Zhang Guanghong, Wei Qian, Lu Lei, Lin Andy L, Qu Chao
School of Medicine, University of Electronic Science and Technology of China, No. 2006, Xiyuan Ave West Hi-Tech Zone, Chengdu, CN611731, China.
Department of Ophthalmology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, No. 2006, Xiyuan Ave West Hi-Tech Zone, Chengdu, CN611731, China.
Graefes Arch Clin Exp Ophthalmol. 2023 Nov;261(11):3083-3095. doi: 10.1007/s00417-023-06045-w. Epub 2023 Apr 27.
Myopia and presbyopia are two major optometry problems facing the whole society. The mechanism of accommodation is strongly related to the treatments of myopia and presbyopia. However, the key mechanism of accommodation has puzzled us for over 400 years and is still not clear at present, leading to the stagnation of prevention and treatment of myopia and presbyopia. With the continued development of experimental technologies and equipment, the approaches to elucidate accommodation's intricacies have become more methodological and sophisticated. Fortunately, some significant progress has been made. This article is to review the evolution of the mechanism of accommodation. Helmholtz proposed a classical theory of "zonules relax during accommodation." In contrast, Schachar put forward a theory of "zonules taut during accommodation." Those hypotheses are relatively complete, but either do not fully explain everything about the accommodation mechanism or lack sufficient experimental and clinical evidence to support them. Then, some contentious issues are discussed in detail to find the truth. Finally, we proposed our hypothesis about accommodation based on the anatomy of the accommodative apparatus.
近视和老花眼是全社会面临的两大主要验光问题。调节机制与近视和老花眼的治疗密切相关。然而,调节的关键机制困扰了我们400多年,目前仍不清楚,导致近视和老花眼的防治停滞不前。随着实验技术和设备的不断发展,阐明调节复杂性的方法变得更加系统和精密。幸运的是,已经取得了一些重大进展。本文旨在综述调节机制的演变。亥姆霍兹提出了“调节时悬韧带松弛”的经典理论。相比之下,沙查尔提出了“调节时悬韧带拉紧”的理论。这些假说相对完整,但要么没有完全解释调节机制的所有方面,要么缺乏足够的实验和临床证据支持。然后,详细讨论了一些有争议的问题以探寻真相。最后,我们基于调节装置的解剖结构提出了关于调节的假说。
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