Gifford Paul, Gifford Kate Louise
*PhD, FAAO †BAppSc(Optom), FAAO University of New South Wales, Sydney, New South Wales, Australia (PG); and Queensland University of Technology, Brisbane, Queensland, Australia (KLG).
Optom Vis Sci. 2016 Apr;93(4):336-43. doi: 10.1097/OPX.0000000000000762.
The growing incidence of pediatric myopia worldwide has generated strong scientific interest in understanding factors leading to myopia development and progression. Although contact lenses (CLs) are prescribed primarily for refractive correction, there is burgeoning use of particular modalities for slowing progression of myopia following reported success in the literature. Standard soft and rigid CLs have been shown to have minimal or no effect for myopia control. Overall, orthokeratology and soft multifocal CLs have shown the most consistent performance for myopia control with the least side effects. However, their acceptance in both clinical and academic spheres is influenced by data limitations, required off-label usage, and a lack of clear understanding of their mechanisms for myopia control. Myopia development and progression seem to be multifactorial, with a complex interaction between genetics and environment influencing myopigenesis. The optical characteristics of the individual also play a role through variations in relative peripheral refraction, binocular vision function, and inherent higher-order aberrations that have been linked to different refractive states. Contact lenses provide the most viable opportunity to beneficially modify these factors through their close alignment with the eye and consistent wearing time. Contact lenses also have potential to provide a pharmacological delivery device and a possible feedback mechanism for modification of a visual environmental risk. An examination of current patents on myopia control provides a window to the future development of an ideal myopia-controlling CL, which would incorporate the broadest treatment of all currently understood myopigenic factors. This ideal lens must also satisfy safety and comfort aspects, along with overcoming practical issues around U.S. Food and Drug Administration approval, product supply, and availability to target populations. Translating the broad field of myopia research into clinical practice is a multidisciplinary challenge, but an analysis of the current literature provides a framework on how a future solution may take shape.
全球儿童近视发病率的不断上升引发了科学界对了解导致近视发生和发展因素的浓厚兴趣。尽管隐形眼镜（CLs）主要用于屈光矫正，但据文献报道取得成功后，用于减缓近视进展的特定方式的使用正在迅速增加。标准的软性和硬性隐形眼镜已被证明对近视控制作用极小或没有作用。总体而言，角膜塑形术和软性多焦点隐形眼镜在近视控制方面表现出最一致的效果，且副作用最小。然而，它们在临床和学术领域的接受度受到数据限制、需要超说明书使用以及对其近视控制机制缺乏清晰了解的影响。近视的发生和发展似乎是多因素的，遗传和环境之间的复杂相互作用影响着近视的发生。个体的光学特性也通过相对周边屈光、双眼视觉功能以及与不同屈光状态相关的固有高阶像差的变化发挥作用。隐形眼镜通过与眼睛紧密贴合和一致的佩戴时间，为有益地改变这些因素提供了最可行的机会。隐形眼镜还有潜力提供一种药物递送装置以及一种可能的反馈机制，用于改变视觉环境风险。对当前近视控制专利的研究为理想的近视控制隐形眼镜的未来发展提供了一个窗口，这种隐形眼镜将综合目前所有已知的近视发生因素进行最广泛的治疗。这种理想的镜片还必须满足安全性和舒适性方面的要求，同时克服围绕美国食品药品监督管理局批准、产品供应以及目标人群可及性的实际问题。将广泛的近视研究领域转化为临床实践是一项多学科挑战，但对当前文献的分析提供了一个关于未来解决方案可能如何形成的框架。
