Cooper Jeffrey, Schulman Erica, Jamal Nadine
State University of New York, State College of Optometry, 33 W. 42nd Street, New York, NY 10036, USA.
Optometry. 2012 May 31;83(5):179-99.
This is a review of the current literature describing the effect of atropine, bifocals, and/or contact lenses on slowing the progression of myopia. Cumulative data from a number of studies have demonstrated atropine instilled once a day in myopic eyes resulted in a 90% average reduction of myopia progression, as compared to untreated eyes, i.e., from 0.50 D/year to 0.05 D/year. Pirenzepine, a muscarinic pharmacological agent, has a minimal effect on pupil size and accommodation, and it has been shown to slow myopia by 44%. Bifocals and progressive lenses, which have been used for years to slow the progression of myopia, have recently been shown to produce, on average, only small, clinically insignificant treatment effects. However, their effectiveness is increased in children who are esophoric and have a large lag of accommodation, reducing myopia progression to between 0.25 and 0.40 D/year. Traditional correcting soft and gas permeable contact lenses, as well as novel spectacle lens designs, have not been shown to be effective in reducing myopic progression. Under-correction of the refractive error has been shown not only to be ineffective in slowing myopia, but has also been associated with an increased rate of myopia progression. Orthokeratology, using reverse geometry designed lenses, has been shown to be moderately effective in decreasing the progression of myopia by between 30 to 50% in a number of short-term, well-controlled studies, reducing myopia progression to between -0.25 and -0.35 D/year. Recently, there have been pilot studies using novel peripherally correcting soft contact lenses to slow the progression of myopia. Two of those lens designs have been shown to be moderately effective in slowing the progression of myopia, both of which had a 30% efficacy, reducing myopia progression to 0.35 D/year. In summary, myopia control is entering a new era with the use of contact lenses and pharmaceutical agents to effectively slow its progression with minimal side effects.
这是一篇关于当前文献的综述，描述了阿托品、双焦点眼镜和/或隐形眼镜对减缓近视进展的影响。多项研究的累积数据表明，与未治疗的眼睛相比，每天在近视眼中滴注一次阿托品可使近视进展平均降低90%，即从每年0.50 D降至每年0.05 D。哌仑西平是一种毒蕈碱类药理剂，对瞳孔大小和调节作用极小，已被证明可使近视减缓44%。多年来一直用于减缓近视进展的双焦点眼镜和渐进多焦点镜片，最近显示平均仅产生微小的、临床意义不大的治疗效果。然而，对于有内隐斜且调节滞后较大的儿童，其有效性会增加，可将近视进展降低至每年0.25至0.40 D。传统的矫正软性和透气性隐形眼镜以及新型眼镜镜片设计，尚未显示出对降低近视进展有效。屈光不正欠矫不仅在减缓近视方面无效，还与近视进展加快有关。在一些短期、严格控制的研究中，使用反向几何设计镜片的角膜塑形术已被证明在降低近视进展方面有一定效果，可将近视进展降低30%至50%，使近视进展降至每年-0.25至-0.35 D。最近，有一些初步研究使用新型周边矫正软性隐形眼镜来减缓近视进展。其中两种镜片设计已被证明在减缓近视进展方面有一定效果，二者的有效率均为30%，可将近视进展降至每年0.35 D。总之，随着隐形眼镜和药物制剂的使用，近视控制正进入一个新时代，它们能以最小的副作用有效减缓近视进展。
