渐进镜与近视的控制

渐进镜自20世纪50年代始应用于老视的矫治。近年来随着近视“离焦”学说的提出以及近视患者调节明显滞后现象的发现，佩戴渐进镜因能减少调节刺激、提高调节准确度而可能成为延缓近视发展的方法。尽管近几年有关渐进镜控制近视的研究较多，但其临床效果说法不一。就近视的发病机制、渐进镜的作用机制以及几个主要的相关研究尤其是其优缺点进行综述。     

The effectiveness of progressive addition lenses on the progression of myopia in Chinese children

Purpose: To evaluate the effectiveness of progressive addition lenses (PALs), with a near addition of +1.50 D, on the progression of myopia in Chinese children. Methods: We enrolled 178 Chinese juvenile‐onset acquired myopes (aged 7–13 years, ?0.50 to ?3.00 D spherical refractive error), who did not have moderately or highly myopic parents, for a 2‐year prospective study. They were randomly assigned to the PAL group or single vision (SV) group. Primary measurements, which included myopia progression and ocular biometry, were performed every 6 months. Treatment effect was adjusted for important covariates, by using a multiple linear regression model. Results: One hundred and forty‐nine subjects (75 in SV and 74 in PAL) completed the 2‐year study. The myopia progression (mean ± S.D.) in the SV and PAL groups was ?1.50 ± 0.67 and ?1.24 ± 0.56 D, respectively. This difference of 0.26 D over 2 years was statistically significant (p = 0.01). The lens type (p = 0.02) and baseline spherical equivalent refraction (p = 0.05) were significant contributing factors to myopia progression. Mean increase in the depth of vitreous chamber was 0.70 ± 0.40 and 0.59 ± 0.24 mm, respectively. This difference of 0.11 mm was statistically significant (p = 0.04). Age (p < 0.01) was the only contributing factor to the elongation of vitreous chamber. Different near phoria (p < 0.01) and gender (p = 0.02) caused different treatment effects when wearing SV lenses. However, there were no factors found to influence the treatment effect of wearing PALs. Conclusions: Compared with SV lenses, myopia progression was found to be retarded by PALs to some extent in Chinese children without moderately or highly myopic parents, especially for subjects with near esophoria or females.     

Pseudoaccommodation and progressive addition lenses

The limitations of traditional multifocal lenses to replace normal ocular accommodation are well known. The recent development of progressive addition lenses circumvent many of those problems, furnishing smoothly varying power in desired amounts for various distances and allowing freedom from distracting lines. Optical characteristics, screening considerations, prescribing and fitting requirements, and the advantages and limitations of progressive addition lenses are discussed.     

渐变多焦点视力镜防治青少年近视的初步观察

目的：探讨多焦点视力镜防治青少年近视的疗效。方法：6～23岁青少年近视1597例,屈光度由-1．00～-6．00D。分为治疗组876例和对照组721例。前组应用渐变多焦点视力镜进行治疗,对照组配戴普通树脂镜片。治疗组根据其年龄与屈光度细分为4小组。所有病例每月复诊1次,并以8mo后复诊结果作为统计数据。结果：治疗组876例中多数近视程度得到有效控制,与对照组721例结果有显性差异。其中近视未得到控制共计18例,占治疗组病例的2．1％。该18例中有6例近视进展超过-1．00D。结论：渐变多焦点视力镜对控制青少年中低度近视的发展有较好的效果。     

Effect of multifocal spectacle lenses on accommodative errors over time: Possible implications for myopia control

The study purpose was to improve understanding of how multifocal spectacle lenses affect accommodative errors and whether this changes over time. Fifty-two myopes aged 18 to 27 years were allocated randomly to one of two progressive addition lens (PAL) types with 1.50 D additions and different horizontal power gradients across the near-periphery boundary. Lags of accommodation were determined with a Grand Seiko WAM-5500 autorefractor and a COAS-HD aberrometer for several near distances with the distance correction and the near PAL correction. For the COAS-HD the neural sharpness (NS) metric was used. Measures were repeated at three-month intervals over 12 months. At the final visit, lags to booster addition powers of 0.25, 0.50, and 0.75 D were measured. Except at baseline, both PALs’ data were combined for analysis. For the Grand Seiko autorefractor, both PALs reduced accommodative lag at baseline compared with SVLs (p < 0.05 and p < 0.01 at all distances for PAL 1 and PAL 2, respectively). For the COAS-HD, at baseline PAL 1 reduced accommodative lag at all near distances (p < 0.02), but PAL 2 only at 40 cm (p < 0.02). Lags measured with COAS-HD were greater for shorter target distances with PALs. After 12 months’ wear, the PALs no longer reduced accommodative lags significantly, except at 40 cm distance, but 0.50 D and 0.75 D booster adds decreased the lags to those measured at baseline or less. In conclusion, for PALs to reduce accommodative lag effectively, addition power should be tailored to typical working distances and after the first year of wear should be boosted by at least 0.50 D to maintain efficacy.     

Technical note: Apparatus for comparison of progressive addition spectacle lenses

Apparatus is described for the measurement of lens power distribution across the surface of a progressive addition spectacle lens. Although the method used is different to that specified in BS 2738-7:1996, the measurements are nevertheless comparable, and are considered sufficiently accurate for making basic comparisons of lens type.     

渐变多焦镜治疗远视引起的儿童屈光不正性弱视

目的探讨规范化验配的远视渐变多焦镜治疗儿童远视引起的屈光不正性弱视的可行性。方法对远视引起的双眼屈光不正性弱视（排除斜视与屈光参差）儿童,在规范的验光条件下配镜,戴镜治疗弱视,根据矫正方法分为全矫组、欠矫组、渐变多焦镜组。收集随访期满24个月,资料完整病例179例（358眼）,观察治愈时间及戴镜依从性。结果全矫组、欠矫组和渐变多焦镜组的治愈时间分别为（11．66±5．79）月、（11．42±5．80）月和（9．75±4．35）月,差异有统计学意义（P〈0．05）。患儿在配戴渐变镜初期依从性好,习惯并依赖戴镜占其总数的85％．欠矫组为86．7％．全矫组为零。结论在规范的验光条件下．儿童远视所致屈光不正性弱视眼配戴远视渐变镜治疗效果确切．具有很好的可行性,相对全矫与欠矫配镜疗法具有优越性。     

渐进多焦点眼镜对青少年近视眼作用的研究

目的了解渐进多焦点眼镜对学龄青少年近视眼近视的作用。方法2组病例,每组50例,符合下列务件:年龄6-12岁,近视度数-1.25-4.50D(为扩瞳后电脑验光度数的等效球镜值),双眼散光绝对度数<1.5D'屈光参差<1.0D,每个病例详细记录过去史及家族史,进行规范验光后分别配戴普通近视眼镜和渐进多焦点眼镜。每隔0.5a进行随访观察,la后选取右眼对其近视度数上升值进行比较。结果1a后渐进多焦点眼镜组共有42例完成随访,近视度数平均上升(0.70±0.49)D;普通眼镜组有44例完成随访,近视度数平均上升(0.85±0.61)D,2组差别无显著性(t=1.575,P=0.118)。但当在2组中删除有高度近视家族史的病例后,渐进多焦眼镜组(35例)平均近视度数上升(0.60±0.50)D,普通近视眼镜组(42例)平均近视度数上升(0.85±0.61)D,差异有显著性(t=2.04,P=0.043)。结论渐进多焦点眼镜对青少年近视度数的发展可能有一定的控制作用,但其控制近视的详细机理有待进一步证实。     

Theoretical performance of progressive addition lenses with poorly measured individual parameters

Purpose

The aim of this paper was to present a theoretical study of how poorly measured individual parameters affect the optical performance of progressive addition lenses (PALs). Modern progressive lenses can be prescribed based on parameters such as vertex distance, pantoscopic and wrap angles. These parameters can be measured from the lens wearer using specific devices; however, not all of them can be measured with the same precision, and the impact of measurement errors on the lens performance is still unknown.

Methods

Data from 1900 patients were used to simulate the performance of four PAL designs with different degrees of complexity: perfect individual design, individual design with induced errors in the individual parameters, optimised design and conventional/basic design. For each patient and design, a quality metric was calculated to describe the optical performance of the lens.

Results

The design having the best performance was the perfect individual design, followed by the individual design with induced errors, the optimised design and finally the conventional/basic design.

Conclusions

Individual designs with measurement errors have better optical performance than lenses with less complexity, such as the optimised or conventional designs. This knowledge is useful for the eye care professional to make informed choices when dispensing these lenses.     

高度近视儿童青少年配戴多焦点软性接触镜延缓近视进展的有效性研究

目的　评估高度近视儿童青少年配戴多焦点软性亲水性接触镜延缓近视进展的有效性。方法　回顾性研究。纳入2018年11月到2020年2月于天津市眼科医院视光中心配戴多焦点软性亲水性接触镜的近视儿童青少年36例和配戴单光框架眼镜者36例（均选取右眼）,年龄为8~15岁,等效球镜度（SE）为-5.00~-10.00 D。记录患者年龄、性别等信息,收集患者基线及戴镜1年后的主觉屈光度、眼轴长度等指标。采用独立样本t检验分析两组患者基线与1年后的SE变化量及眼轴长度变化量,采用多元线性回归分析影响屈光度及眼轴长度变化的因素,二元Logistic回归分析影响进展性近视发展的因素。结果　配戴多焦点软性亲水性接触镜组患儿与单光框架眼镜组患儿相比,两组间1年的SE变化量及眼轴长度变化量差异均有统计学意义（t=5.407,P<0.001;t=-2.763,P=0.007）。多元线性回归分析发现,SE进展的主要影响因素是戴镜组别和基线眼轴长度,回归方程:SE=3.982+0.458×戴镜组别-0.138×基线眼轴长度（R²=0.375,调整R²=0.357）;眼轴变化主要影响因素为戴镜组别,回归方程:AL=0.116+0.120×戴镜组别（R²=0.097,调整R²=0.097）。对于是否成为进展性近视儿童来说,配戴单光框架眼镜组的风险是多焦点软镜的12.571倍。结论　高度近视儿童青少年配戴多焦点软性接触镜能延缓近视进展（65.4%）及眼轴生长（33.3%）。     

老视渐变镜的近视眼配戴者年龄和近附加的关系

目的研究成功验配渐进多焦点镜片（渐变镜,progressive addition lenses,PALs）的近视患者的年龄与其近附加（presbyopic add,ADD）的关系。方法将本中心2005年1月1日至2008年6月15日间成功验配渐变镜、资料完整的近视验配者69例（双眼均为近视眼,等效球镜〉-0．50 D）．按照每5岁分为一组,共分5组（40～45岁为第1组．46～50岁为第2组,51～55岁为第3组,56～60岁为第4组,61岁及以上为第5组）,线性回归分析年龄与最终成功验配的渐变镜近附加的关系。结果随着年龄的增加,近附加逐渐增加,年龄和近附加呈线性回归（t=9．662,P〈0．01）,得出公式：近附加=-0．697＋0．051×年龄（年龄≥40岁）。5组患者的近附加分别为（1.44±0．27）D、（1.73±0.32）D、（2.08±0.28）D、（2.38±0.38）D和（2．52±0．38）D,各组之间差异有非常显著的统计学意义（F=21．303,P〈0．01）。结论从昆明地区验配近视眼渐变镜的中老年人近视眼的现状可知,该人群每5年增加约0．25 D的近附加是初步成功验配的基础：     

The impact of continuing professional development on ophthalmic dispensing of progressive addition lenses in the Asia–Pacific region

Background: Discrepancies exist in optometric education, practice and regulation across the Asia–Pacific region and the competence of optometric practitioners in adopting new lens technologies may vary widely. Over the past 10 years, a continuing professional development program, Varilux Academy Asia–Pacific (VAAP), was implemented and conducted in countries across the Asia–Pacific region to improve practitioners' understanding of optometric fitting principles, with special emphasis on progressive addition lenses (PAL). The aim was to demonstrate the effectiveness of VAAP and to compare the competence of practitioners across the Asia–Pacific region in new lens fitting technologies. Methods: From 2002 to 2008, all VAAP participants from 12 countries across Asia–Pacific were invited to complete a pre‐ and a post‐program competency test and a post‐program survey. Results: A total of 5658 practitioners were trained, and 69.9 per cent (n = 3,957) of participants completed the pre‐ and post‐program competency test; 80.9 per cent (n = 4,580) of participants completed the post‐program survey. There was a significant improvement in competency after VAAP (mean change = 19.4 per cent ± 3.3, p < 0.01). Before VAAP was conducted the mean competency score was significantly lower in developing countries compared with developed countries (mean score of developed countries = 50.6 ± 10.3, mean score of developing countries = 45.0 ± 7.8, p < 0.05). After VAAP, these differences were not significant. Confidence in fitting PAL improved by 27.1 per cent. Most participants (91.6 per cent) intended to fit more PAL and 96.8 per cent of participants rated the program as excellent or good. Conclusion: Our findings highlight the need for further continuing education of practitioners across the Asia–Pacific region. The results of the training course indicate that, across Asia–Pacific, continuing education courses in ophthalmic optics and dispensing encompassing modern lens design and best practice fitting principles are warranted.     

不同屈光状态的模糊敏感度比较

目的分析不同屈光组模糊阈值之间的差异,探讨模糊阈值在近视发生发展中的可能作用机制。方法38名志愿者参加本实验,正视组15位,等效球镜度为0.50～-0.50D;近视组23位,其中稳定性近视组17位,屈光不正平均为(-4.76±1.40)D,进展性近视组6位,屈光不正平均为(-3.33±1.43)D。受试者在屈光全矫基础上,采用JND标准测量模糊阈值。结果正视组模糊阈值为(0.21±0.06)D,稳定性近视组为(0.27±0.05)D,进展性近视组为(0.33±0.06)D。近视组的模糊阈值高于正视组(P=0.001),近视组中,进展性近视组的模糊阈值高于稳定性近视组(P=0.028)。结论近视对模糊的敏感度下降,其中进展性近视的敏感度下降更显著,这可能是近视调节滞后增加的部分原因。     

Prescribing patterns of myopia control contact lenses among optometrists in Ireland

Purpose

This retrospective analysis of electronic medical record (EMR) data investigated the prescribing patterns of soft myopia control contact lens (MCCL) treatments since their introduction in Ireland in 2017.

Methods

Anonymised EMR data were sourced from 33 optometry practices in Ireland from 2017 to 2021 to determine the number of practices prescribing MCCLs to myopic children 5–18 years old. In MCCL-prescribing practices, the proportion of contact lens wearing children fitted with MCCLs and the proportion of progressive (≤−0.25 D/year) myopic children fitted with MCCLs were determined. Logistic regression was used to determine which factors influenced the likelihood of being prescribed a MCCL.

Results

Overall, just 10 practices were found to prescribe MCCLs of any type. The Coopervision MiSight contact lens was used in 85% of all MCCL fittings with most other fits being off-label multifocals. The use of MCCLs rose from 3% of contact lens fits in 2017 to 27% in 2021. Children fitted with MCCLs were on average younger (12.2 ± 2.3 years vs. 15.4 ± 2.1 years) but more myopic (−3.46 ± 1.84 D vs. −3.03 ± 1.69 D) than those fitted with standard contact lenses. The most predictive factors for being fitted with MCCLs were year of examination (OR: 2.54, 95% CI: 2.13, 3.03), younger age (OR: 1.52, 95% CI: 1.39, 1.64) and greater myopia (OR: 1.25, 95% CI: 1.11, 1.39).

Conclusion

Clinician engagement in myopia management has increased in Ireland since the formal introduction of MCCLs, but more than two-thirds of practices included are yet to offer this form of myopia management. The proportion of children with progressive myopia that has been prescribed MCCLs has increased, but the majority of children are still managed for vision correction only. There is significant scope for improving the uptake of evidence-based myopia control treatments and for optimising the age and degree of myopia at which such interventions are initiated.     

A longitudinal study on the relationship between myopia development and near accommodation lag in myopic children.

PURPOSE: To investigate the possible relationship between myopia progression and near accommodative lag. METHODS: A 1-year longitudinal study was carried out to measure the accommodative response and myopia progression in 62 children with mild and progressing myopia at two visits: they were 10.81 +/- 1.60 years old with refractive error -1.70 +/- 0.76 D on entry. Repeated measurements included refractive error, ocular biometry and accommodative response at 33 cm. The refractive error was determined by autorefraction after cycloplegia; ocular biometry by A-scan ultrasonography; and accommodative response by an open-field autorefractor. Results were based on the right eye and analysed by paired t-test and Pearson's correlation coefficient. RESULTS: Myopia progression in the year was -0.72 +/- 0.37 D (p < 0.001) with a range from -0.06 to -1.96 D. The change of axial length and vitreous depth were 0.41 +/- 0.25 mm (p < 0.001) and 0.36 +/- 0.24 mm (p < 0.001), respectively. The near lag was 0.76 +/- 0.29 D on entry and 0.72 +/- 0.38 D 1 year later (p = 0.79). No statistically significant correlations were found between near lag vs myopia progression and the change of ocular biometry as a whole (p > 0.10 for all). There was no significant difference in myopia progression between myopic children with greater than, compared to less than the mean amount of near lag (p = 0.36). CONCLUSIONS: This study demonstrates no statistically significant relationship between myopia progression and near accommodation lag in children with mild and progressing myopia. There is no evidence that near lag provides a stimulus to progression in this stage of myopia.     

Bifocal soft contact lenses as a possible myopia control treatment: a case report involving identical twins

Background: Several studies have suggested that bifocal and progressive spectacles can reduce progression of myopia in esophoric children. This study compared myopic progression with bifocal (BSCL) and single vision soft contact lenses (SVSCL) in identical twins with near point esophoria. Methods: Two 12‐year‐old myopic girls were randomly assigned to wear either BSCL or SVSCL for one year using a double‐masked design. Both twins then wore BSCLs for another year. Ocular measurements included cycloplegic and manifest refractions, corneal curvature and axial length. Distance and near phorias were measured through distance corrections and near associated phorias, with both types of contact lenses. Results: Through their SVSCLs, both children exhibited near associated esophorias, which were neutralised by the BSCLs. The child wearing SVSCLs over the first year showed significant myopic progression, increasing ‐1.19 D (binocular average), while the child wearing BSCLs showed no progression (+0.13 D). The latter child showed limited progression (‐0.28 D) over the second year, while switching from SVSCLs to BSCLs arrested progression in the other child (+0.44 D after one year). Axial length data were consistent with the refractive findings; the child exhibiting more myopia at the end of the first 12 months of the study had longer eyes (by 0.64 mm) than her sister, although their corneas also had steepened more (by 0.44 D compared to 0.18 D). The children showed similar, small increases in eye size over the second year when both wore BSCLs (binocular averages: 0.05, 0.09 mm, respectively). Conclusion: The apparent inhibitory effect of BSCLs on myopic progression reported in this twin study argues for further study of their efficacy as a control treatment for myopes with near esophoria.