多焦软性角膜接触镜对周边屈光度及周边角膜屈光力的影响

Effect of Multifocal Soft Contact Lenses on Peripheral Refraction and Peripheral Corneal Refractive Power

目的:观察配戴多焦软性角膜接触镜引起的周边屈光度及周边角膜屈光力的变化,研究二者之间的关系。方法:自身对照研究。于2020年10月1─15日在温州医科大学收集成年近视受检者18例,在配戴单焦软性角膜接触镜(简称单焦软镜)和多焦软性角膜接触镜(简称多焦软镜)状态下分别采用红外自动验光仪和角膜地形图测量周边屈光度及周边角膜屈光力。周边屈光度的测量范围为鼻颞侧30°(5°间隔)。周边屈光度与中心屈光度的差值为相对周边屈光度(RPR)。通过拟合获得鼻颞侧相对周边屈光度曲线,曲线下面积即视网膜相对周边屈光面积(ARPR)。根据高斯光学系统,计算各注视方位相应的角膜坐标,获取各位点的全角膜屈光力,并计算角膜相对周边屈光力(CRPR)和角膜ARPR。采用配对t检验比较各状态RPR和CRPR,采用Pearson相关分析法分析视网膜ARPR与角膜ARPR的关系。结果:配戴单焦软镜时鼻侧(5°至25°)及颞侧(5°至20°)的RPR呈远视状态,配戴多焦软镜使各点RPR发生近视性漂移(均P<0.001),除鼻侧5°、颞侧30°外。配戴多焦软镜时,鼻侧(25°~30°)及颞侧(10°~30°)CRPR与配戴单焦软镜时相比呈现出更大的正屈光力(均P<0.001)。配戴多焦软镜时,视网膜ARPR与相应的角膜ARPR呈正相关(r=0.54,P=0.031)。结论:多焦软镜使角膜周边的相对正屈光力增加,从而增加了视网膜的周边近视性离焦量。临床上,配戴多焦软镜引起的角膜屈光力变化可以在一定程度上反映视网膜离焦的变化。

Objective:To observe the effect of multifocal soft contact lenses on peripheral refraction and peripheral corneal refractive power,and to investigate their correlation.Methods:This was a self-controlled study.Eighteen myopic adults were enrolled in Eye Hospital,Wenzhou Medical University from October 1,2020 to October 15,2020.They underwent peripheral refraction and corneal refractive power measurements using infrared autorefractor and corneal topography when wearing monofocal soft contact lenses and multifocal soft contact lenses.The measurement range of peripheral refraction was from nasal 30°to temporal 30°(at 5°intervals).The difference between peripheral refraction and central refraction was identified as relative peripheral refraction(RPR).The nasal and temporal RPR was plotted on a curve,and the area under the curve was defined as the retinal area of relative peripheral refractive power(ARPR).The corresponding corneal coordinates of each fixation direction were calculated according to the Gaussian optical system to obtain the total corneal refractive power of each point.The corneal relative peripheral refractive power(CRPR)and corneal ARPR were calculated.RPR and CRPR values of each state were compared using a paired t-test,and the relationship between retinal ARPR and corneal ARPR was analyzed by a Pearson correlation test.Results:Parts of the nasal(5°to 25°)and the temporal(5°to 20°)RPR were hyperopic when wearing monofocal soft contact lenses.While wearing multifocal soft contact lenses,each RPR was more myopic(P<0.001)except 5°nasal and 30°temporal.When wearing multifocal soft contact lenses,parts of the nasal(25°to 30°)and temporal(10°to 30°)CRPR showed greater positive refractive power than under the monofocal soft contact lenses condition(P<0.001).Retinal ARPR was positively correlated with the corresponding corneal ARPR(r=0.54,P=0.031)while wearing multifocal soft contact lenses.Conclusions:Multifocal soft contact lenses increase the corneal peripheral positive refractive power,thus increasing the retinal peripheral myopic defocus.Clinically,while wearing multifocal soft contact lenses,the change in corneal refractive power can reflect the change in retinal defocus to some extent.