.00 D and astigmatism less than -1.00 D. The first recruited participant started treatment on July 11, 2017, and the last participant was enrolled on June 4, 2020; the date of the final follow-up session was June 4, 2022.
INTERVENTIONS
Participants were assigned at random to the 0.05% atropine (n = 160), 0.01% atropine (n = 159), and placebo (n = 155) groups and had eyedrops applied once nightly in both eyes over 2 years.
MAIN OUTCOMES AND MEASURES
The primary outcomes were the 2-year cumulative incidence rate of myopia (cycloplegic spherical equivalent of at least -0.50 D in either eye) and the percentage of participants with fast myopic shift (spherical equivalent myopic shift of at least 1.00 D).
RESULTS
Of the 474 randomized patients (mean age, 6.8 years; 50% female), 353 (74.5%) completed the trial. The 2-year cumulative incidence of myopia in the 0.05% atropine, 0.01% atropine, and placebo groups were 28.4% (33/116), 45.9% (56/122), and 53.0% (61/115), respectively, and the percentages of participants with fast myopic shift at 2 years were 25.0%, 45.1%, and 53.9%. Compared with the placebo group, the 0.05% atropine group had significantly lower 2-year cumulative myopia incidence (difference, 24.6% [95% CI, 12.0%-36.4%]) and percentage of patients with fast myopic shift (difference, 28.9% [95% CI, 16.5%-40.5%]). Compared with the 0.01% atropine group, the 0.05% atropine group had significantly lower 2-year cumulative myopia incidence (difference, 17.5% [95% CI, 5.2%-29.2%]) and percentage of patients with fast myopic shift (difference, 20.1% [95% CI, 8.0%-31.6%]). The 0.01% atropine and placebo groups were not significantly different in 2-year cumulative myopia incidence or percentage of patients with fast myopic shift. Photophobia was the most common adverse event and was reported by 12.9% of participants in the 0.05% atropine group, 18.9% in the 0.01% atropine group, and 12.2% in the placebo group in the second year.
CONCLUSIONS AND RELEVANCE
Among children aged 4 to 9 years without myopia, nightly use of 0.05% atropine eyedrops compared with placebo resulted in a significantly lower incidence of myopia and lower percentage of participants with fast myopic shift at 2 years. There was no significant difference between 0.01% atropine and placebo. Further research is needed to replicate the findings, to understand whether this represents a delay or prevention of myopia, and to assess longer-term safety.
TRIAL REGISTRATION
Chinese Clinical Trial Registry: ChiCTR-IPR-15006883.
Topics: Child; Female; Humans; Male; Atropine; Disease Progression; Incidence; Mydriatics; Myopia; Ophthalmic Solutions; Refraction, Ocular; Age of Onset; Double-Blind Method; Child, Preschool
PubMed: 36786791
DOI: 10.1001/jama.2022.24162 -
Progress in Retinal and Eye Research Jul 2021There is rapidly expanding interest in interventions to slow myopia progression in children and teenagers, with the intent of reducing risk of myopia-associated... (Review)
Review
There is rapidly expanding interest in interventions to slow myopia progression in children and teenagers, with the intent of reducing risk of myopia-associated complications later in life. Despite many publications dedicated to the topic, little attention has been devoted to understanding 'efficacy' in myopia control and its application. Treatment effect has been expressed in multiple ways, making comparison between therapies and prognosis for an individual patient difficult. Available efficacy data are generally limited to two to three years making long-term treatment effect uncertain. From an evidence-based perspective, efficacy projection should be conservative and not extend beyond that which has been empirically established. Using this principle, review of the literature, data from our own clinical studies, assessment of demonstrated myopia control treatments and allowance for the limitations and context of available data, we arrive at the following important interpretations: (i) axial elongation is the preferred endpoint for assessing myopic progression; (ii) there is insufficient evidence to suggest that faster progressors, or younger myopes, derive greater benefit from treatment; (iii) the initial rate of reduction of axial elongation by myopia control treatments is not sustained; (iv) consequently, using percentage reduction in progression as an index to describe treatment effect can be very misleading and (v) cumulative absolute reduction in axial elongation (CARE) emerges as a preferred efficacy metric; (vi) maximum CARE that has been measured for existing myopia control treatments is 0.44 mm (which equates to about 1 D); (vii) there is no apparent superior method of treatment, although commonly prescribed therapies such as 0.01% atropine and progressive addition spectacles lenses have not consistently provided clinically important effects; (viii) while different treatments have shown divergent efficacy in the first year, they have shown only small differences after this; (ix) rebound should be assumed until proven otherwise; (x) an illusion of inflated efficacy is created by measurement error in refraction, sample bias in only treating 'measured' fast progressors and regression to the mean; (xi) decision to treat should be based on age of onset (or refraction at a given age), not past progression; (xii) the decreased risk of complications later in life provided by even modest reductions in progression suggest treatment is advised for all young myopes and, because of limitations of available interventions, should be aggressive.
Topics: Adolescent; Atropine; Child; Disease Progression; Eyeglasses; Humans; Myopia; Refraction, Ocular; Vision Tests
PubMed: 33253901
DOI: 10.1016/j.preteyeres.2020.100923 -
Iranian Journal of Basic Medical... Sep 2020Rosemary ( L.) is an evergreen bushy shrub which grows along the Mediterranean Sea, and sub-Himalayan areas. In folk medicine, it has been used as an antispasmodic, mild... (Review)
Review
Rosemary ( L.) is an evergreen bushy shrub which grows along the Mediterranean Sea, and sub-Himalayan areas. In folk medicine, it has been used as an antispasmodic, mild analgesic, to cure intercostal neuralgia, headaches, migraine, insomnia emotional upset, and depression. Different investigations have highlighted rosemary neuropharmacological properties as their main topics. Rosemary has significant antimicrobial, anti-inflammatory, anti-oxidant, anti-apoptotic, anti-tumorigenic, antinociceptive, and neuroprotective properties. Furthermore, it shows important clinical effects on mood, learning, memory, pain, anxiety, and sleep. The aim of the current work is to review the potential neuropharmacological effects of different rosemary extracts and its active constituents on nervous system disorders, their relevant mechanisms and its preclinical application to recall the therapeutic potential of this herb and more directions of future research projects. The data were gathered by searching the English articles in PubMed, Scopus, Google Scholar, and Web of Science. The keywords used as search terms were '', 'rosemary', 'nervous system', 'depression', 'memory', 'Alzheimer's disease' 'epilepsy', 'addiction', 'neuropathic pain', and 'disorders'. All kinds of related articles, abstracts and books were included. No time limitation was considered. Both and studies were subjected to this investigation. This review authenticates that rosemary has appeared as a worthy source for curing inflammation, analgesic, anti-anxiety, and memory boosting. It also arranges new perception for further investigations on isolated constituents, especially carnosic acid, rosmarinic acid, and essential oil to find exquisite therapeutics and support drug discovery with fewer side effects to help people suffering from nervous system disorders.
PubMed: 32963731
DOI: 10.22038/ijbms.2020.45269.10541 -
Indian Journal of Ophthalmology Aug 2022Myopia or short-sightedness is an emerging pandemic affecting more than 50% population in South-Asian countries. It is associated with several sight-threatening... (Review)
Review
Myopia or short-sightedness is an emerging pandemic affecting more than 50% population in South-Asian countries. It is associated with several sight-threatening complications, such as retinal detachment and choroidal neovascularization, leading to an increased burden of visual impairment and blindness. The pathophysiology of myopia involves a complex interplay of numerous environmental and genetic factors leading to progressive axial elongation. Environmental factors such as decreased outdoor activity, reduced exposure to ambient light, strenuous near work, and role of family history of myopia have been implicated with increased prevalence of this refractive error. While multiple clinical trials have been undertaken to devise appropriate treatment strategies and target the modifiable risk factors, there is no single treatment modality with ideal results; therefore, formulating a comprehensive approach is required to control the myopia epidemic. This review article summarizes the epidemiology, dynamic concepts of pathophysiology, and evolution of the treatment modalities for myopia such as pharmacological (atropine and other agents) and optical methods (spectacles, contact lenses, and orthokeratology).
Topics: Atropine; Contact Lenses; Disease Progression; Eyeglasses; Humans; Myopia
PubMed: 35918919
DOI: 10.4103/ijo.IJO_2098_21 -
Frontiers in Public Health 2022The myopia epidemic has become a global public health problem. Although myopia is progressing worldwide, the recent coronavirus infections 2019 (COVID-19) outbreak has... (Review)
Review
The myopia epidemic has become a global public health problem. Although myopia is progressing worldwide, the recent coronavirus infections 2019 (COVID-19) outbreak has spurred myopia progression. The current evidence-based treatments for humans are atropine eye drops, optical treatment with defocus, use of orthokeratology, extending proximity working distance, pausing from near work every half hour and increased time outside the home. Studies on myopia using animal models have been conducted for more than 40 years. In recent years, new mechanisms of myopia suppression have been revealed from animal experiments such as inflammation control, intraocular pressure control, light control, and the activity of early growth response protein 1 control. This mini-review provides a summary of the scientific evidence currently available on the control of myopia, and the possible treatments mitigating myopia.
Topics: Atropine; COVID-19; Disease Progression; Humans; Myopia; Ophthalmic Solutions
PubMed: 35619815
DOI: 10.3389/fpubh.2022.897600 -
The American Journal of Gastroenterology Aug 2021Chronic abdominal pain is a common gastrointestinal (GI) symptom that characterizes many functional GI disorders/disorders of gut-brain interaction, including irritable... (Review)
Review
Chronic abdominal pain is a common gastrointestinal (GI) symptom that characterizes many functional GI disorders/disorders of gut-brain interaction, including irritable bowel syndrome, functional dyspepsia, and centrally mediated abdominal pain syndrome. The symptoms of abdominal pain in these highly prevalent disorders are often treated with antispasmodic agents. Antispasmodic treatment includes a broad range of therapeutic classes with different mechanisms of action, including anticholinergic/antimuscarinic agents (inhibition of GI smooth muscle contraction), calcium channel inhibitors (inhibition of calcium transport into GI smooth muscle), and direct smooth muscle relaxants (inhibition of sodium and calcium transport). The aim of this review article was to examine the efficacy and safety of antispasmodics available in North America (e.g., alverine, dicyclomine, hyoscine, hyoscyamine, mebeverine, otilonium, pinaverium, and trimebutine) for the treatment of chronic abdominal pain in patients with common disorders of gut-brain interaction. For the agents examined, comparisons of studies are limited by inconsistencies in treatment dosing and duration, patient profiles, and diagnostic criteria employed. Furthermore, variability in study end points limits comparisons. Risk of selection, performance, detection, attrition, and reporting bias also differed among studies, and in many cases, risks were considered "unclear." The antispasmodics evaluated in this review, which differ in geographic availability, were found to vary dramatically in efficacy and safety. Given these caveats, each agent should be considered on an individual basis, rather than prescribed based on information across the broad class of agents.
Topics: Abdominal Pain; Chronic Pain; Humans; North America; Parasympatholytics
PubMed: 33993133
DOI: 10.14309/ajg.0000000000001266 -
The Lancet. Gastroenterology &... Feb 2020Although novel therapies for irritable bowel syndrome (IBS) continue to be developed, many doctors rely on more established, traditional therapies as first-line or...
BACKGROUND
Although novel therapies for irritable bowel syndrome (IBS) continue to be developed, many doctors rely on more established, traditional therapies as first-line or second-line treatment options. These therapies include soluble fibre (eg, ispaghula husk), antispasmodic drugs, peppermint oil, and gut-brain neuromodulators (including tricyclic antidepressants, selective serotonin reuptake inhibitors, or α-2-δ calcium channel subunit ligands). However, the relative efficacy of traditional treatments in patients with IBS is unclear because there have been few head-to-head randomised controlled trials (RCTs). We aimed to compare and rank the efficacy of traditional therapies in patients with IBS to help inform clinical decisions.
METHODS
For this systematic review and network meta-analysis, we searched MEDLINE, Embase, Embase Classic, and the Cochrane Central Register of Controlled Trials from inception to week 2 of August 2019; ClinicalTrials.gov for unpublished trials or supplementary data published up to Aug 18, 2019; and gastroenterology conference proceedings for study abstracts published between 2001 and Aug 18, 2019. We included RCTs that compared any of these treatments with each other (head-to-head trials) or with placebo, in which the efficacy of soluble fibre, antispasmodic drugs, peppermint oil, or gut-brain neuromodulators was assessed in adults (aged at least 18 years) with IBS of any subtype after 4-12 weeks of treatment. Only RCTs reporting a dichotomous assessment of overall response to therapy, in terms of either improvement in global IBS symptoms or improvement in abdominal pain, were included. The efficacy and safety of all treatments were reported as a pooled relative risk (RR) with 95% CIs to summarise the effect of each comparison tested, and treatments were ranked according to their P-score.
FINDINGS
Our search identified 5863 references, of which 81 were screened for eligibility. 51 RCTs with data from 4644 patients were eligible for inclusion in our analysis, but only 13 of these trials were at low risk of bias. Based on an endpoint of failure to achieve improvement in global IBS symptoms at 4-12 weeks, peppermint oil capsules were ranked first for efficacy (RR 0·63, 95% CI 0·48-0·83, P-score 0·84) and tricyclic antidepressants were ranked second (0·66, 0·53-0·83, P-score 0·77). For failure to achieve an improvement in global IBS symptoms at 4-12 weeks, there were no significant differences between active treatments after direct or indirect comparisons. For failure to achieve improvement in abdominal pain at 4-12 weeks, tricyclic antidepressants were ranked first for efficacy (0·53, 0·34-0·83, P-score 0·87); however, this result was based on data from only four RCTs involving 92 patients. For failure to achieve an improvement in abdominal pain, none of the active treatments showed superior efficacy upon indirect comparison. Tricyclic antidepressants were more likely than placebo to lead to adverse events (1·59, 1·26-2·06, P-score 0·16).
INTERPRETATION
In this network meta-analysis of RCTs of soluble fibre, antispasmodic drugs, peppermint oil, and gut-brain neuromodulators for IBS, few of which were judged as being at a low risk of bias, peppermint oil was ranked first for efficacy when global symptoms were used as the outcome measure, and tricyclic antidepressants were ranked first for efficacy when abdominal pain was used as the outcome measure. However, because of the lack of methodological rigour of some RCTs analysed in our study, there is likely to be considerable uncertainty around these findings. In addition, because treatment duration in most included trials was 4-12 weeks, the long-term relative efficacy of these treatments is unknown.
FUNDING
None.
Topics: Brain; Dietary Fiber; Humans; Intestinal Mucosa; Irritable Bowel Syndrome; Network Meta-Analysis; Neurotransmitter Agents; Parasympatholytics; Treatment Outcome
PubMed: 31859183
DOI: 10.1016/S2468-1253(19)30324-3