生理
Axial length and reduced macular sensitivity before changes in acuity
Summary
Adult high myopes (6D or more) with axial length minimum of 25mm in at least one eye were evaluated for myopic macular degeneration (MMD) by the META-PM category system, and classified into ‘MMD absent’ (categories 0-1), ‘mild MMD’ (category 2) and ‘severe MMD’ (category 3). Macular sensitivity was assessed with microperimetry at 2, 4 and 6 degrees diameter of fixation. As expected, reduced sensitivity was correlated with more severe MMD. After adjusting for several factors, longer axial length was independently associated with worse macular sensitivity. Furthermore, while ‘absent’ and ‘mild’ MMD categories had similar best corrected visual acuity (BCVA), the ‘mild MMD’ category showed reduced macular sensitivity, indicating this microperimetry test could be a more sensitive marker of visual function in eyes with macular disease than BCVA.
临床相关性
新加坡近视的普遍频率为了解高近视的视觉后遗症提供了很多机会。在这项研究中，与没有MMD的眼睛相比，在任何BCVA丧失之前，具有弥漫性脉络化脉络膜萎缩（Meta-PM 2级）的高度近视成年人（META-PM 2级）在任何BCVA丧失之前都降低了。这些患者的平均年龄为54岁，轴向长度为28mm，反映了工作年龄的人可能会在常规临床实践中看到，而不仅仅是在三级视网膜护理中。虽然较长的轴向长度与黄斑敏感性降低有关，但尽管轴向长度只有15-25％的敏感性丧失，表明其他因素可以发挥作用。这强调了密切监测视网膜健康的重要性，对于任何更长的眼睛和高近视的患者以及使用微量工 - 更常用于视网膜专科第三纪念眼护理的点 - 比BCVA更敏感的临床工具用于监测高危处高风险的临床工具并破坏了黄斑。
Limitations and future research
这是Arvo摘要的视频演示，因此不可用于批评的完整同行评审方法。The authors themselves mentioned their small sample size and the repeatability of the microperimetry test as limitations, although noted that testing more points would take more time and could lead to more variability through fatigue. Future research cited by the authors includes investigating correlations between microperimetry results in different categories of MMD with choroidal and retinal thickness using OCT; as well as with retinal vascular parameters using OCT-A.
Binocular Vision
Accommodation training in multifocal contact lens wear
Summary
The accommodation response in multifocal contact lens (MFCL) wear could influence myopia control efficacy, and previous studies have shown that non-presbyopic MFCL wearers may relax their accommodation and use the ‘add’ at near, generating a larger lag of accommodation. This study used custom-developed photorefractor software to measure the lag and found it to be greater in young adult myopes wearing MFCL compared to single vision soft contact lenses (SCL) or trial spectacle lenses. They then undertook auditory biofeedback training for 200 seconds and found lag reduced in all three correction scenarios, but less so for the MFCL wearers. The authors concluded that while biofeedback training improved accommodative accuracy (reduced lag) in young myopes, it was less modifiable in MFCL wear and further training may be required.
临床相关性
MFCL磨损的建筑量减少了儿童和年轻人的适应性反应（增加了适应性滞后），并且减少的适应性反应可能与降低的近视控制效果有关。在这里进行的听觉生物反馈培训改善了适应性的反应，但是在MFCL磨损中，这种改善较低。它尚未市售，但是还有其他临床方法可以增加适应性反应。这项研究表明，评估年轻近视的适应性的价值 - 正常的适应性反应对于视觉舒适性很重要，并且似乎对达到近视控制功效的价值越来越有价值。随着我们更多地了解MFCL与住宿之间的相互作用，将来我们可能会根据他们的住宿选择特定类型的MFCL，并通过特定的校正或培训来改善适应性的回应优化近视控制功效。
Limitations and future research
这是Arvo摘要的视频演示，因此不可用于批评的完整同行评审方法。话虽如此，这种方法在这项小型研究中似乎很强大。主要限制是，在同一参与者上重复单一视力SCL和MFCL测量值时，试验镜镜头佩戴者是一个单独的组 - 没有基线比较，这使得试验眼镜镜头数据对进一步分析的有用程度降低。这项研究是针对年轻的近视成年人进行的 - 在近视儿童中进行了较长的培训和重复，他们纵向遵循，将允许与近视控制进一步相关。
Myopia Progression
Predicting future myopia progression from prior myopia progression
Summary
从现有的年度近视进展的速度dataset is used to determine if rate of subsequent years of myopia progression can be reliably predicted, to reveal a statistically significant though only modest clinical relevance of myopia progression from one year to the next, with no improvement to the model from averaging up to three prior years of myopia progression measurement.
临床相关性
仅依赖于先前的年度近视进展率并不是随后几年的可靠预测指标。因此，应根据多个患者特异性因素（包括上一年的近视进展，较高的初始SE，近视发病年龄和父母近视的近视进展）确定给定个人的近视管理策略。
Limitations and future research
- Meeting abstract so not fully peer-reviewed
- Dataset restricted to Singapore children - results don’t necessarily extrapolate to other nationalities / ethnicities
- Gives promise of more accurate prediction models hopefully in the near future
使用增长图来跟踪近视的进展 - 可以用误导来预测成功吗？
Summary
Translating clinical trial results into clinical practice is made difficult by differences in participants vs patients and applying clinical trial analysis to a practice setting. The authors introduce the concept of using growth (centile) charts to monitor myopia progression and use these charts to assess the previously conducted MiSight 3-year data set to establish a good fit between the published outcomes from the clinical trial and representation on changes to centile chart tracking. This research establishes centile charts as a useful tool to use in clinical practice to determine successful outcome from a myopia control intervention.
临床相关性
Centile charts offer a simple way to monitor myopia development in an individual to determine whether they are likely to be slow or fast Progressors and whether a myopia control intervention is having an effect. However, while this provide promise, they are still at a relatively early stage of development.
Limitations and future research
- Meeting abstract so not fully peer-reviewed
- Growth charts and dataset restricted to European children - results don’t necessarily extrapolate to other nationalities / ethnicities
- Gives promise of easy to use myopia progression charts to:
- track progression of myopia in children
- help explain to parents the predicted change to myopia progression and outcomes from myopia management intervention
