Table 3.
Implementation Outcomes
| Author, Year; Study Design; Sample Size | % of LTFU + Reasons | Compliance Rate | Implementation Factors: Drivers and Strategies | Implementation Factors: Barriers |
|---|---|---|---|---|
| He et al., 202323; RCT; N = 278 | 10.8% (30/278); lost to follow up (COVID-19), withdrew | Median compliance rate of intervention group: 60.0% (IQR = 54.2%–64.8%) | Training of parents/guardians to supervise intervention, assignment of investigators to monitor intervention compliance, weekly reminders about the intervention | Participants did not bring the devices home from school during the COVID-19 lockdown period |
| Chen et al., 202322; RCT; N = 102 | 15.7% (16/102); lost contact, withdrew, turned to other myopia treatments | Not available | WeChat group to monitor compliance, uploading photographs of the LRL treatment to the WeChat group daily | Not available |
| Dong et al., 202324; RCT; N = 112 | 3.6% (4/112); refusal to follow up, did not have at least one post-randomization follow-up time point | 87.5% compliance rate in RLRL group and 94.5% compliance rate in sham device control groups | Reminders were sent to parents/guardians about intervention compliance | Not available |
| Jiang et al., 202225; RCT; N = 264 | 14.8% (39/264); self-reported discomfort, refused to follow up, turned to other myopia treatments | Median treatment compliance rate of 75% (IQR = 14.1–112.1%) | Reminders were sent to parents/guardians about intervention | Not available |
| Liu et al., 202426; RCT; N = 94 | 9.6% (9/94) lost to follow up, segmentation errors, poor image quality | Not available | Training of parents/guardians to supervise intervention, assignment of investigators to monitor intervention compliance, weekly reminders about the intervention, device was integrated with an automated diary function and connected to the internet | Not available |
| Lin et al., 202327; RCT; N = 164 | 21.9% (46/210); refusal to follow up, did not meet the inclusion criteria, lost to follow up (COVID-19), lost to other myopia control methods | Not available | Supervision of intervention by parents/guardians | Not available |
| Yang et al., 202228; RCT; N = 25 | No LTFU | Not available | Not available | Not available |
| Wang et al., 202329; non-randomized controlled trial; N = 49 | 10.2% (5/49); turned to other myopia treatments, COVID-19 | Median therapy adherence rate of 75% (IQR = 88.89–94.44%) | Not available | Not available |
| Xiong et al., 202230; post-trial follow up RWS of Jiang et al., 2022; N = 138 | 17.4% (24/138); turned to other myopia treatments, did not adhere to treatment protocol | Not available | Not available | Not available |
| Zhou et al., 202431; RCT; N = 200 | 11.5% (23/200); too busy/inconvenient for participants to follow up, lost contact, COVID-19, withdrawal, concern over side effects, worsening myopia, turned to other myopia treatments | Not available | Not available | Not available |
| Zhao et al., 202332; non-randomized controlled trial; N = 67 | No LTFU | Not available | Not available | Not available |
| Xiong et al., 202133; RCT; N = 200 | 26% (52/200); explore other myopia control methods, no time for aftercare, not following doctors’ instructions, lost to follow up | Not available | Not available | Not available |
| Tian et al., 202234; RCT; N = 224 | 20.1% (45/224); discontinued treatment, turned to other myopia treatments, lost contact | Not available | Not available | Not available |
| Mori et al., 202135; RCT; N = 113 | 19.5% (22/113); using other myopia treatments, did not spend at least 1 h outside daily, excludable baseline characteristics, withdrawal due to participant issues and family issues | Not available | Not available | Participants did not have sufficient outdoor time exposure |
| Torii et al., 202236; RCT; N = 43 | 18.6% (8/43); did not receive intervention, discontinued intervention from not satisfying study design, dropped out due to concern over myopia progression, participant was taking an excluded medicine, discontinued from fragile eyeglasses | Not available | Irradiation time was recorded by violet light frames and saved to a cloud server involving software installed on an iPod touch | Trial was initially suspended, and three participants withdrew due to the fragility of experimental and pseudo-placebo violet-light emitting eyeglass frames |
| Hua et al., 201537; RCT; N = 317 | No LTFU | Not available | Average illuminance of desks after the intervention surpassing the 300 lux requirement and the median uniformity of desk lighting increasing to 0.67 | Intervention was not consistent regarding the illuminance and uniformity of blackboards - only one light fixture was added to just one half of the blackboard as the other half was used for multi-media presentationsAverage illuminance was achieved on only 88% of the recommended value for blackboards in the intervention group and significantly lower than the control arm |
| He et al., 202219; RCT; N = 6295 | 19.5% (1228/6295); refusal to accept cycloplegia, absent, transferred schools | Not available | Approval and support from the Shanghai Education Bureau and Shanghai Health Bureau, issuance of an official statement inviting the schools and eye health departments to participate in and support the intervention program, supervision of intervention at various levels (e.g. school, district, and municipal), recording of information using a web-based application, assignment of investigators to monitor intervention compliance, assignment of a wearable wrist-watch light sensor to participants | Physical space availability, opportunity for structured activities, cultural attitudes on sun exposure and academic performance, weather (e.g. pollution) and short duration of breaks may have limited chances for children to be outdoor while on breakNumerous breaks for the additional 80 min intervention required multiple transitions from outdoor to classroom, which were made difficult by multi-story design of buildings |
| Wu et al., 201820; RCT; N = 930 | 25.5% (237/930); excluded due to presence of other myopia treatments but still attended baseline examinations, did not attend final follow up assessment | At final assessment, compliance of participants was 86% in the intervention group and 88% in the control group | Assignment of a wearable wrist-watch light sensor to participants during school time and a diary log to track outdoor time outside of school time | Changing climate in different regions of Taiwan |
| Wu et al., 201321; non-randomized controlled trial; N = 571 | No LTFU | Not available | Not available | Not available |
LTFU, loss to follow-up; RCT, randomized controlled trial; RWS, real-world study.