双眼视力在近视管理中重要的四个原因

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First published: June 29, 2018
更新：2021年8月16日

双目视觉是一个被忽视的(甚至发作igned?) domain of eye care - even though I’ve had numerous colleagues say their professional excitement and learning opportunities have been reinvigorated through seeing the clinical imperative and application in practice. Not only does binocular vision assessment add so much more to your clinical picture, and make optometric life more interesting, it could be the secret sauce that helps us bridge the gap towards higher myopia control efficacy, or at the very least answer questions in cases where we get lower efficacy than expected.

1.BV可以帮助我们to identify children at risk of myopia

前横向的滞后滞后比没有近视的同龄人更高，近视发作后的相关性变得更强，这表明这可能是近视的特征和原因。[3]AC/A比率较高的儿童在20次以上的一年内会增加近视发育的风险。[4]

If we see esophoria and accommodative lag in combination with a lower than age-normal level of hyperopia (+0.75 or less at age 6-7 is the strongest risk factor for future myopia),[1] then controlling binocular vision is our main management tool for these children, along with recommending more time spent outdoors.[2]

间歇性外果（IXT）也与近视的较高患病率有关 - 到10岁，有50％的IXT儿童是近视的近视，到20岁。[5]

在此中阅读更多有关此的信息How to identify and manage pre-myopes。

2. BV可以帮助识别将回应渐进式奇观镜头治疗的孩子

In myopia control studies of progressive addition spectacle lenses (PAL), children with esophoria in single vision spectacle control groups were found to progress more quickly,[6] and children with a larger baseline accommodative lag in the PAL groups showed statistically greater treatment effect.[7]

If we have a child with normal binocular vision, PALs may not show much of a myopia control effect. But in the presence of esophoria and/or accommodative lag, PALs can show treatment effects approaching that of some contact lens options. Overall, though, bifocals seem to be more effective than PALs across various BV presentations.[8] Learn more about how PAL and bifocal spectacle lens prescribing in myopia relates to binocular vision inWhen to prescribe spectacles for myopia control.

3. BV is altered in contact lens wear, and could be related to efficacy

Three key research papers are relevant here. Firstly, fitting bifocal soft contact lenses to myopic children with esophoria at near, where the add was chosen to neutralize the associated phoria, resulted in a 70% reduction in axial elongation over twelve months compared to single vision soft contact lens wearing controls.[9]

其次，在两年的研究中，与普通可容纳器相比，基线副本幅度较低的儿童与正常人类学隐形眼镜的磨损相比，对正性角膜镜隐形眼镜磨损的近视控制反应增长了56％。研究参与者的平均宽图幅度分为“低于平均水平”和“平均水平高”。“低于平均水平”住宿的孩子表明，其OK磨损的放大器的改善（相比之下，与上述平均住宿者约为1D）和更好的近视控制效果。[10]

Finally, a study investigating a soft contact lens designed with positive spherical aberration for myopia control (think of it as a type of 'distance centred' multifocal) showed that children wearing this lens relaxed their accommodation compared to a single vision control lens.[11] This reduction in accommodative response was correlated with a reduced myopia control effect in the test lens, but no such association was found in the control (single vision) lens. This study was the first to link accommodation with myopia control efficacy in soft contact lenses, with the relationship in OrthoK indicated previously.

如果您想深入研究科学，请查看此研究摘要，标题为Spherical aberration, accommodation and multifocal soft contact lenses。如果您对此感兴趣，请查看哪个多灶性软镜头？功效和视觉功能。

4. BV can influence our prescribing choices for comfort and acceptance

To comprehensively customize treatment for your patient, managing their binocular vision can influence visual comfort as well as myopia control efficacy. We know that:

  • 食管和适应性滞后可能会改善正差异。[12,13]
  • 多灶性隐形眼镜may also cause a small exophoric shift but may slightly increase accommodative lag depending on their design.[14-16]
  • 双重焦点隐形眼镜设计（误差）似乎没有改变住宿或凤凰。[15-17]
  • The new generation of myopia controlling spectacle lenses (eg. DIMS Hoya MiyoSmart) and H.A.L.T technology (Essilor Stellest) also don't alter binocular vision function.[18,19]
  • Exophoria and accommodative lag can worsen when changing the myope (especially the higher myope) from spectacles to contact lenses.[20]

为什么这很重要?首先binocula症状r vision problems can be confused with dry eye symptoms - this has been shown in young adult myopic CL wearers.[21] This could be extrapolated to children; although the link between binocular vision disorders and reduced reading speed and comprehension could be more concerning.[22,23] Secondly, if a child does not accommodate normally through a multifocal contact lens, it could influence the ideal optics required for myopia control efficacy.[24]

Learn more about how to factor binocular vision into your prescribing decisions - for both visual comfort and myopia control efficacy - in选择一个选项：临床决策树。

BV底线

Myopia has long been associated with inaccurate and insufficient accommodative behaviour at near and increased accommodative convergence in comparison to emmetropes.[4,25-26] Detecting these conditions in both the at-risk emmetrope and myopic child can reveal the picture of myopia progression risk, and their management could provide added benefit to myopia control treatment.

Binocular vision status is additionally relevant to visual comfort, to ensure children have functional skills for reading and schoolwork and acceptance of their correction, and to avoid dry eye-type symptoms in young adults.

如果双眼视力功能正常，则选择肌无肌症控制选项并不复杂 - 选择适合儿童和家庭的最佳治疗方法。但是，如果双眼视力异常，那么对此进行管理以及管理近视可能需要不同的策略。

观看有关双眼视觉技术的这些近视资料YouTube视频：

Read more about accommodation, binocular vision and myopia:

Want to learn more about binocular vision?

Check out my online courseBinocular Vision Fundamentals, which starts with my two-system approach to BV assessment and diagnosis. Stepping through understanding of the accommodation and vergence systems, the course then covers clinical tests, diagnostic criteria, prescribing and management. Once this foundation is set, it moves onto clinical communication and the importance of BV in myopia management. Always with a laser sharp focus on the clinical applications.

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。

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关于Kate

Dr Kate Gifford是澳大利亚布里斯班的临床验光师，研究人员，同伴教育者和专业领导者，也是Myopia个人资料的联合创始人。

References

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