Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands.
Bartiméus, Institute for the Visually Impaired, Zeist, The Netherlands.
Acta Ophthalmol. 2019 Jun;97(4):378-393. doi: 10.1111/aos.13944. Epub 2018 Oct 27.
Children with Down syndrome (DS) typically have reduced visual acuity (VA) and accommodation lag, but it is unclear whether prescribed glasses should correct both distance VA (DVA) and near VA (NVA) due to the lack of RCTs. We therefore conducted a multicentre RCT to compare the effects of bifocals designed to correct both DVA and NVA with distance-correcting unifocal glasses in children with DS.
A total of 119 children with DS, aged 2-16, were randomly allocated for bifocal or unifocal glasses (with full correction of refraction error in cycloplegia) in 14 Dutch hospitals and followed during 1 year. VA data were analysed in relation to baseline VA with ancova.
Treatment groups showed no differences at baseline. Shortly after receiving new corrections (~6 weeks), uncrowded NVA (bifocals 0.18 ± 0.33 LogMar; unifocals 0.09 ± 0.19 LogMar) and crowded NVA with bifocals (bifocals 0.13 ± 0.36 LogMar; unifocals 0.08 ± 0.33 LogMar) were significantly better than at baseline, but these short-term improvements in NVA were not significantly different between the two treatments (p > 0.151). The 1-year treatment differences were as follows: significantly larger improvement for bifocals compared to unifocals in both uncrowded NVA (bifocals 0.23 ± 0.29 LogMar, unifocals 0.12 ± 0.30 LogMar, p = 0.045) and crowded NVA (bifocals 0.31 ± 0.28 LogMar; unifocals 0.16 ± 0.30 LogMar, p = 0.017). Improvements in DVA were comparable (bifocals 0.07 ± 0.21 LogMar, unifocals 0.08 ± 0.22 LogMar, p = 0.565). Children with poor baseline VA improved more. Accommodation lag stayed unchanged.
After one year, bifocals with full correction of ametropia led to significantly larger improvement of both uncrowded NVA and crowded NVA in children with DS with accommodation lag compared to unifocals.
唐氏综合征（DS）患儿通常存在视力（VA）和调节滞后降低，但由于缺乏 RCT，尚不清楚矫正远距 VA（DVA）和近距 VA（NVA）时是否应同时矫正。因此，我们开展了一项多中心 RCT，以比较设计用于矫正 DVA 和 NVA 的双焦点镜片与用于矫正屈光不正的单焦点远视镜在 DS 患儿中的效果。
共 119 名 2-16 岁的 DS 患儿在 14 家荷兰医院中被随机分配至双焦点或单焦点组（睫状肌麻痹下完全矫正屈光不正），随访 1 年。采用协方差分析比较基线 VA 与随访时 VA 数据。
治疗组基线时无差异。在新矫正后不久（约 6 周），未拥挤的 NVA（双焦点 0.18±0.33 LogMar；单焦点 0.09±0.19 LogMar）和拥挤的 NVA 用双焦点（双焦点 0.13±0.36 LogMar；单焦点 0.08±0.33 LogMar）均显著优于基线，但两种治疗方法在 NVA 上的这些短期改善差异无统计学意义（p>0.151）。1 年治疗差异如下：双焦点组在未拥挤的 NVA（双焦点 0.23±0.29 LogMar，单焦点 0.12±0.30 LogMar，p=0.045）和拥挤的 NVA（双焦点 0.31±0.28 LogMar；单焦点 0.16±0.30 LogMar，p=0.017）方面的改善明显大于单焦点组。DVA 的改善相似（双焦点 0.07±0.21 LogMar，单焦点 0.08±0.22 LogMar，p=0.565）。基线 VA 较差的患儿改善更多。调节滞后无变化。
1 年后，与单焦点远视镜相比，矫正屈光不正的双焦点远视镜可显著改善 DS 患儿未拥挤的 NVA 和拥挤的 NVA 以及调节滞后。
