这是第3部分的3年协会Research in Vision and Ophthalmology 2019 (ARVO) conference summary, discussing the latest and greatest in contact lens research for myopia control. Click on the headings for links to abstracts, and you'll find links to Part 1 and Part 2 of the ARVO latest at the end of this blog.
Katrina Schmid (in action, below) presented our research where we compared these measurements in a single Visio distance CL to the Coopervision Misight concentric add design and continuous aspheric Coopervision Biofinity centre distance +2.50 Add and Visioneering NaturalVue designs.
我们发现，与单一视觉相比，误导镜头并没有显着改变Gergence，适应或视觉质量。这两种连续的非球面设计类似地都在佛罗里亚附近的散失偏移（约2个棱镜双膜），并在33厘米处降低了约0.50d的适应性反应（增加ACCOM滞后）。这些设计还影响了距离和接近敏锐度的影响，而不是误导或SV。该图显示了效果的摘要。
The clinical relevance? If you don’t want a BV change in selecting a MFCL, the concentric Misight design appears to be your choice. But if you do want an exophoric shift for an eso myope, then the continuous aspheric designs could be better.
我的海报演示明天将进一步研究这些镜头的住宿效果，并在中心距离+1.50添加镜头以进行额外比较。
在我们的顶级货架学生团体克里斯蒂娜·诺瓦（Kristina Nova），本·克里斯蒂（Ben Christie），马林·尤斯夫（Marlin Youssef），帕特里克·陈（Patrick Chan），莎拉·克鲁瑟（Sarah Crouther），奥利维亚·纳瓦森（Olivia Nahuysen）和劳拉·塞维尔（Laura Sevil）上再次做得很好。
Could we apply what we know about myopia progression to manage childhood hyperopia?
伊恩·比斯利（Ian Beasley）（如下图中）一直在进行迷人的博士学位研究，该研究将近视控制转化为近视 - 使用近乎中心的多焦点软接触镜头（MFSCL）改变了年轻女型的眼睛生长模式。到目前为止，他发现：
- The natural pattern of axial growth in hyperopia is so minimal as to be statistically insignificant after 18 months of monitoring
- This growth rate can be increased after 12 and 18 months of near-centred MFSCL wear in both eyes
- 仅在更触及眼睛的眼睛中穿着接近中心的MFSCL的Aniso Hyperopes的反应较低。
这些结果表明，施加相对的外周绩效确实可以改变儿童远视的轴向和折射。尽管儿童近视和远视的自然生长模式显然是不同的，但这也许是反对对我们年轻的近视使用中心的MFSCL的证据，尽管包括外围折射，球形异常和适应性在内的有趣的光学讨论可能会在该主题上进行。就目前而言，我相信临床信息是坚持年轻近视的中心距离，并留意Ian创新工作的进一步启示。
戴维·阿奇森（David Atchison），卡特里娜·施密德（Katrina Schmid）和我（在最高图像中）与一群才华横溢的QUT学生一起进行了这项研究＆Sevanna Zhang）。我们研究了4种因其近视控制功效而正在研究的镜头类型。Coopervision的误会，Coopervision的中心D +1.50和+2.50增加了Vieweering Tech的自然景度。我们用1m，50厘米，33厘米和25厘米的自动磨蚀器测量了自动磨蚀器的响应，以从需求的1-4 d中获得适应性刺激反应函数。我们将其与SV SCL进行了比较，并测量了20名年轻的成年近视，其散光幅度很小，没有明显的BV疾病。
The continuous aspheric designs (CD +1.50, CD +2.50 and N’Vue) all reduced the accommodation response; the young eyes ‘used’ the add. Despite different add powers on the label, they were not significantly different from each other in this effect. By contrast, the MiSight did not alter the accommodation response, being no different to SV, the eyes accommodated normally.
What does this mean? Well this wasn’t a myopia control study, it was a short term repeated measures exploration, but it agrees with other authors who have found similar results in some of these designs and agreed with modelling that indicated that young eyes might ‘use the add’ at near and under-accommodate at near in lenses with smaller central optic zones. (Miguel Faria Ribeiro et al 2018).Miguel的建模还证明，如果年轻的眼睛的体积不足，那么镜头的距离部分可能会在中央和外围产生远视散焦，这可能是实现近视控制功效的坏事。
Two weeks after I printed this poster, apaperwas published by Xu Cheng (Cathy), Jing Xu and Noel Brennan indicating just that - in J&J’s experimental MFCL design (not commercially available), a reduced accommodation response was correlated with a reduced myopia control efficacy. This is a landmark paper in my opinion, opening up the accommodation and BV response in CLs for further investigation.
So back to the implications of our QUT research - if MiSight doesn’t alter the accommodation response, does it have the edge over other MFCLs for efficacy? Maybe. But then maybe you want to reduce the accommodation response in some kids, if they’re over-active at it. And which is the bigger signal - on- or off-axis refractive state?
我猜想将来我们可能会有一个措施或衡量住宿和BV的组合（甚至可能也是外围折射和畸变），这有助于指出正确的MFCL。我觉得现在，回家的信息是，我们需要从视觉舒适和接受的角度测量这些镜片中的BV，这可能会对近视控制产生影响。
Paul Gifford (below), Vinod Maseedupally, Pauline Kang and talented UNSW students Michael Tran and Courtney Priestley performed a study where a test lens with a 0.5mm smaller BOZD, altered BOZR asphericity and first peripheral curve, reduced the topographical treatment zone diameter (TZD) and was compared with a control lens and worn for 1 week in a repeated measures study design.
Did the test lens alter corneal topography compared to the control? Yes. It reduced TZD by about 1mm and increased corneal refractive power relative to the central apex at the 2, 2.5 and 3mm nasal locations but not temporal locations.
Did the test lens alter peripheral refraction (PR) compared to the control? The answer is no. The greater increase in mid-peripheral corneal refractive power along the horizontal nasal meridian failed to translate into a significant difference in change to PR profile between test and control designs.
The take home message? At this stage, if we presume the PR is driving myopia progression and is a mechanism of control, then altering OK lens design ‘for myopia control’ may not have the intended influence on PR. But maybe something else is going on given numerous anecdotal reports of better results with smaller OZD OK - Paul and team might be able to tell us more about this in the near future, as he’s now doing some further optics analysis including pupil size interactions to compare between the lens designs.
关于凯特
凯特·吉福德博士is a clinical optometrist, researcher, peer educator and professional leader from Brisbane, Australia, and a co-founder of Myopia Profile.
