我们应该如何管理高近视？

发布：

是否有用于管理和治疗高近视的特殊考虑？

It is estimated that there are almost 1.5 billion people with myopia, 163 million with high myopia and a significant proportion of the population suffering non-refractive visual consequences of the worldwide boom in myopia.1据估计，全球1000万人目前因近视黄斑变性而受到视力障碍，而330万人遭受了失明。2If these numbers don’t feel staggering enough, with projections based on the rising levels of myopia, this number could rise to 55 million people vision impaired and 18.5 million blind by 2050, or 0.57% and 0.19% of the world’s population respectively.2

Young children (under age 10) with high levels of myopia often have an associated general or ocular health condition of concern, and typically require co-management between optometry and ophthalmology.Read more about this inHigh Myopia in Childhood - Special Considerations and Safe Management。Complications of myopia are rapidly becoming a leading cause of vision impairment in children1，近视刺激已经是日本成年人单眼失明的主要原因。3As Ian Flitcroft first revealed - there is no safe level of myopia, but the risks really escalate in high myopia.4以下描述了我们在管理高度近视患者时应考虑的步骤。

高近视is defined by the International Myopia Institute as 6D or more of myopia.5

1. Provide ocular health management

The risk of complications of macular maculopathy escalate exponentially with myopic dioptres: double the risk in the 1-3D group compared to the emmetrope, 10x greater risk in those with myopia of 3-5D and 40x greater risk as myopia increases beyond 5D.4

Childhood retinal detachments make up 3-13% of all retinal detachments, so these consequences of myopia are not simply an 'adult only' problem.6Younger children can have limited capacity as observers of their own symptoms, and the consequences of this are significant: 97% of paediatric retinal detachments are macula off.7

Once axial length becomes longer than 26mm, the risk of a host of myopia-associated complications increases steeply.8We have discussed how measuring axial length is useful in monitoring myopia progression in有关近视管理中轴向长度测量的六个问题，however it is also useful in assessing the risk of maculopathy and other complications of myopia for the individual patient.

任何一个近视的人与一个轴向长度超过26毫米外壳d be considered a 'high myope' from the retinal perspective. The IMI Clinical Management Guidelines suggest that these patients be reviewed annually with retinal health examination through dilated pupils.9

If you don't have access to axial length measurement, even once as a single measure to gain an idea of your patient's disease risk, it's helpful to know that 26mm is approximately equivalent to 5D of myopia.8

It's also important to note, though, that variation in axial length can mean that a lower myope can have a longer axial length. Beware these patients in cases where the patient has a flatter cornea - since the cornea doesn't typically tend to change much in school-aged children,10a flatter cornea with moderate myopia can be a particular clue to longer axial length. Read more about this in the clinical caseA mismatch between myopia and axial length。

如果您是验光师，而无需使用MyDriatic诊断药物，具体取决于您的国家的实践范围和适当的临床途径，则可能需要与眼科协调，以通过高肌肉和其他近视的学生进行年度视网膜健康检查，以进行年度视网膜健康检查指示。

关于眼健康的建议

应告知近视较高的患者及其家人的定期视网膜健康检查的重要性以及视网膜脱离的症状。钝性创伤负责90％的儿童巨型视网膜眼泪11so advise parents and patients on this risk and how to avoid it.Protective eye wear (especially if otherwise wearing contact lenses) can be very important for ball sports.

If the retina is at particular risk, for example through predisposing retinal degenerations or prior surgery, the patient may need to be advised to avoid or limit any sports and activities that involve excessive shaking or forces on the head: such as contact sports, extreme roller-coaster rides, trampoline jumping and bungee jumping.

2. Consider the best optical correction

For high myopia, it's important to control the vertex distance in both refraction and optical dispensing.High myopes approaching 10D and beyond can suffer reduced visual acuity12和对比灵敏度13compared to lower myopes, and impaired quality of life similar to that of patients with keratoconus.12确保在折射中测量顶点距离，检查试验框中的敏锐度，并尝试在框架的顶点距离中匹配以达到最佳敏锐度。

Spectacle frame choices for stability and sturdiness; and high index lenses for improved visual quality and comfort, are vital to give high myopes the clearest possible vision. More tips on refraction and dispensing can be found in this Points de Vue article entitledHigh Myopia: the specificities of refraction and optical equipment.

Contact lenses can improve distance acuity and field of view in high myopia,因此，是关键的校正选项。但是，与强力强大的近视眼镜相比，接近的隐形眼镜需要增加适应性和狂热的努力。This may not be an issue for children, teens and young adults with normal binocular vision function, but can lead to earlier presbyopic correction required by contact lens-wearing high myopes compared to those wearing spectacles.14

Contact lenses can also have significant functional and psychological benefits for children and teens- read more on these topics in孩子和隐形眼镜 - 福利，安全和“是”。

3. Consider myopia control

由于每个屈光都会增加近视病理和视觉障碍的风险，因此15it makes sense to discuss myopia control with all myopes at risk of progression.

但是，大多数近视控制研究都排除了超过5D近视的儿童，这确实意味着我们必须推断这些患者的证据基础。There is a small amount of evidence for high myopia control intervention with orthokeratology and low-concentration atropine.

唯一的光学干预措施具有高肌关注的证据是部分校正正差异学，其表现出与其他近视级别相等的近视控制作用。在研究中，将6至8D之间的近视部分部分校正至4D左右，在白天用玻璃校正了残留的折射率。16The Low-concentration Atropine for Myopia Progression (LAMP) study enrolled children up to around 8D of myopia, with around 10-15% being high myopes. It showed a concentration-dependent myopia control impact of 0.05% and 0.025% atropine, with minimal effect of 0.01%.17它没有报告与基线折射有关的特定结果。

Other myopia control methods, where available for high myopia correction, can still be discussed with parents and patients, with the caveat that results can't necessarily be predicted for that individual's situation.

Do high myopes progress more quickly?

实际上，没有很多数据。更快的近视进展之间的主要关系是孩子的当前年龄 - 无论当时的近视水平如何，年幼的孩子进展更快。18

A recent large-scale European study showed faster progression in children aged 7-9 years with more than 4D of myopia. The authors also noted that regardless of baseline myopia, the 7-9 year olds progressed most quickly. Children younger or older than this, or with lower baseline myopia, didn't progress as quickly.19

这次在印度这次的另一项大型研究类似地显示了6-10岁儿童的进展最快。高肌关调（6至9D）表现出比低和中度肌关（分别为0.50至3D和3至6D）的进展快。严重的近视（超过9D）表现出一年以来最快的进展，即使在十几岁和成年初期。

  • In myopes under 15 years, the mean annual progression in low and moderate myopes was just under 0.50D. High myopes were around 0.62D and severe myopes 0.75D.
  • In myopes over 15 years of age, low, moderate and high myopes all progressed similarly, by less than 0.25D. The severe myopes over 15 years, though, progressed by around 0.50D in one year.20

总数是10岁以下儿童将progress most quickly, and high myopes probably will progress a little faster. Severe myopes (9D or more) progress more quickly than the rest, even in late childhood and adulthood.

临床Plan

  1. Manage ocular health in high myopes, by ensuring retinal examination through dilated pupils occur yearly. For optometrists, this may require co-management with ophthalmology, especially in younger children.
  2. The best optical correction for high myopes is likely to be contact lenses, which can provide improved acuity, field of view and quality of life. Spectacles are a necessity for all contact lens wearers, though (even if as a backup) so remember to manage vertex distance, dispense a sturdy frame and high index lenses for best vision and comfort outcomes.
  3. 每个肢体都很重要 - 讨论对患有近视进行性近视的儿童，青少年和年轻人的近视控制的选择，但要考虑临床研究结果如何直接适用于该特定患者。

进一步阅读高近视

Cassandra Haines BIO image 2019_white background

About Cassandra

Cassandra Hainesis a clinical optometrist, researcher and writer with a background in policy and advocacy from Adelaide, Australia. She has a keen interest in children's vision and myopia control.

凯特个人资料缩略图

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.

References

  1. 霍尔顿英航FrickeTR, Wilson DA, Jong M, Naidoo KS, Sankaridurg P, Wong TY, Naduvilath TJ, Resnikoff S. Global Prevalence of Myopia and High Myopia and Temporal Trends from 2000 through 2050. Ophthalmology. 2016 May;123(5):1036-42.（（关联）
  2. Fricke TR，Jong M，Naidoo KS，Sankaridurg P，Naduvilath TJ，Ho SM，Wong TY，ResnikoffS。与2000年至2050年相关的近视黄斑变性和时间趋势有关的全球视觉障碍率。Br J Ophthalmol。2018年7月; 102（7）：855-862。（（关联）
  3. Iwase A, Araie M, Tomidokoro A, Yamamoto T, Shimizu H, Kitazawa Y; Tajimi Study Group. Prevalence and causes of low vision and blindness in a Japanese adult population: the Tajimi Study. Ophthalmology. 2006 Aug;113(8):1354-62.（（关联）
  4. Flitcroft di。视网膜，光学和环境因素在近视病因学中的复杂相互作用。PROG视网膜眼睛。2012年11月； 31（6）：622-60。（（关联）
  5. Flitcroft DI, He M, Jonas JB, Jong M, Naidoo K, Ohno-Matsui K, Rahi J, Resnikoff S, Vitale S, Yannuzzi L. IMI - Defining and Classifying Myopia: A Proposed Set of Standards for Clinical and Epidemiologic Studies. Invest Ophthalmol Vis Sci. 2019 Feb 28;60(3):M20-M30. (关联)
  6. Coussa RG, Sears J, Traboulsi EI. Stickler syndrome: exploring prophylaxis for retinal detachment. Curr Opin Ophthalmol. 2019 Sep;30(5):306-313.（（关联）
  7. Nagpal M, Nagpal K, Rishi P, Nagpal PN. Juvenile rhegmatogenous retinal detachment. Indian J Ophthalmol. 2004 Dec;52(4):297-302.（（关联）
  8. Tideman JW, Snabel MC, Tedja MS, van Rijn GA, Wong KT, Kuijpers RW, Vingerling JR, Hofman A, Buitendijk GH, Keunen JE, Boon CJ, Geerards AJ, Luyten GP, Verhoeven VJ, Klaver CC. Association of Axial Length With Risk of Uncorrectable Visual Impairment for Europeans With Myopia. JAMA Ophthalmol. 2016 Dec 1;134(12):1355-1363.（（关联）
  9. Gifford KL，Richdale K，Kang P，Aller TA，Lam CS，Liu YM，Michaud L，Mulder J，Orr JB，Rose KA，Saunders KJ，Seidel D，Seidel D，Tideman JWL，Sankaridurg P. Imi-临床管理指南报告。投资Ophthalmol Vis Sci。2019年2月28日； 60（3）：M184-M203。（（关联)
  10. Mutti DO，Mitchell GL，Sinnott LT，Jones-Jordan LA，Moeschberger ML，Cotter SA，Kleinstein RN，Manny RE，Twelker JD，Zadnik K，Cleere研究小组。近视开始前后的角膜和结晶镜头尺寸。Optom Vis Sci。2012; 89（3）：251-262。（（关联）
  11. Rahimi M, Bagheri M, Nowroozzadeh MH. Characteristics and outcomes of pediatric retinal detachment surgery at a tertiary referral center. J Ophthalmic Vis Res. 2014 Apr;9(2):210-4. (关联)
  12. Rose K, Harper R, Tromans C, Waterman C, Goldberg D, Haggerty C, Tullo A. Quality of life in myopia. Br J Ophthalmol. 2000 Sep;84(9):1031-4. (关联)
  13. Jaworski A, Gentle A, Zele AJ, Vingrys AJ, McBrien NA. Altered visual sensitivity in axial high myopia: a local postreceptoral phenomenon? Invest Ophthalmol Vis Sci. 2006 Aug;47(8):3695-702. (关联)
  14. Vincent SJ。在低视力康复中使用隐形眼镜：光学和治疗应用。Clin Exp Optom。2017年9月; 100（5）：513-521。（（关联)
  15. Bullimore MA, Brennan NA. Myopia Control: Why Each Diopter Matters.Optom Vis Sci。2019;96(6):463-465.（（关联）
  16. Charm J, Cho P. High myopia-partial reduction ortho-k: a 2-year randomized study. Optom Vis Sci. 2013 Jun;90(6):530-9.（（关联）
  17. Yam JC, Jiang Y, Tang SM et al. Low-Concentration Atropine for Myopia Progression (LAMP) Study. Ophthalmol. 2019;126:113-24. (关联）
  18. Chua SY, Sabanayagam C, Cheung YB, Chia A, Valenzuela RK, Tan D, Wong TY, Cheng CY, Saw SM. Age of onset of myopia predicts risk of high myopia in later childhood in myopic Singapore children. Ophthalmic Physiol Opt. 2016 Jul;36(4):388-94. (关联)
  19. Tricard D, Marillet S, Ingrand P, Bullimore MA, Bourne RRA, Leveziel N. Progression of myopia in children and teenagers: a nationwide longitudinal study. Br J Ophthalmol. 2021 Mar 12:bjophthalmol-2020-318256. (关联)
  20. Verkicharla PK, Kammari P, Das AV. Myopia progression varies with age and severity of myopia. PLoS One. 2020 Nov 20;15(11):e0241759. (关联)
Baidu