Impact of myopia control interventions on choroidal thickness in children: a systematic review and meta-analysis of randomized controlled trials

Abstract

Topic This systematic review and meta-analysis evaluated whether myopia control interventions produce measurable changes in choroidal thickness (ChT) in children and adolescents with myopia compared with single-vision lenses or placebo. The primary aim was to describe patterns of ChT modulation. Clinical Relevance Myopia is the most common ocular disorder worldwide and is projected to affect 50% of the global population by 2050. High myopia increases the risk of complications such as myopic maculopathy and retinal detachment. Early biomarkers of treatment efficacy are critical, and ChT has emerged as a promising candidate given its rapid and bidirectional response to visual and pharmacological stimuli. Methods The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO; CRD420251144689). Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines and A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR-2) standards, randomized controlled trials (RCTs) were included if they assessed ChT changes after myopia control interventions in pediatric populations. Searches of PubMed, Web of Science, and Scopus were completed on August 5, 2025. Two reviewers independently screened, extracted, and assessed risk of bias using the Cochrane tool. Pooled mean differences with 95% confidence intervals (CIs) were calculated, and certainty of evidence was rated with Grading of Recommendations, Assessment, Development and Evaluation. Results Eleven RCTs including 2190 eyes were analyzed. Repeated low-level red-light therapy induced the largest thickening (mean difference = 24.1 μm, 95% CI: 19.8–28.5; I2 = 77%). Atropine produced modest but significant effects (mean difference = 10.6 μm, 95% CI: 6.7–14.5) with high heterogeneity (I2 = 97%). Orthokeratology yielded consistent increases (mean difference = 13.3 μm, 95% CI: 9.5–17.1; I2 = 6%), while lenslet spectacles showed moderate effects (mean difference = 13.2 μm, 95% CI: 5.7–20.7; I2 = 0%). Evidence certainty was rated high for most interventions and moderate for atropine. Conclusions Myopia control interventions produce early, measurable increases in ChT. These findings characterize patterns of choroidal modulation, while their clinical relevance remains uncertain. Further studies integrating ChT with efficacy measures are needed