儿童青少年配戴多焦软性角膜接触镜对调节聚散功能的影响

Accommodation and Vergence in Myopic Children and Juvenile Fitted with Soft Multifocal Contact Lenses

目的:比较儿童青少年近视患者配戴单光框架眼镜和多焦软性角膜接触镜(简称多焦软镜)对调节和聚散功能的影响。方法:系列病例研究。选取2017年7─10月在温州医科大学附属眼视光医院视光门诊就诊的46例近视患者参加本研究,分别在配戴单光框架眼镜和多焦软镜时测量其调节参数和聚散参数,包括调节幅度、调节反应、调节微波动、相对调节、远近隐斜以及远近BI/BO破裂点。采用配对t检验对数据进行分析。结果:同一受检者配戴单光框架眼镜和多焦软镜时在33 cm处的调节反应无明显差异,多焦软镜配戴后的调节微波动高于单光框架眼镜(t=-5.155,P<0.001),近距隐斜向外隐斜方向偏移(单光框架眼镜:-0.83△±7.03△,多焦软镜:-2.46△±6.29△,t=-2.647,P=0.011),远距BO破裂点变小(t=-3.023,P=0.004),近距BI破裂点变大(t=2.575,P=0.013)。结论:青少年近视患者配戴多焦软镜后近距调节微波动增大,近距外隐斜增大,近距发散范围变大,提示多焦软镜的周边离焦设计会对配戴者的双眼视功能产生一定的影响,儿童青少年近视患者选择多焦软镜作为近视防控手段时需评估其双眼视功能。

Objective:To investigate the effect of multifocal soft contact lenses on accommodation and vergence behavior in juvenile myopia subjects.Methods:In this case series study,forty-six children and juvenile myopia subjects were recruited at the Eye Hospital,Wenzhou Medical University from July to October 2017.Accommodative response and micro-fluctuations were measured as the subject observed targets at 3.0 D vergence(33 cm)using the Grand Seiko WAM-5500 open-field autorefractor with either single-vision spectacle lenses or multifocal soft contact lenses.Secondary measures included accommodative amplitude,facility,relative accommodation,distance/near phoria by von-Graefe,as well as BI/BO to break at distance and near.Data were analyzed using paired t-tests.Results:The results showed that there was no statistically significant difference between single-vision spectacle lenses and multifocal soft contact lenses in the accommodative response,which was measured at 33 cm;but higher micro-fluctuations were found with single-vision spectacle lenses when compared with multifocal soft contact lenses(t=-5.155,P<0.001).With multifocals,subjects were more exophoric at 40 cm(single-vision spectacle lenses:-0.83△±7.03△,multifocal soft contact lenses:-2.46△±6.29△;t=-2.647,P=0.011).There was a smaller BO to break at distance(t=-3.032,P=0.004)and larger BI to break at near(t=2.575,P=0.013).Conclusions:Juvenile myopes with multifocal contact lenses show an increase in accommodative micro-fluctuations,more exophoria,and a larger vergence range at near than with single-vision spectacle lenses.This suggests that the special designs of multifocal contact lenses may have an impact on accommodation and vergence behavior in juvenile myopes,and binocular vision should be examined before multifocal contact lenses are chosen for myopia control.