佩戴多焦点隐形眼镜的儿童的调节与隐斜视
Accommodation and Phoria in Children Wearing Multifocal Contact Lenses.
作者信息
Gong Celia R, Troilo David, Richdale Kathryn
机构信息
*BA †PhD, FAAO ‡OD, PhD, FAAO State University of New York College of Optometry, New York, New York (all authors).
出版信息
Optom Vis Sci. 2017 Mar;94(3):353-360. doi: 10.1097/OPX.0000000000001044.
PURPOSE
To determine the effect of multifocal contact lenses on accommodation and phoria in children.
METHODS
This was a prospective, non-dispensing, randomized, crossover, single-visit study. Myopic children with normal accommodation and binocularity and no history of myopia control treatment were enrolled and fitted with CooperVision Biofinity single vision (SV) and multifocal (MF, +2.50D center distance add) contact lenses. Accommodative responses (photorefraction) and phorias (modified Thorington) were measured at four distances (>3 m, 100 cm, 40 cm, 25 cm). Secondary measures included high- and low-contrast logMAR acuity, accommodative amplitude, and facility. Differences between contact lens designs were analyzed using repeated measures regression and paired t-tests.
RESULTS
A total of 16 subjects, aged 10 to 15 years, completed the study. There was a small decrease in high (SV: -0.08, MF: +0.01) and low illumination (SV: -0.03, MF: +0.08) (both P < .01) visual acuity, and contrast sensitivity (SV: 2.0, MF: 1.9 log units, P = .015) with multifocals. Subjects were more exophoric at 40 cm (SV: -0.41, MF: -2.06 Δ) and 25 cm (SV: -0.83, MF: -4.30 Δ) (both P < .01). With multifocals, subjects had decreased accommodative responses at distance (SV: -0.04; MF: -0.37D, P = .02), 100 cm (SV: +0.37; MF: -0.35D, P < .01), 40 cm (SV: +1.82; MF: +0.62D, P < .01), and 25 cm (SV: +3.38; MF: +1.75D, P < .01). There were no significant differences in accommodative amplitude (P = .66) or facility (P = .54).
CONCLUSIONS
Children wearing multifocal contact lenses exhibited reduced accommodative responses and more exophoria at increasingly higher accommodative demands than with single vision contact lenses. This suggests that children may be relaxing their accommodation and using the positive addition or increased depth of focus from added spherical aberration of the multifocals. Further studies are needed to evaluate other lens designs, different amounts of positive addition and aberrations, and long-term adaptation to lenses.
目的
确定多焦点隐形眼镜对儿童调节和隐斜的影响。
方法
这是一项前瞻性、非配镜、随机、交叉、单次就诊研究。纳入有正常调节和双眼视功能且无近视控制治疗史的近视儿童，为其佩戴酷柏视康Biofinity单焦点（SV）和多焦点（MF，中心距加光+2.50D）隐形眼镜。在四个距离（>3米、100厘米、40厘米、25厘米）测量调节反应（电脑验光）和隐斜（改良Thorington法）。次要测量指标包括高对比度和低对比度的对数视力、调节幅度和调节灵活度。使用重复测量回归和配对t检验分析隐形眼镜设计之间的差异。
结果
共有16名年龄在10至15岁的受试者完成了研究。多焦点隐形眼镜使高照明度（SV：-0.08，MF：+0.01）和低照明度（SV：-0.03，MF：+0.08）下的视力（均P<.01）以及对比敏感度（SV：2.0，MF：1.9对数单位，P=.015）略有下降。受试者在40厘米（SV：-0.41，MF：-2.06Δ）和25厘米（SV：-0.83，MF：-4.30Δ）处的外隐斜度更大（均P<.01）。佩戴多焦点隐形眼镜时，受试者在远距离（SV：-0.04；MF：-0.37D，P=.02）、100厘米（SV：+0.37；MF：-0.35D，P<.01）、40厘米（SV：+1.82；MF：+0.62D，P<.01）和25厘米（SV：+3.38；MF：+1.75D，P<.01）处的调节反应降低。调节幅度（P=.66）或调节灵活度（P=.54）无显著差异。
结论
与单焦点隐形眼镜相比，佩戴多焦点隐形眼镜的儿童在调节需求增加时，调节反应降低，外隐斜度更大。这表明儿童可能在放松调节，并利用多焦点镜片增加的正度数或增加的球差所带来的焦点深度。需要进一步研究来评估其他镜片设计、不同的正度数和像差量，以及对镜片的长期适应性。
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