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。     

国际近视研究学会（IMI）近视防控研究白皮书解读

国际近视研究学会发布了一系列近视防控研究白皮书，主要涉及近视的定义和分类、近视干预、近视相关临床试验及仪器、行业准则和伦理考量、临床管理指南、近视的正视化和近视的实验模型以及近视的基因学等一系列内容。本文对上述系列白皮书涉及的临床相关内容进行介绍及解读。     

IMI 2021 Yearly Digest

PurposeThe International Myopia Institute (IMI) Yearly Digest highlights new research considered to be of importance since the publication of the first series of IMI white papers.MethodsA literature search was conducted for articles on myopia between 2019 and mid-2020 to inform definitions and classifications, experimental models, genetics, interventions, clinical trials, and clinical management. Conference abstracts from key meetings in the same period were also considered.ResultsOne thousand articles on myopia have been published between 2019 and mid-2020. Key advances include the use of the definition of premyopia in studies currently under way to test interventions in myopia, new definitions in the field of pathologic myopia, the role of new pharmacologic treatments in experimental models such as intraocular pressure–lowering latanoprost, a large meta-analysis of refractive error identifying 336 new genetic loci, new clinical interventions such as the defocus incorporated multisegment spectacles and combination therapy with low-dose atropine and orthokeratology (OK), normative standards in refractive error, the ethical dilemma of a placebo control group when myopia control treatments are established, reporting the physical metric of myopia reduction versus a percentage reduction, comparison of the risk of pediatric OK wear with risk of vision impairment in myopia, the justification of preventing myopic and axial length increase versus quality of life, and future vision loss.ConclusionsLarge amounts of research in myopia have been published since the IMI 2019 white papers were released. The yearly digest serves to highlight the latest research and advances in myopia.     

IMI Accommodation and Binocular Vision in Myopia Development and Progression

The role of accommodation in myopia development and progression has been debated for decades. More recently, the understanding of the mechanisms involved in accommodation and the consequent alterations in ocular parameters has expanded. This International Myopia Institute white paper reviews the variations in ocular parameters that occur with accommodation and the mechanisms involved in accommodation and myopia development and progression. Convergence is synergistically linked with accommodation and the impact of this on myopia has also been critiqued. Specific topics reviewed included accommodation and myopia, role of spatial frequency, and contrast of the task of objects in the near environment, color cues to accommodation, lag of accommodation, accommodative-convergence ratio, and near phoria status. Aspects of retinal blur from the lag of accommodation, the impact of spatial frequency at near and a short working distance may all be implicated in myopia development and progression. The response of the ciliary body and its links with changes in the choroid remain to be explored. Further research is critical to understanding the factors underlying accommodative and binocular mechanisms for myopia development and its progression and to guide recommendations for targeted interventions to slow myopia progression.     

近视发展预测模型相关研究进展

近视是导致视觉障碍的重要原因之一,随着全球范围内近视患病率的迅速攀升,近视已成为全球重大公共卫生问题。由于近视呈低龄化趋势,准确预测近视的发生及进展有助于对近视高危人群和儿童青少年近视患者进行有针对性的干预,以延缓近视的发生或减缓近视进展程度。近些年来,基于基线期眼部生物测量数据、屈光状态、环境因素、遗传因素、生活行为方式等循证医学证据制定的多种近视预测模型陆续被建立。基因-环境相互作用在近视病因学中的作用已被证实,随着基因学研究手段的不断创新,未来具有更高预测效能的特异性基因也将被应用于近视发展的预测及防控。文章对这些近视发展预测模型的内容、实用性、研究进展等进行了综述,以期为儿童青少年近视的防控提供参考依据和指导。     

Multifocal versus single vision lenses intervention to slow progression of myopia in school-age children: a meta-analysis

Myopia in school-aged children is a major public health problem in Asians that has been extensively studied. Multifocal lenses (MLs) are advocated as a substitute for single vision lenses (SVLs) to slow myopia progression in children, but results vary greatly across studies. We systematically searched currently available randomized controlled trials that compared the effects of MLs and SVLs in children. A meta-analysis of nine of these trials showed that MLs with powers ranging from +1.50 to +2.00D were associated with a statistically significantly decrease in myopia progression in school-aged children compared with SVLs. The benefit was greater in children with a higher level of myopia at baseline and sustained for a minimum of 24 months. Asian children appeared to have greater benefit from intervention with MLs than white children.     

近视的人格因素研究现状

近视在全球范围内已成为一种常见病,在我国学生近视呈现出高发、低龄化趋势。近视影响着人们心理的发展。人格作为区别于他人的独特的心理特性,与近视也存在联系。近视患者多以内向型人格、情绪型人格为主,但也有研究表示近视患者尚未出现与正常人有显著差异的人格特质。本文查阅国内外相关文献从近视与人格因素的关系、二者的相互作用等方面对近视的人格因素研究进展进行综述。     

环境光的光谱组成对屈光发育的影响研究进展

近视作为屈光发育异常中最常见的一种屈光状态,不仅给个人和社会造成一定的经济负担,而且还增加了患近视性黄斑变性等损害视力疾病的风险。研究表明,不同光谱组成的光可以通过改变眼的调节、脉络膜厚度以及视锥细胞信号转导等来影响眼的屈光发育,改变近视进展。主流的观点认为增加短波长光含量有利于延缓近视的进展,但也有学者对此持不同的观点。本文总结环境光的光谱差异对屈光发育的影响及相应的眼部改变,为后续的研究提供参考。     

【In Press】 Optic disc and peripapillary changes by optic coherence tomography in high myopia

Myopia, a worldwide condition, is a multifactorial disease resulting in many ocular complications. Early onset of myopia has a great tendency to develop high myopia and pathological myopia later in life. The pathophysiology and progression of myopia is still unclear. Owing to its involving in visual function, optic disc and peripapillary change in high myopia can''t be neglected, and it may help in better understanding of the pathophysiology or mechanism of myopia progression. Recently, advanced imaging techniques have been developed, such as optical coherence tomography (OCT), allowing for better detecting of optic disc and peripapillary change. OCT is a high-resolution and noninvasive measurement for detection of ocular structure. Herein, we provide an updated review of optic disc and peripapillary change in OCT image, including its characteristics and clinical significance. We also propose some problems needed further investigation.     

近视相关的遗传学研究进展

近视是极为常见的眼屈光不正状态,近视发病率逐年上升且发病年龄趋于提前,已成为危害人们视觉健康的重大公共卫生问题。研究表明,近视是遗传因素和环境因素及基因-环境交互作用影响的多因素复杂疾病。遗传学包括经典的遗传学和表观遗传学。表观遗传学研究的出现为近视基础研究开拓了新视角。近年来不断有研究者提出近视发生可能与表观遗传学有关联,而且有越来越多的实验研究也证明了该观点。近视的遗传研究通过使用连锁法和全基因组关联方法,现已鉴定出高度近视以及近视的多个近视基因和候选基因,极大地加深了对近视遗传学基础的认识。本文就近年来近视在经典遗传学和表观遗传学两个方面的研究进行综述。     

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。     

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.     

光学离焦技术控制近视的研究进展

近视是一种常见的眼病,近年来,近视的发生率在全球范围内呈逐年上升趋势,高度近视会增加视力丧失的风险,近视的并发症可引起巨大的经济和社会效益损失。因此,实施控制近视的有效措施至关重要且迫在眉睫。人们对近视的发病机制研究表明,周围远视离焦引起眼球轴向伸长不受控制可能是近视发展的机制之一,由此引申的各种光学策略尤其是光学离焦技术控制近视日益成为近视管理主流临床实践的一部分。本文从光学离焦控制近视的原理、离焦性近视动物实验研究、不同光学离焦技术控制近视的最新临床应用等方面进行综述,总结了使用渐进多焦眼镜、周边离焦框架眼镜、多点近视离焦框架眼镜、角膜塑形镜及多焦点软性角膜接触镜控制近视的临床研究结果,拟为延缓近视进展的治疗方案设计提供新的选择。     

儿童近视防控干预方法的研究进展

近视是我国三大学校公共卫生问题之一,其发病率逐年升高且呈现低龄化趋势,而高度近视可造成黄斑变性、白内障、视网膜脱离、脉络膜新生血管等相关并发症,这些并发症已经成为主要的视力障碍和致盲原因,严重影响个人生活质量。因此近视防控已成为家庭、教育和卫生部门共同关注的社会问题。本文对近年来儿童近视防控的干预方法的进展作一综述。     

人工智能技术在近视防控领域的研究进展

近视是引起视力损害的主要原因之一,近年来,其发病率逐年升高。有效的近视防控对于维持患者的视觉功能和生活质量非常重要。随着计算机大数据技术的不断发展,人工智能(AI)在医疗卫生领域飞速发展。机器学习和深度学习逐渐在近视防控领域崭露头角。通过对屈光度、眼轴、彩色眼底照相和光学相干断层扫描成像等近视相关数据的训练而形成的AI模型,借助远程医疗平台,人工智能在近视的发生、进展预测、监测、预警病理性近视、近视防控治疗和眼科远程医疗等方面均取得了积极的作用。本文主要就人工智能技术在近视防控领域的研究进展进行综述,旨在为未来近视防控工作提供新的方向。     

Myopia,an underrated global challenge to vision: where the current data takes us on myopia control

Myopia is the most frequent cause of distance impairment in the world and is creating an alarming global epidemic with deleterious ramifications for the quality of life and economic health of individuals and nations as a whole. In addition to being immediately disadvantageous, myopia increases the risk of serious disorders such as myopic macular degeneration, retinal detachment, glaucoma, and cataract and is a leading cause of visual impairment and blindness across many countries. The reduction in age of onset of myopia is of great concern since the earlier the onset, the more myopic the individual will become, with all the attendant increased risks of accompanying debilitating eye conditions. The economic burden is great; both in consequences of uncorrected refractive error and also in the provision of devices for correcting visual acuity. Earlier onset of myopia increases the lifetime economic burden related to loss of productivity and independence, leading to a reduced quality of life. Recent data suggest addressing accommodation per se has little direct amelioration of myopia progression. Pharmacological interventions that effect changes in the sclera show promising efficacy, whereas optical interventions based on a myopic shift in the retinal image are proving to effect up to 55% reduction in the rate of progression of myopia. Early contact lens and spectacle interventions that reduce the rate of progression of myopia are able to significantly reduce the burden of myopia. These non-pharmacological interventions show profound promise in reducing the overall associated morbidity of myopia.     

通辽市蒙汉族中小学生视力及屈光调查分析

目的了解蒙汉族中小学生视力及屈光状态,为中小学生视力保健提供依据。方法对通辽市2002年至2005年7～18岁蒙汉族、城乡中小学生以随机分层、整群抽样方法,进行裸眼视力检查,对视力低常者做常规眼科检查。共调查学生35944名,蒙族学生9084名,汉族学生26860名。正常视力者24471名,占总数68.1%。在视力低常学生中抽取2760名,除11名其它眼病外,对2749名进行散瞳验光,汉族1576人,蒙族1173人。结果视力低常者为11473名(22946眼),占受检总数31.9%,其中小学生视力低常率为18.8%,初中为39.2%,高中为55.9%。蒙族视力低常率为28.4%,汉族为33.1%。随学龄增长增高4.6倍。视力低常者中近视眼有3518眼,占视力低常者64%,轻度近视占视力低常者的38.5%,中度近视22.7%,重度近视2.8%;远视眼占18.8%,正视眼占12.1%,混合散光5.1%;弱视占1.6%,其它占0.4%。视力低常者中近视居首位,7岁时近视眼42.3%,13岁时近视眼66.7%,16岁时近视眼77.9%。随着年龄增长而近视眼患病率增高。视力低常率、近视患病率在中小学生、蒙汉族、城乡、男女之间差异有高度统计学意义(P<0.01)。蒙族学生低于汉族,男生低于女生,农村低于城市。结论通辽市蒙汉族中小学生视力低常率高于国内报告的其它少数民族地区,视力低常率近视患病率随年龄增长而增高,中小学生视力低常的主要原因是近视眼。     

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.     

Posterior segment conditions associated with myopia and high myopia

Myopia, and especially high myopia, is associated with a number of posterior segment changes that are considered to be mostly a consequence of the increased axial elongation. This can result in mechanical strain, attendant vascular changes, stretching and thinning of tissues, and atrophy/deformation of tissues in later or more advanced stages. Such myopia-related changes are observed as changes and/or abnormalities in the vitreous, choroid, retina and peripheral retina, sclera and/or optic disc. Although many of these changes are benign, at times they may be associated with significant vision impairment that either requires active intervention or may suggest future progression of the disease. This review systematically addresses the posterior segment conditions seen in myopic eyes, describes the features associated with the condition and details management pathways.     

近视对青少年心理健康影响的研究方法与进展

流行病学调查显示我国青少年儿童近视发生率已达到53.6%以上。近视已成为青少年儿童视力下降的首要原因。视力降低对正处于发育关键期的青少年儿童心理健康产生负面影响,进而导致学习、生活质量下降甚至影响身体发育。基于对近视人群与正视人群存在心理健康显著差异的观察,国内外学者采用不同的心理学量表评估近视与焦虑及抑郁等不良情绪、偏向于情绪化和内向型人格等心理健康之间的联系。本文综述近视对青少年心理健康的影响及其研究方法和防治策略的研究进展。