The Centre for Myopia Research, School of Optometry, The Hong Kong Polytechnic University, Kowloon, Hong Kong.
Centre for Eye and Vision Research (CEVR), 17W Hong Kong Science Park, Hong Kong.
Invest Ophthalmol Vis Sci. 2021 Nov 1;62(14):21. doi: 10.1167/iovs.62.14.21.
Peripheral refraction and accommodation are intrinsic factors that were once hypothesized to trigger myopia but are now controversial. Previously, home nearwork environment (i.e., extrinsic factor) was reported to be associated with myopia progression. In this study, we aimed to evaluate the potential interaction between extrinsic and intrinsic factors with juvenile refractive development.
Nearwork environmental parameters were measured for 50 children (aged 9.3 ± 1.2 years), including net amount and dispersion of defocus. Refraction was measured at near distances and in central field (±30° horizontal) at 3m. The relative peripheral refraction (RPRE) was obtained and presented in a vectoral approach. The linear regression coefficient was extracted (mAcc) from the accommodative stimulus-response curve. RPRE was quadratically regressed against field eccentricity, and the first coefficients (aM, aJ0, aP90, and aP180) were extracted. Relationships between RPRE, baseline accommodation, and 1-year myopia progression (∆M), controlled for the nearwork environment, were evaluated.
Coefficients of RPRE were independent of ∆M. However, additional nearwork environmental parameters significantly improved the variance in ∆M explained by aM and aP180 (P < 0.03). The relationship between intrinsic factor and ∆M was stronger when the extrinsic risk was low (P ≤ 0.01), whereas the relationship was abolished when extrinsic risk was high. For mAcc, it also significantly improved the variance in ∆M explained by nearwork environmental parameters.
The interaction between extrinsic (environment) and intrinsic (RPRE and accommodation) factors is speculated to contribute to juvenile myopia progression. Our findings may also explain the inconsistencies of such intrinsic factors in the literature.
周边离焦和调节是曾经被假设为导致近视的内在因素，但现在存在争议。先前，家庭近距工作环境（即外在因素）被报道与近视进展有关。在这项研究中，我们旨在评估外在和内在因素与青少年屈光发育之间的潜在相互作用。
测量了 50 名儿童（年龄 9.3 ± 1.2 岁）的近距工作环境参数，包括离焦的净量和分散度。在 3m 处测量近距和中央视野（±30°水平）的屈光度。通过向量方法获得相对周边离焦（RPRE）并进行呈现。从调节刺激反应曲线中提取调节性刺激反应曲线的线性回归系数（mAcc）。将 RPRE 与视野偏心度进行二次回归，并提取第一系数（aM、aJ0、aP90 和 aP180）。评估 RPRE、基础调节与 1 年近视进展（∆M）之间的关系，同时控制近距工作环境。
RPRE 系数与 ∆M 无关。然而，额外的近距工作环境参数显著改善了 aM 和 aP180 对 ∆M 解释的方差（P < 0.03）。当外在风险较低时，内在因素与 ∆M 之间的关系更强（P ≤ 0.01），而当外在风险较高时，这种关系则被消除。对于 mAcc，它也显著改善了近距工作环境参数对 ∆M 解释的方差。
外在（环境）和内在（RPRE 和调节）因素之间的相互作用被推测为导致青少年近视进展的原因。我们的发现也可能解释了文献中内在因素不一致的原因。
