改良式多焦软性角膜接触镜矫正老视的视觉效果

目的: 探讨改良式多焦点软性角膜接触镜(多焦软镜)和单光软性角膜接触镜(单焦软镜)联合验配方式矫正老视的视觉效果。方法: 前瞻性研究。于2018年1—12月在温州医科大学附属眼视光医院招募20例老视观察对象(老视度数+1.00～+2.00 D), 分别按多焦法(双眼配戴多焦软镜)、单眼视法(一眼配戴远用单焦软镜, 一眼配戴近用单焦软镜)和改良法(主视眼配戴单焦软镜, 非主视眼配戴多焦软镜)3种方法验配角膜接触镜。每种方法配戴1周, 间隔1周作为洗脱期, 分析选用单光框架眼镜和3种接触镜矫正方法矫正下的观察对象双眼远、中、近距离100%及10%的双眼对比度视力(后文中视力均为双眼视力), 同时采用VFQ-25汉化版视觉质量量表评估视觉效果。通过单因素方差分析不同方法下视力的差异。结果: 在远距视力对比中, 多焦法视力低于单光框架眼镜(t=3.91, P=0.001)和改良法(t=2.94, P=0.008)。在50 cm处100%和10%对比度时, 多焦法(100%:t=-4.76, P<0.001;10%:t=-4.22, P<0.001)、单眼视法(100%:t=-3.5...     

高近附加设计多焦软性角膜接触镜与角膜塑形镜对近视儿童调节的影响

目的 比较高近附加设计多焦软性角膜接触镜(多焦软镜)和角膜塑形镜(OK镜)对近视儿童调节的影响。方法 纳入30例近视儿童,依次配戴单焦软性角膜接触镜(单焦软镜)、多焦软镜、OK镜。分别在不同矫正状态(OK镜矫正1个月后裸眼检查)测量角膜形态、3 D和6 D调节刺激下的调节反应及调节微波动。结果 在3 D、6 D调节刺激下,配戴多焦软镜产生的调节反应均低于单焦软镜(3 D,F=5.94,P<0.01;6 D,F=4.81, P<0.05),但近似于OK镜(P> 0.05);配戴多焦软镜产生的调节微波动大于OK镜和单焦软镜(3 D,F=7.51, P<0.01;6 D,F=4.81, P<0.05),而配戴OK镜与单焦软镜的调节微波动差异无统计学意义(P>0.05)。结论 高近附加设计多焦软镜的调节反应与OK镜接近,但调节微波动高于OK镜,为近视防控机制研究进一步探索提供思路和依据。     

配戴多焦点硬性角膜接触镜对近视患者双眼视功能的影响

目的：探讨多焦点设计的硬性角膜接触镜对近视患者双眼视功能的影响。

方法：自身前后对照研究。于2020-07/08在川北医学院招募近视学生15人作为试验者,试验者首先配戴框架眼镜行双眼视功能检查,然后分别配戴单焦点与多焦点硬性角膜接触镜(间隔1wk),每种镜片配戴2wk后行双眼视功能检查。采用单因素方差分析比较多焦点硬性角膜接触镜(MFRGP)、单焦点硬性角膜接触镜(SVRGP)和框架眼镜双眼视功能的差异。

结果：三种镜片立体视、远距水平隐斜、远距正融像性聚散、远距负融像性聚散、近距正融像性聚散、聚散灵活度、集合近点、调节幅度、调节灵活度、负相对调节比较均无差异(P>0.05)。与框架眼镜相比,配戴MFRGP近距水平隐斜、近距负融像性聚散、调节滞后、正相对调节增大,AC/A降低(P=0.023、0.048、0.001、0.013、0.046); 与SVRGP相比,MFRGP近距水平隐斜、调节滞后、正相对调节增大,AC/A降低(P=0.014、<0.001、0.001、0.009)。

结论：配戴MFRGP会引起近距水平隐斜、调节滞后、正相对调节增大和AC/A降低,这些变化可能对配戴者近距离用眼产生一定影响,在临床应用中要考虑这些预期的变化,以便正确评估和管理患者。     

改良式多焦软性角膜接触镜矫正老视的视觉效果

目的：探讨改良式多焦点软性角膜接触镜（多焦软镜）和单光软性角膜接触镜（单焦软镜）联合验配方式矫正老视的视觉效果。方法：前瞻性研究。于2018 年1—12 月在温州医科大学附属眼视光医院招募20例老视观察对象（老视度数+1.00～+2.00 D）,分别按多焦法（双眼配戴多焦软镜）、单眼视法（一眼配戴远用单焦软镜,一眼配戴近用单焦软镜）和改良法（主视眼配戴单焦软镜,非主视眼配戴多焦软镜）3种方法验配角膜接触镜。每种方法配戴1周,间隔1周作为洗脱期,分析选用单光框架眼镜和3种接触镜矫正方法矫正下的观察对象双眼远、中、近距离100%及10%的双眼对比度视力（后文中视力均为双眼视力）,同时采用VFQ-25汉化版视觉质量量表评估视觉效果。通过单因素方差分析不同方法下视力的差异。结果：在远距视力对比中,多焦法视力低于单光框架眼镜（t=3.91,P=0.001）和改良法（t=2.94,P=0.008）。在50 cm处100%和10%对比度时,多焦法（100%：t=-4.76,P<0.001;10%：t=-4.22,P<0.001）、单眼视法（100%：t =-3.50,P=0.002;10%：t=-4.76,P<0.001）和改良法视力（100%：t=-4.22,P<0.001;10%：t=-3.90,P=0.001）均高于单光框架眼镜;在30 cm处100%和10%对比度时,多焦法（100%：t=-4.36,P<0.001;10%：t=-5.48,P<0.001）、单眼视法（100%：t =-7.43,P<0.001;10%：t =-4.03,P=0.001）和改良法（100%：t =-5.67,P<0.001;10%：t=-3.93,P=0.001）视力均高于单光框架眼镜。所有观察对象中有1 例认为单光框架眼镜最佳,7 例认为多焦法最佳,2 例认为单眼视法最佳,10 例认为改良法最佳。结论：联合多焦法和单眼视法的改良验配方法能很好地矫正老视,提供不弱于单眼视法和多焦法的视觉效果,更容易被老视患者接受。     

保留生理性调节张力对儿童青少年近视控制的影响

目的 分析配戴保留生理性调节张力的单光框架眼镜与配戴单光框架眼镜、角膜塑形镜对防治近视的临床效果。方法 226例近视患者分别选择保留生理性调节张力的单光框架眼镜(观察组)、单光框架眼镜(SVLs对照组)和角膜塑形镜(OK镜对照组)作为矫正方式,分别于初次就诊、6个月、12个月时进行睫状肌麻痹验光、眼轴、角膜曲率、正/负相对调节(PRA/NRA)、调节反应(BCC)等检查,并比较分析。结果 基线眼轴(F=1.162,P>0.05)、等效球镜(F=0.846,P>0.05)的差异没有统计学意义,1年后观察组眼轴增长小于SVLs对照组,差异有统计学意义(F=5.364,P<0.05)。观察组近视进展量小于SVLs对照组,两组间差异有统计学意义(F=8.941,P<0.05)。结论 保留生理性调节张力的单光框架眼镜对儿童近视的控制有延缓作用。     

渐进多焦眼镜对青少年近视眼隐斜的影响

目的探讨渐进多焦眼镜对青少年近视眼隐斜的影响。方法用Von Graefe法测定50例单光眼镜配戴者及50例渐进多焦近视眼镜配戴者在配戴初,配戴后3、6月隐斜量。结果与单光眼镜相比,青少年近视患者在配戴渐进多焦眼镜前后隐斜量的改变无显著性差异(P>0.05)。结论与单光眼镜相比,渐进多焦近视眼镜的配戴不会增加青少年近视患者的外隐斜量。     

配戴角膜塑形镜后调节幅度的改变及其控制近视进展的临床观察

目的:观察和分析配戴角膜塑形镜后调节幅度、眼轴的改变,探讨配戴角膜塑形镜延缓近视进展的机制。方法:前瞻性研究。收集2018-05/2019-08至我院治疗的7～14岁中低度青少年近视患者215例。行全面眼科检查后,根据检查结果、患者及家长依从性等综合评估,其中113例患者配戴角膜塑形镜,102例患者配戴框架眼镜。配戴期间规律复诊,测量角膜塑形镜组戴镜前,戴镜后1、3、6mo, 1a时的调节幅度及1a后两组眼轴的改变。结果:随访1a后,角膜塑形镜组共100例100眼完成随访,13例13眼失访。框架眼镜组共77例77眼完成随访,25例25眼失访。配戴角膜塑形镜前,患者调节幅度为13.57±2.47D,戴镜后1、3、6mo, 1a后调节幅度均较戴镜前显著提高(均P<0.005),调节幅度在戴镜6mo时达到峰值,戴镜1a(15.44±2.35D)较戴镜6mo(15.74±2.32D)略有下降。配戴角膜塑形镜1a后眼轴增长明显小于框架眼镜组(0.13±0.15 vs 0.50±0.28mm,P<0.001)。结论:中低度青少年近视患者在配戴角膜塑形镜后伴有调节幅度的提高。配戴角膜塑形...     

多焦软性角膜接触镜对周边屈光度及周边角膜屈光力的影响

目的：:观察配戴多焦软性角膜接触镜引起的周边屈光度及周边角膜屈光力的变化,研究二者之间的关系。方法：:自身对照研究。于2020年10月1─15日在温州医科大学收集成年近视受检者18例,在配戴单焦软性角膜接触镜（简称单焦软镜）和多焦软性角膜接触镜（简称多焦软镜）状态下分别采用红外自动验光仪和角膜地形图测量周边屈光度及周边...     

近视青少年配戴角膜塑形镜前后调节参数变化

目的：:观察近视青少年配戴角膜塑形镜前后调节参数及隐斜度的变化,探讨角膜塑形镜延缓近视进展的机制及近视发病病因。方法：:回顾性研究。收集2011年1月至2019年3月在中国医科大学附属第一医院眼科门诊进行角膜塑形镜配戴前后调节参数资料完整的患者51例（102眼）,比较角膜塑形镜配戴前、配戴后1、12个月或以上的正负相对...     

新冠肺炎疫情期间角膜塑形镜眼轴控制效果观察

目的 探讨新冠肺炎疫情期间OK镜对眼轴控制的效果是否会受影响。方法 2022年1月至2023年1月配戴OK镜56眼、多焦点近视离焦框架眼镜38眼、普通单焦点框架眼镜23眼及2021年1月至2022年1月配戴OK镜23眼学生被纳入研究。比较各组眼轴1年内的变化值,采用独立样本t检验及单因素方差分析统计方法。结果 疫情期间配戴OK镜组学生眼轴年增长值最低0.152±0.116mm,其次是多焦点近视离焦框架眼镜组0.189±0.124mm,但两组之间无明显统计学差异(P=0.967),配戴普通单焦点框架眼镜眼轴增长最多0.451±0.156mm,与前两组之间差异均有统计学意义(P<0.01)。配戴OK镜学生眼轴增长与非疫情期间0.171±0.115mm相比眼轴增长值略减少,但差异无统计学意义(P=0.828)。结论 疫情期间OK镜对眼轴增长的控制效果没有受到影响。     

Contact lenses vs spectacles in myopes: is there any difference in accommodative and binocular function?

Background  

Theoretically, the accommodative and vergence demands are different between single-vision contact lenses and spectacle lenses. The aim of the present study was to determine whether these differences exist when these two correction methods are used in clinical practice. For this, different visual parameters that characterize the accommodative (accommodation amplitude, accommodative facility, and accommodative response) and binocular function (near and distance horizontal and vertical dissociated phorias, near and vertical associated phorias, near and distance negative and positive fusional vergence, vergence facility, near point of convergence, negative and positive relative accommodation, stimulus AC:A ratio and stereoacuity) were evaluated in a student population when their myopia was corrected with either spectacles or soft contact lenses (SCL).     

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%）。     

Reliability of rotary prism fusional vergence ranges.

BACKGROUND: The measurement of fusional vergence ranges is an important clinical test in the assessment of binocular vision status. Fusional vergence ranges are typically measured by recording a patient's reports of blur, break, and recovery to base-in (BI) and base-out (BO) prism. Published reliability data on fusional vergence ranges are very limited. METHODS: Eight subjects underwent four testing sessions, at which repeated measurements of fusional vergence ranges were taken. Near ranges were tested at the first session only Distance ranges were tested at all four sessions. Intra-examiner standard deviations were calculated for each fusional vergence test result (BI and BO; blur, break, and recovery) for each session. Intra-examiner standard deviations were averaged. These values were used to determine 95% limits of agreement. RESULTS: The 95% limits of agreement were between 2 delta and 2.5 delta for the distance BI break and recovery and for the near BI recovery; between 3 and 4 delta for near BI break and near BO break; between 4 and 5 delta for distance BO blur and recovery and for near BI blur; and between 5 and 5.5 delta for distance BO break and near BO blur and recovery.     

硬性透气性角膜接触镜、渐进多焦镜和单光眼镜对青少年近视进展的延缓作用比较

目的比较硬性透气性角膜接触镜（RGPCL）、渐进多焦镜、单光眼镜对青少年近视发展的延缓作用。方法青少年近视患者85例（170眼）,年龄9～14岁,屈光度-1．00～4．OHDD。将这些患者分为3组给予不同矫正方式：RGPCL组30例,散光均低于1／2球镜;渐进镜组30例,均为近距内隐斜伴调节滞后≥＋0．25D;单光镜对照组25例。3组患者基本资料的差异均无统计学意义．均要求每日配戴6h以上。戴镜前和戴镜后1年,对各组眼生物参数进行测量和比较。对屈光度、角膜曲率、眼轴长度、前房深度、晶状体厚度等变化值进行单因素方差分析。结果随访1年后．3组近视患者的等效屈光度均有增长的趋势,RGPCL组增长（-0．48±0．42）D,渐进镜组增长（-0．54±0.36）D,单光镜组增长（-0．93±0．53）D,3组之间差异有统计学意义（F=29．36,,P=0．01）,其中单光镜组屈光度增加最多。3组患者的眼轴均有增长,角膜曲率均有变平的趋势,前房深度均有增加,品状体厚度也有变薄的趋势,但各组间变化差异均无统计学意义。结论与单光框架眼镜比较,RGPCL有延缓近视进展的作用,渐进多焦镜能延缓近距内隐斜患者的近视增长,但两者均不能阻止近视进展。     

Magnification and accommodation with phakic intraocular lenses

BACKGROUND AND PURPOSE: The calculation of phakic lenses (PL) was described by van der Heijde et al. [Klin. Monatsbl. Augenheilkd (1988) Vol. 193, pp. 99-102], but a formalism for estimating relative magnification compared with spectacle correction and accommodation effects are not yet published. The purpose of this study was to describe a mathematical strategy for calculating PL and relative magnification as a function of object vergence (phakic accommodation). METHODS: Parameters used for the calculations are the spectacle refraction before and after (target refraction) surgery, the vertex distance, corneal refraction, and the predicted position of the phakic intraocular lens. The lens power is determined as the difference in vergences between the spectacle-corrected eye and the uncorrected eye at the reference plane of the predicted lens position. If we simplify the crystalline lens to a single refracting surface located at the principal plane of the crystalline lens, the vergence of the eye with spectacle correction and with PL is determined as a function of object distance [object vergence 0 D (infinity) to 10 D (object at a distance of 10 cm)] to evaluate accommodation effects of the crystalline lens. RESULTS: The method was applied to two clinical examples. In example 1 we calculated the power of a PL for correction of a 10-D myopia and determined the relative magnification and the vergence at the principal plane of the crystalline lens as a function of object vergence. Magnification gain increases with objects at near from 17% to 26%, whereas the vergence at the principal plane of the crystalline lens changes by 3.04 D less than in the spectacle-corrected eye. In example 2, a 20-D myopia was corrected with a PL. The gain in magnification changed from 33% to 58% with nearer objects. The change in vergence at the principal plane of the crystalline lens with objects at near was much higher with the PL compared with the spectacle correction, which implies that the refractive change necessary for focusing objects at near distance is much higher in the PL correction. CONCLUSIONS: Even if the predictability of postoperative refraction with PL is comparable or better than in other methods of correcting high or excessive ametropia, the effects of lateral magnification change and accommodation have to be considered to avoid image-size disparities (aniseikonia) and to maintain binocular vision, especially with monocular PL implantation and anisometropia.     

Higher order aberrations,refractive error development and myopia control: a review

Evidence from animal and human studies suggests that ocular growth is influenced by visual experience. Reduced retinal image quality and imposed optical defocus result in predictable changes in axial eye growth. Higher order aberrations are optical imperfections of the eye that alter retinal image quality despite optimal correction of spherical defocus and astigmatism. Since higher order aberrations reduce retinal image quality and produce variations in optical vergence across the entrance pupil of the eye, they may provide optical signals that contribute to the regulation and modulation of eye growth and refractive error development. The magnitude and type of higher order aberrations vary with age, refractive error, and during near work and accommodation. Furthermore, distinctive changes in higher order aberrations occur with various myopia control treatments, including atropine, near addition spectacle lenses, orthokeratology and soft multifocal and dual-focus contact lenses. Several plausible mechanisms have been proposed by which higher order aberrations may influence axial eye growth, the development of refractive error, and the treatment effect of myopia control interventions. Future studies of higher order aberrations, particularly during childhood, accommodation, and treatment with myopia control interventions are required to further our understanding of their potential role in refractive error development and eye growth.     

Myopia and contrast sensitivity function

PURPOSE: to measure the contrast sensitivity function of varying degrees of myopia with two types of optical correction (spectacle lens and contact lens). METHODS: One hundred and five myopic eyes and twenty-eight emmetropic eyes were collected. The myopic group included 105 eyes corrected with spectacle lenses and 71 eyes of them corrected with contact lenses, too; all had corrected vision acuity of 20/20 or better. The myopic eyes were divided into four groups: group 1 (-1D to -3D), low myopia; group 2 (-3.25D to -6D), medium myopia; group 3 (-6.25D to -12D), high myopia; and group 4 (> -12D), severe myopia. Spatial contrast sensitivity was measured using the OPTEC 2000 Contrast Sensitivity System. RESULTS: In groups 1 and 2, no statistically significant difference was found between myopes and emmetropes. In group 3, statistically significant loss of contrast sensitivity at higher spatial frequencies was found for myopic subjects corrected with spectacle lens, but not for myopes corrected with contact lens. In group 4, myopic subjects corrected with spectacle lenses showed significantly reduced contrast sensitivity function at all spatial frequencies; subjects corrected with contact lenses showed statistical sensitivity losses at 6, 12, 18 cycle/degree spatial frequencies. CONCLUSIONS: 1. We may suppose that low and medium myopes (groups 1 and 2), who showed normal contrast sensitivity functions, had no retinal dysfunction. 2. For high myopes, contact lens correction could reduce optical defocus and improve contrast sensitivity function in high spatial frequencies. 3. As retinal function disturbances occurred in severe myopes, the diminished contrast sensitivity was not fully compensated by contact lens correction. 4. Loss of contrast sensitivity might be interpreted as evidence for early retinal function disruption before retinal pathological events occur in severe myopes.