渐进多焦点镜矫正状态下青少年近视周边屈光的变化

Effect of progressive addition lens on peripheral refraction in adolescent myopic eye

背景视网膜周边屈光状态会影响近视的发生和发展，不同的矫正方式对周边屈光状态产生不同的影响。目的比较青少年近视配戴渐进性多焦点镜（PALs）和单光镜（SVLs）下周边屈光状态及其两种状态间的差异。方法采用自身对照横断面研究设计。共纳入受试者40例40眼；年龄10～15岁，平均（12．54＋1．45）岁；男女比例为23：17；等效球镜度为-1．50—-6．00D，平均（-3．74±1.09）D，散光度〈-1．50D；矫正视力均≥20／25。用质量分数1％托吡卡胺滴眼液点眼3次麻痹睫状肌后，使用Grand Seiko WAM5500型红外验光仪测量受试眼周边屈光状态，测量点为黄斑中心凹（0°）、鼻侧及颞侧视网膜各10°、20°、30°共7个点的周边屈光力，各点测量6次，取其平均值。受试者按随机序号原则分别在PALs和SVLs矫正状态下完成周边屈光状态的测量，分析参数包括M值、相对周边屈光不正（RPRE）、J45、J180值，对检测结果进行统计学分析。结果PALs和SVLs的矫正视力分别为4．98±0．65和4．97±0．53，差异无统计学意义（t=0．222，P=0．639）。两种矫正状态下，随着偏心角度的增加，周边M值、RPRE屈光力逐渐向“远视性离焦”偏移，而周边J180屈光力逐渐向“近视性离焦”偏移；以上3个参数周边6个点之间相互比较，差异均有统计学意义（P〈0．05）；J45值周边变化不显著，在颞侧偏负，鼻侧偏正；在M值、RPRE、J180、J45值的周边6个角度中，部分角度的上述屈光力与中心凹相比差异均有统计学意义（P〈0．05）。与单光镜比较，渐变镜的周边M值及周边RPRE值均偏近视性离焦，差异有统计学意义（P〈0．05）。结论相对于单光镜，渐变镜矫正了部分周边远视性离焦，核心表现在M值和RPRE参数。PALs延缓青少年近视进展可能与周边屈光有关。

Background Peripheral refraction of retina brings about influence on myopia development, and different corrective methods will play different roles on the peripheral refraction. Objective This study was to measure the peripheral refraction with progressive addition lenses （PALs） and single-vision spectacle lenses （SVLs） corrected in adolescent myopic eyes and to investigate the difference between them. Methods This was a self-controlled cross-sectional study. Forty corrected myopic eyes with PALs were recruited for the study. Twenty-three male and seventeen female subjects aged 10-15 years （ mean 12.54 years± 1.45 years） enrolled in this study. The refractive errors of the subjects ranged form -1.50 D to -6. 00 D （mean -3.74 D±1. 09 D） and the astigmatism was less than -1.50 D with the corrected visual acuity at least 20/25. 1% Tropicamide eye drops was topically administered for the cycloplegia and then Grand Seiko WAM-5500 Auto-refractor was used to measure the peripheral refraction. The measured points were determined follows as：fovea（0°）, peripheral temporal （T30°, T20°, T10°） and nasal （N30° ,N20°, N10°） visual fields from the right eyes. The mean of the six measuring points for each position was calculated. Peripheral refraction was measured from each subject under the wearing of PALs or SVLs （ randomly in succession） ,and the statistic analyse perimeters included M value,relative peripheral refractive error （RPRE） , J45, J180. Written informed consent was obtained from each subject before examination. Results The corrected visual acuity was 4. 98 ± 0.65 and 4.97 ± 0. 53 under the PALs and SVLs conditions respectively, showing in significant difference between them （t = 0. 222, P = 0. 639 ）. Hypermetropic shift in peripheral M value and RPRE value were found with the increase of visual angle field,in contrast, the peripheral J180 showed a myopic shift, and significant difference was found among the six peripheral points with all of the above three perimeters （P〈0.05）. Negative J45 values in the temporal visual filed and positive J45 values in the nasal filed showed less shift. Some peripheral angles of the peripheral refractions in M value, RPRE value, J180, J45 showed significantly difference from the fovea refraction（P〈0.05）. Compared with SVLs correction,PALs induced relatively myopic shifts in M value and RPRE value in all of the peripheral angle fields, showing significant differences （P〈0.05）. Conclusions PALs causes relatively myopic shift at the peripheral retina in adolescent myopic eyes in comparison with SVLs,and the important parameters are M value and RPRE value. The effect of PALs on controlling the onset and progression of myopia may be interpreted by peripheral refraction.