青少年近视危险因素综述

近视是危害青少年视力最主要的病因,其发病原因复杂。近年来,在全球各个地区针对近视发生的危险因素进行了大量的流行病学研究,这些研究中大多数为横断面研究,纵向队列研究相对缺乏。总的来说,近视的发生是遗传易感性和环境暴露之间复杂相互作用的结果。本文将对近年来国内外学者关于近视相关危险因素的研究作一综述。     

核磁共振技术在高度近视临床研究中的应用

近视是一种可改变视觉皮层活动,并影响相应神经功能的危害性眼科疾病。目前我国的近视率呈空前上升之势,尤其是高度近视(HM),遂实现近视的有效防控及治疗极为重要。然而近视的具体发病机制至今仍未阐明,难以从根源上实现该病的防控防治。近年来,不断有研究从遗传、环境、神经递质等角度出发探讨近视的相关致病因素,但鲜有研究从大脑结构及神经活动的角度探讨近视的神经影像机制。随着磁共振成像技术的发展,脑影像逐步出现在近视的相关机制研究中,本文主要对近视的相关脑影像研究作一综述,以期为开展近视的临床防控防治工作提供重要参考依据。     

A synopsis of the prevalence rates and environmental risk factors for myopia

The prevalence rates of myopia are higher in urban Asian cities such as Hong Kong and Singapore. One observation over the past few decades is that the prevalence rates of myopia have been rising and there is an epidemic of myopia in Asia. The age‐old question of the roles of nature and nurture in this process remains unanswered. The strongest evidence for an environmental link to myopia is near work activity. Childhood exposure to night lighting has also been explored in different studies but the results have been mixed. Twin studies, segregation analysis and association studies have demonstrated that hereditary factors play an important role in myopia development. The exact nature and interplay of genetic and environmental factors is not known and data suggest that environmental factors may interact with genetic factors to increase the risks of developing myopia. Future research is needed to identify specific modifiable lifestyle factors and genetic markers for myopia. This will enable preventive measures such as health education to be instituted.     

IMI 2021 Reports and Digest – Reflections on the Implications for Clinical Practice

The International Myopia Institute''s (IMI) mission is to advance research, education, and management of myopia to decrease future vision impairment and blindness associated with increasing myopia. Its approach is to bring together scientists, clinicians, policymakers, government members, and educators into the field of myopia to stimulate collaboration and sharing of knowledge. The latest reports are on pathologic myopia, the impact of myopia, risk factors for myopia, accommodation and binocular vision in myopia development and progression, and the prevention of myopia and its progression. Together with the digest updating the 2019 International Myopia Institute white papers using the research published in the last 18 months, these evidence-based consensus white papers help to clarify the imperative for myopia control and the role of environmental modification initiatives, informing an evidence-based clinical approach. This guidance includes who to treat and when to start or stop treatment, and the advantages and limitations of different management approaches.     

多巴胺及其受体对形觉剥夺近视发展的影响

我国近视人口已近6亿,青少年近视率居世界第一,近视已成为危害我国居民视力健康的主要疾病之一。多巴胺是视网膜中主要的儿茶酚胺,众多研究发现提高多巴胺含量可有效抑制近视的发展。形觉剥夺是一种经典的近视造模方法,通过观察多巴胺及其受体对形觉剥夺近视发展的影响,可以反映其在近视发展中的作用,对指导控制近视的发生发展具有重要意义。本文就多巴胺及其受体对形觉剥夺性近视发展的影响进行综述,以期为近视的防治提供参考。     

Myopia and orthokeratology for myopia control

The prevalence of myopia in children is increasing worldwide and is viewed as a major public health concern. This increase has driven interest in research into myopia prevention and control in children. Although there is still uncertainty in the risk factors underlying differences in myopia prevalence between ethnic groups, rates in children of East Asian descent are typically higher regardless of where they live. Mounting evidence also suggests that myopia prevalence in children increases with age. Earlier commencement and more rigorous education systems in these countries, resulting in more time spent on near‐work activities and less time on outdoor activities, may be responsible for the earlier age of myopia onset. However, to date, the mechanisms regulating myopia onset and progression are still poorly understood. Findings from several studies have shown orthokeratology to be effective in slowing axial elongation and it is a well‐accepted treatment, particularly in East Asian regions. While our understanding of this treatment has increased in the last decade, more work is required to answer questions, including: How long should the treatment be continued? Is there a rebound effect? Should the amount of myopia control be increased? To whom and when should the treatment be offered? Practitioners are now faced with the need to carefully guide and advise parents on whether and when to undertake a long somewhat complex intervention, which is costly, both in time and money. In the near future, a greater demand for effective prophylaxis against childhood myopia is envisaged. Other than orthokeratology, atropine therapy has been shown to be effective in slowing myopia progression. While its mechanism of control is also not fully understood, it is likely that it acts via a different mechanism from orthokeratology. Thus, a combined treatment of orthokeratology and atropine may have great potential to maximise the effectiveness of myopia control interventions.     

青少年近视发生发展的相关环境因素及机制研究进展

近视是影响青少年视力健康的最常见疾病,已引起公众的广泛关注。近视发生发展的相关环境因素包括:近距离工作、户外时间、光照强度及时间、居住环境、吸烟暴露等。大量研究发现,增加户外时间、光照强度及光照时间可以有效降低近视的发生发展;还有研究发现多巴胺与此过程密切相关,但这些仍需要进一步研究去证实。本文就青少年近视发生发展的相关环境因素以及可能的作用机制作一综述,为青少年近视的进一步研究和防治提供理论支持。     

视黄酸在实验性近视发生中作用的研究进展

近视是一种常见的导致视力障碍的眼科疾病,其患病率逐年升高,而目前临床上尚无有效的根治手段,原因在于近视的发病机制尚不明确.目前与近视发生相关的因子很多,如多巴胺、视黄酸、胰高血糖素及ZENK(Zif269、EGR-1、NGFI-A或Krox-24)等.视黄酸是维生素A的衍生物,是视网膜光感受器细胞中视蛋白结合物视黄醛的最终代谢产物.许多研究表明视网膜与脉络膜中的视黄酸在近视发生中起到重要作用,可以调节近视相关的多种因子的作用,如转化生长因子-β、糖胺聚糖、基质金属蛋白酶(MMP)-2、金属蛋白酶组织抑制剂(TIMP)-2等.本文基于眼内视黄酸的产生、代谢及作用,就视黄酸在形觉剥夺、光学离焦及色光诱导性近视等3种实验性近视发生中的作用做一综述,以期对今后的近视机制研究带来一些启发.     

Clinical management of progressive myopia

Myopia has been increasing in prevalence throughout the world, reaching over 90% in some East Asian populations. There is increasing evidence that whereas genetics clearly have an important role, the type of visual environment to which one is exposed to likely influences the onset, progression, and cessation of myopia. Consequently, attempts to either modify the environment or to reduce the exposure of the eye to various environmental stimuli to eye growth through the use of various optical devices are well under way at research centers around the globe. The most promising of current treatments include low-percentage atropine, bifocal soft contact lenses, orthokeratology, and multifocal spectacles. These methods are discussed briefly and are then categorized in terms of their expected degree of myopia progression control. A clinical strategy is presented for selecting the most effective treatment for the appropriate type of patient at the optimal stage of refractive development to achieve the maximum control of myopia progression.     

生长因子在近视发病及发展中作用的研究进展

近视是患病率最高的眼科疾病之一,目前对其发生发展机制的认识仍然有限。许多研究发现,生长因子与眼球发育和近视发病密切相关。一些具有生物学活性的生长因子,如转化生长因子( TGF)、成纤维细胞生长因子(FGF)、表皮生长因子(EGF)等分别具有影响巩膜厚度变化和调控近视发生发展等功能,在近视发病过程中起着不可忽略的作用,本文将对此进行综述。     

形觉剥夺性近视中巩膜重塑机制的研究

近视是全球发病率最高的屈光不正,发病机制至今不明。形觉剥夺性近视（FDM）动物模型的建立为近视的病因学研究开辟了新局面。形觉剥夺主要通过“局部视网膜机制”来调控邻近巩膜的生长。外界刺激作用于视网膜,启动视网膜一视网膜色素上皮层一脉络膜信号转导系统,把局部视网膜信号转化为调控巩膜重塑的信号,诱导细胞外基质异常表达,巩膜胶原纤维改变等,引起巩膜重塑。就FDM中不同种属动物间巩膜重塑发生的形态学变化及相关因素等做一综述。     

睡眠行为与近视发生发展关系研究进展

近视已成为全球范围的公共卫生问题.睡眠是在褪黑素调节下,人类生命过程中重要的周期性生理过程.睡眠与近视一样都会受到环境因素的影响,不同近视程度患者及正视人群在睡眠时间、睡眠质量及褪黑素水平上存在差异.本文回顾了近视发生发展与人群睡眠行为的现状研究及相关的基础实验学研究,从流行病学和生物学机制两方面,对近视发生发展与睡眠...     

Choroidal changes in human myopia: insights from optical coherence tomography imaging

The choroid is a vascular tissue which plays a range of critical roles in the normal physiology of the eye, such as supplying the outer retina with oxygen and nutrients and the regulation of intraocular pressure. There is also substantial evidence, particularly from animal studies, that the choroid plays an important role in the regulation of eye growth and the development of common refractive errors like myopia. In recent years, advances in optical coherence tomography technology have improved our ability to image and measure the choroid in the human eye. Research using this technology over the past decade has dramatically improved our knowledge of the normal choroid, and its potential role in the regulation of eye growth and refractive error development. This review aims to provide an overview of recent work examining the normal human choroid, its changes with myopia and the possible role of the choroid in the mechanism regulating eye growth. Studies have demonstrated that choroidal thinning accompanies the development and progression of myopia, and have established a close link between eye growth and choroidal thickness changes. Dramatic thinning of the choroid is seen with high myopia, and associations are also observed between choroidal thinning and reduced vision, and the development of retinal pathology associated with high myopia. In the short‐term, environmental factors known to be associated with myopia development and more rapid eye growth typically lead to a thinning of the choroid, whereas factors linked to a slowing of eye growth are typically associated with short‐term choroidal thickening. Collectively, these findings suggest that the choroid is an important biomarker of eye growth in the human eye, and additional research to better understand the human choroid is likely to further our knowledge of the signals and pathways regulating eye growth, myopia development and progression.     

Gene–environment interaction in myopia

Myopia is a health issue that has attracted global attention due to its high prevalence and vision-threatening complications. It is well known that the onset and progression of myopia are related to both genetic and environmental factors: more than 450 common genetic loci have been found to be associated with myopia, while near work and outdoor time are the main environmental risk factors. As for many complex traits, gene–environment interactions are implicated in myopia development. To date, several genetic loci have been found to interact with near work or educational level. Gene–environment interaction research on myopia could yield models that provide more accurate risk predictions, thus improving targeted treatments and preventive strategies. Additionally, such investigations might have the potential to reveal novel genetic information. In this review, we summarised the findings in this field and proposed some topics for future investigations.     

第二版国际近视研究学会近视防控白皮书解读

全球近视率居高不下,儿童青少年近视发病率不断攀升。近视进展会影响个人视力、视力相关生活质量和生产力,高度近视及其相关眼部并发症亦会加剧家庭和社会负担。因此,针对近视的机制、相关并发症与防控方法亟需进一步探究。国际近视研究学会(IMI)于2021-04发布了第二版近视防控白皮书,内容包括近视临床实践反思、近视的影响、近视的危险因素、近视进展过程中的调节与双眼视觉、病理性近视、近视防控及年度汇编。第二版白皮书在第一版白皮书的基础上增加了对上千篇文章和重要的会议摘要的研究,突出了近视防控相关的最新研究和进展。本文对上述第二版近视防控白皮书的内容进行简要汇总和解读,包括近视概述、近视影响、危险因素、近视进展过程中的调节与眼结构改变以及近视防控,以期对近视防控的临床和科研工作有所帮助。     

角膜塑形镜对近视患者双眼视功能的影响

角膜塑形镜通过本身逆几何的特殊设计,可以改变角膜形态和控制眼轴的增长,对青少年近视的控制和矫正取得了显著的临床效果,因此,获得了国内外专家的高度评价,并得到了广泛的应用。近年来的实验表明,角膜塑形镜对近视性屈光参差患者屈光度数的控制以及对近视患者双眼视功能的改善,也有明显的效果。本文通过角膜塑形镜控制近视屈光度数增长的机制和效果、对屈光参差患者的治疗、对眼调节参数的影响和对双眼视功能的改善等方面最新的研究进展进行介绍。     

Practical applications to modify and control the development of ametropia

For many individuals, the developmental trend of lessening hyperopia from birth continues past emmetropia towards myopia during childhood. The global pattern for prevalence of refractive errors indicates that the prevalence of hyperopia is low; in contrast, the burden of myopia is on the rise because of rising prevalence and magnitude of myopia. This review highlights the need to lessen the global burden of myopia by intervening with the development and/or slowing the progression of myopia. Further, outcomes from human clinical trials of pharmaceutical, optical, and environmental approaches to control myopia will be summarised. Pharmaceutical treatments are effective in controlling eye growth but are associated with deleterious side effects. Optical strategies that induce myopic defocus at the retina such as peripheral defocus reducing lenses, simultaneous defocus lenses, bifocals, and orthokeratology as well as environmental influences such as increased outdoor activity show promise and provide a substantially risk-free environment in which to control eye growth.     

近视与脉络膜厚度的相关性

近视是引起视力损害的一个全球性公共问题,它的发生发展常常伴随着眼部各个组织结构的变化,尤其是病理性近视,涉及巩膜、脉络膜及视网膜等退行性变化.近年来,随着近视患病率越来越高,近视病理机制的探索及防治已成为全球性无法忽视的重要问题.近视的发生发展涉及多种因素的参与,最终会造成严重的视觉损害.脉络膜作为眼部重要的血管组织,...     

角膜塑形镜离焦技术在近视防控中的研究进展

近视发病率在全球范围内呈逐渐上升趋势,严重影响青少年儿童的眼部健康,引起了巨大的经济和社会效益损失。因此,近视防控工作至关重要且刻不容缓。近年来,角膜塑形镜逐渐在近视防控领域体现出其优越性。目前,角膜塑形镜控制近视发展的原理主要以视网膜远视性光学离焦学说为主,促使近视患者的远视性离焦向近视性离焦漂移从而延缓眼轴增长。其控制近视发展的效果与多种因素相关,包括离焦总量、瞳孔直径、光学区设计及镜片偏心等。角膜塑形镜的广泛使用将有效降低青少年儿童的近视发病率,本文就角膜塑形镜利用离焦技术控制近视发展的原理、离焦量和离焦环位置与近视防控效果的关系等方面进行综述,旨在阐明角膜塑形镜离焦技术在近视防控中的研究进展。     

A review of environmental risk factors for myopia during early life,childhood and adolescence

Myopia is a significant public health problem worldwide, particularly in East Asian countries. The increasing prevalence of myopia poses a huge socio‐economic burden and progressive high myopia can lead to sight‐threatening ocular complications. Hence, the prevention of early‐onset myopia progressing to pathological high myopia is important. Recent epidemiological studies suggest that increased outdoor time is an important modifiable environmental factor that protects young children from myopia. This protective effect may be due to high light intensity outdoors, the chromaticity of daylight or increased vitamin D levels. This review summarises the possible underlying biological mechanisms for the protective association between time outdoors and myopia, including the potential role of nicotinic acetylcholine receptors in refractive error development. Recent evidence for the role of other environmental risk factors such as near work, birth seasons, parental smoking and birth order are also summarised.