McMonnies Charles W
School of Optometry and Vision Science, University of New South Wales, Kensington, Australia.
Cont Lens Anterior Eye. 2009 Apr;32(2):55-63. doi: 10.1016/j.clae.2008.11.001. Epub 2009 Feb 1.
To describe how and why many keratoconus patients do not comply with strong advice to control chronic habits of abnormal rubbing. To outline a behaviour modification approach for controlling chronic habits of abnormal rubbing.
Common reasons for chronic habits of abnormal rubbing have been reviewed as a basis for specifying a behavioural modification approach to habit reversal.
The methods described are organized into the classic behavioural modification structure of: (1) habit awareness, (2) competing responses, (3) development of motivation, and (4) social support. This structure is supported by the application of social influence principles to achieve optimum compliance.
The use of take-home written information in the form of an Abnormal Rubbing Guide is the basis for the development of motivation. Family social support is based upon a widening of the responsibility for avoiding eye rubbing to all family members. Some patients will need minimal application of these principles with patient education being sufficient intervention to achieve habit reversal. For patients with strong provocation to rubbing and/or by having a well established rubbing habit, a greater exposure to the habit reversal program described is indicated. Successful habit reversal may slow the rate of ectasia progression. Prophylactic application of the methods described for patients who are at risk for developing keratoconus, or post-laser assisted in situ keratomileusis keratectasia, may show that some forms of keratectasia are preventable.
描述许多圆锥角膜患者不遵守控制异常揉眼慢性习惯的强烈建议的方式及原因。概述一种用于控制异常揉眼慢性习惯的行为矫正方法。
回顾了异常揉眼慢性习惯的常见原因，以此作为确定习惯逆转行为矫正方法的基础。
所描述的方法被组织成经典的行为矫正结构，包括：（1）习惯意识，（2）替代反应，（3）动机培养，以及（4）社会支持。这种结构通过应用社会影响原则来实现最佳依从性。
以《异常揉眼指南》形式提供的带回家的书面信息是动机培养的基础。家庭社会支持基于将避免揉眼的责任扩大到所有家庭成员。一些患者只需极少应用这些原则，患者教育作为足够的干预措施就能实现习惯逆转。对于有强烈揉眼诱因和/或有牢固揉眼习惯的患者，需要更多地接触所描述的习惯逆转方案。成功的习惯逆转可能会减缓扩张进展的速度。对有发展为圆锥角膜风险的患者或准分子激光原位角膜磨镶术后角膜扩张患者预防性应用所描述的方法，可能表明某些形式的角膜扩张是可预防的。
