While esophoria and myopia have a long-associated link,(1-3) exophoria must also be on our myopia management agenda. The punchline, up front - research has shown that of kids with intermittent exotropia, 50% are myopic by age 10 and 90% are myopic by age 20,(4) and we need to be extra wary if considering fitting a myopic child like this into contact lenses.
Our first consideration in myopia management is correcting the ametropia with spectacles or contact lenses – while contact lens options have generally shown the strongest myopia control efficacy of optical treatments,(5) sometimes spectacles may be the better choice. This generally occurs when contact lens correction will not provide adequate sole management of BV disorders – a key example being the child exhibiting a large exophoria or intermittent exotropia in spectacles.
如所述Specs to Contact Lenses – What happens to BV?，在上图中看到，将毛皮从眼镜更改为隐形眼镜磨损会改变其BV功能。Myope通过他们的眼镜读取，在附近经历了基础棱镜，将图像移至更远的地方。远离镜头的光学中心也可以降低功率，从而有效地减少了适应性需求。当这种雌马变为单一视觉距离（SVD）隐形眼镜时，他们必须增加谦虚的努力，并且由于他们失去了基础奇观校正，并且必须自己汇聚更多。
If a child or young adult is exophoric in their spectacles, this will likely increase in contact lens correction and could lead to decompensation of the phoria or increasing frequency of the intermittent tropia.
阿杰的故事
阿杰（Ajay）在11岁时被转介（OK）。他在一年的折射进展后被转介，为R -0.75ds和L -2.50ds。经检查时，我注意到阿杰（Ajay）表现出左眼几乎是恒定收敛性不足外观（在距离接近时差）。间歇性外果（IXT）已被证明会导致近视的患病率高于一般人群，一项研究表明，在平均持续时间为8年，几乎50％的IXT儿童始于10岁。，到20岁时，超过90％的人已经发展出近视。
It is unknown whether myopia development or progression could trigger IXT, or whether the reverse is true. If myopia comes first, perhaps the decreased demand for accommodation results in lower convergence and for those predisposed, decompensation into significant exophoria or tropia. If the IXT comes first, perhaps it requires increased accommodative effort to drive accurate near point focus, leading to possible pseudo-myopia at distance. Similarly, disrupted fusion from anisomyopia in early childhood can lead to exotropia, with the reverse also being true – that suppression from exotropia can cause sensory strabismus and a type of form deprivation myopia.(7)
在年轻人中从眼镜转移到LASIK校正的转移也与外界和热带转移有关。（8）类似地，对于Ajay而言，从眼镜校正转移了几乎恒定的IXT校正，可能导致恒定的exotemention恢复到恒定的外质量。尽管被称为“合适的合身”，但阿贾伊（Ajay）的BV使他成为不合适的候选人，因此，自那年以来，阿杰（Ajay）一直保持着奇观的纠正，既有棱镜的融合和视觉训练，也都提供了旨在改善他的双向目的性的视觉训练。While a -0.50 shift in both R&L eyes has occurred over this subsequent year, this is much less than the year prior and while the sensory component of Ajay’s strabismus has improved, in time he may be suitable to be fit with OK or another soft myopia controlling contact lens.
玛丽的故事
不幸的是，玛丽在我11岁时见到她的时候，已经进入了高度的Aniso Myopic处方，并且与Ajay -Ajay -Weled IXT有类似的BV图片。玛丽的IXT并不像Ajay那样严重，她很有动力穿着隐形眼镜，因此她最初与Orthok相提并论。她的右眼完全纠正了，并且在她的眼睛中发生了-1.75ds的残留物。考虑到HM-Pro的研究表明，对她的这种选择非常满意，这表明对高近视的部分校正已显示出与完全校正的近视控制效果相似，（9）她仍然需要过度规格的基础 -在提高融合的一致性的棱镜中。
After a year in this correction, Mary’s right eye was refractively stable but her left eye had progressed by -1.50DS. A terrible outcome! What has occurred? Mary’s is a case where an ‘ideal’ correction turned out to be not-so-ideal due to complicating factors. Firstly, having a full OK correction in her right eye was a disincentive to wear the over-specs, so her left eye frequently suffered undercorrection, which has been shown to increase myopia progression.(10) Secondly, wearing the over-specs infrequently meant less consistency of binocular fusion, so the poor left eye suffered a double whammy of undercorrection and intermittent suppression.
玛丽从Orthok中止，并完全校正，距离+2.50添加的距离为中心的圆环多灶性软接触镜头。在第一次审查中，尽管R＆L Plano的重新终极镜检查结果过度重新镜检查，但她的投诉和6/7.5-（20/25）的投诉。我认为她不需要额外的负 - 相反，她被处方了+2.00，并且已经成功穿了一年以上，并实现了折射率。该管理途径与第一个研究人员的建议保持一致，该研究人员发布了一项关于多焦点隐形眼镜近视控制的随机对照试验 - 杰夫·沃林博士。您可以在他的博客中阅读更多小儿双焦点磨损的视力. Mary has been working hard on vision training to improve her binocular stability and base-out (convergent) fusional reserves with loose prism, with the understanding that she needs to continue showing reduction in the IXT to stay in her contact lenses.
因此，总而言之 - 当心近视隐形眼镜配件中的外卖！阅读更多信息双眼视力在近视管理中重要的四个原因，以及关于食管的巨大隐形眼镜食管近视和隐形眼镜. If you want to understand a bit more about how I factor BV into a myopia management strategy, check out our临床决策树and on putting it into practice, ourClinical Management Infographic.
想了解有关双眼视力的更多信息吗？
查看我的在线课程双眼视力基本面，这是从我的两系系统进行BV评估和诊断开始的。逐步了解了对住宿和格式系统的了解，该课程涵盖了临床测试，诊断标准，处方和管理。设定了基础后，它将进入临床交流和BV在近视管理中的重要性。始终以激光敏锐的重点放在临床应用上。
其中包括评估技术的视频示例和椅子方信息图表摘要下载，以参考实践。
您可以免费注册前两个模块，如果您决定继续，全课程的价格为140美元。可通过申请居住在低收入国家 /地区的从业人员的申请可获得30％和50％的课程费用 - 查看课程页面以获取更多信息。
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.
参考
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- Drobe B, de Saint-André R. The pre-myopic syndrome. Ophthal Physiol Opt. 1995;15:375-378.(link)
- Ekdawi NS, Nusz KJ, Diehl NN, Mohney BG. The development of myopia among children with intermittent exotropia. Am J Ophthalmol. 2010;149:503-507.(link)
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- Hunt OA，Wolffsohn JS，Garcia-Resua C.与眼镜镜头相比，具有单视隐形眼镜的眼运动三合会。连续镜头前眼。2006; 29：239-245。(link)
- Kekunnaya R，Chandrasekharan A，Sachdeva V。中东Afr J Ophthalmol。2015; 22：298-306。(link)
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- Charm J，Cho P.高近视偏还原Ortho-K：一项为期2年的随机研究。Optom Vis Sci。2013; 90：530-539。(link)
- Chung K, Mohidin N, O'Leary DJ. Undercorrection of myopia enhances rather than inhibits myopia progression. Vision Research. 2002;42:2555-2559.(link)
