周边离焦软性角膜接触镜在近视矫治中的光学质量及对比敏感度视力分析

Optical Quality and Contrast Sensitivity Visual Acuity of Peripheral Defocus Soft Lens in the Correction of Myopia

目的:选用周边离焦软性角膜接触镜研究其眼球成像特征,分析其对眼球光学质量及对比敏感度视力的影响。方法:前瞻性自身前后对照临床研究。随机选取2019年5月—12月于杭州西湖之江眼科医院视光诊疗中心验配周边离焦软性角膜接触镜的近视患者29例(29眼),年龄19~38(25.9±5.2)岁,近视等效球镜度(SE)为(-3.80±1.34)D,角膜曲率为(42.77±1.14)D,最佳矫正视力(BCVA)不低于5.0。配镜当天采用日本尼德克像差仪(OPD-SCANⅢ)检测周边离焦软性角膜接触镜与框架镜片矫正后的6 mm瞳孔直径下的波前像差;采用西班牙视量双通道客观视觉质量分析系统OQAS-II检测周边离焦软性角膜接触镜与框架眼镜(本院提供的试镜架)测量受检者客观散射指数(OSI)和调制传递函数截止频率(MTF cutoff)。2种不同矫正方式下BCVA、三叶草差、MTF cutoff的比较采用配对t检验;球差(SA)、彗差、全眼总高阶像差(tHOA)和OSI的比较采用Wilcoxon符号秩和检验。结果:受检者配戴周边离焦软性角膜接触镜时全眼SA、彗差、三叶草差和tHOA均显著高于其配戴框架眼镜(Z=-4.68,P<0.001;Z=-4.68,P<0.001;t=-6.48,P<0.001;Z=-4.68,P<0.001)。采用2种不同的屈光矫正方式分别达到其BCVA的情况下,患者配戴周边离焦软性角膜接触镜时MTF cutoff显著低于配戴框架眼镜,差异有统计学意义(t=6.10,P<0.001);OSI显著高于配戴框架眼镜时,差异有统计学意义(Z=-4.21,P<0.001)。结论:配戴周边离焦软性角膜接触镜全眼屈光系统的光学像差提高,对比度敏感度视力下降,但BCVA不变。近视患者选择周边离焦软性角膜接触镜时宜权衡这一影响。

Objective:To determine the imaging characteristics in myopic adults treated with peripheral defocus soft lens and further analyze its influence on optical quality and contrast visual acuity.Methods:This was a prospective before-after self-control clinical study.Twenty-nine patients(29 eyes)who wore peripheral defocus soft lenses in Hangzhou Xihu Zhijiang Eye Hospital were enrolled in this study.The age of the participants was 25.9±5.2(19-38)years,and the myopic spherical equivalent(SE)was-3.80±1.34 D.The mean corneal curvature was 42.77±1.14 D,and the best corrected visual acuity(BCVA)was greater than 5.0.OPD-SCAN III was used to detect wavefront aberrations corrected by peripheral defocus soft lens and spectacles within a 6 mm pupil diameter on the day of lens ftting.The objective optical scattering index(OSI)and modulation transfer function cutoff frequency(MTF cutoff)were measured by OQAS-II.Paired t-test and Wilcoxon signed-rank test were used in this study.Results:The spherical aberration,coma,trefoil aberration and total ocular higher-order aberration were significantly higher when undergoing peripheral defocus soft lenses than wearing spectacles(Z=-4.68,P<0.001;Z=-4.68,P<0.001;t=-6.48,P<0.001;Z=-4.68,P<0.001).When BCVA was fitted in two different ways,MTF cutoff was significantly lower when wearing peripheral defocus soft lenses than spectacles(-6.10,P<0.001).OSI was significantly higher when wearing earing peripheral defocus soft lenses(Z=-4.21,P<0.001).Conclusions:Peripheral defocus soft lenses can increase optical aberrations and decrease contrast sensitivity visual acuity,but BCVA remained unchanged.It is necessary to balance these effects when choosing peripheral defocus soft lenses for myopic patients.