Objective: To identify the baseline factors independently related to 3- year myopia progression and axial elongation in COMET. Methods: A total of 469 children were enrolled, randomly assigned to progressive addition ...Objective: To identify the baseline factors independently related to 3- year myopia progression and axial elongation in COMET. Methods: A total of 469 children were enrolled, randomly assigned to progressive addition lenses with a + 2.00 diopter (D) addition or to single vision lenses and observed for 3 years. Eligible children were 6 to 11 years old, with spherical equivalent myopia of-1.25 to-4.50 D, bilaterally. The primary and secondary outcomes, myopia progression by cycloplegic autorefraction and axial elongation by A-scan ultrasonography, were measured annually. Multiple linear regression was used to adjust for covariates, including treatment. Results: Younger baseline age (6- 7 vs 11 years, 8 vs 11 years, and 9 vs 11 years, P<.001; 10 vs 11 years, P=.04), female sex (P=.01), and each ethnic group compared with African Americans (Asian, P=.02; Hispanic, P=.002; mixed, P=.002; white, P=.001) were independently associated with faster 3- year progression. Children aged 6 to 7 years had the fastest progression of all age groups, progressing by a mean (± SD) of 1.31 D± 0.13 more than children aged 11 years. Females progressed 0.16 D more than the males. Children of mixed, Hispanic, Asian, and white ethnicity progressed more than African American children by 0.49 D± 0.16, 0.33 D± 0.11, 0.32 D± 0.13, 0.27 D ± 0.08, respectively. Age and ethnicity, but not sex, were independently associated with axial elongation. Among these myopic children, a 0.5 mm increase in axial length was associated with 1 D of myopia progression. Conclusions: Younger baseline age was the strongest factor independently associated with faster myopic progression and greater axial elongation at 3 years. African American children had less myopic progression and axial elongation than the other ethnic groups.展开更多
Aim: To evaluate the acceptability, effectivity, and side effects of amonovision spectacle correction designed to reduce accommodation and myopia progression in schoolchildren. Methods: Dominant eyes of 11 year old ch...Aim: To evaluate the acceptability, effectivity, and side effects of amonovision spectacle correction designed to reduce accommodation and myopia progression in schoolchildren. Methods: Dominant eyes of 11 year old children with myopia (- 1.00 to - 3.00 D mean spherical equivalent)were corrected for distance; fellow eyes were uncorrected or corrected to keep the refractive imbalance < 2.00 D. Myopia progression was followed with cycloplegic autorefraction and A-scan ultrasonography measures of vitreous chamber depth (VCD) for up to 30 months. Dynamic retinoscopy was used to assess accommodationwhile reading. Results: All children accommodated to read with the distance corrected (dominant) eye. Thus, the near corrected eye experienced myopic defocus at all levels of accommodation. Myopia progression in the near corrected eyes was significantly slower than in the distance corrected eyes (intereye difference=0.36 D/year (95% CI: 0.54 to 0.19, p=0.0015, n=13); difference in VCD elongation=0.13 mm/year (95% CI: 0.18 to 0.08, p=0.0003, n=13)). After refitting with conventional spectacles, the resultant anisometropia returned to baseline levels after 9- 18 months. Conclusions: Monovision is not effective in reducing accommodation in juvenile myopia. However, myopia progression was significantly reduced in the near corrected eye, suggesting that sustained myopic defocus slows axial elongation of the human eye.展开更多
Purpose: To investigate in a pilot study the potential of an anterior chamber phakic refractive multifocal intraocular lens (IOL) prototype for the correction of near and far vision in those with myopic and hyperopic ...Purpose: To investigate in a pilot study the potential of an anterior chamber phakic refractive multifocal intraocular lens (IOL) prototype for the correction of near and far vision in those with myopic and hyperopic presbyopia. Design: A multicenter, open-label, prospective, noncomparative pilot evaluation. Participants: There were 17 patients (34 eyes), 16 women and 1 man, with a mean age of 52± 3.94 years (range, 46- 62 years). Six eyes were myopic (mean spherical equivalent [SE],-9.3± 3.83 diopters (D)) and 28 were hyperopic (mean SE, + 2.3± 0.77 D), with astigmatism less than 1.5 D. Methods: The prototype multifocal phakic IOL was implanted through a 6.5 mm temporal incision. The dominant eye was targeted for emmetropia and the nondominant eye for-1.0 D. Main Outcome Measures: The efficacy of the implant was assessed after surgery by measuring monocular and binocular uncorrected and distance-corrected visual acuity (VA) at distance, intermediate, and near, and distance-corrected near VA with near add. Distance-corrected distance and near VA also were determined in low contrast (25% ). The safety index and efficacy index were calculated, and patient satisfaction questionnaires also were administered. Follow-up was at 1- 3 days, 5- 9 days, 21 days, 3 months, 6 months, and 1 year after surgery. Results: Spherical equivalent refraction ranged from -11.75 to+ 4.25 D before surgery, and from -2.0 to + 1.85 D 1 year after surgery. The binocular efficacy index was 0.68 (near) and 1.0 (distance), and the binocular safety index was 1.0 for both near and distance. Mean binocular uncorrected distance VA improved from 20/59 (± 4 lines) before surgery to 20/18 (± 1 line) 1 year after surgery. Mean binocular uncorrected intermediate VA improved from 20/125 (± 10 lines) to 20/21 (± 1 line), and mean binocular uncorrected near VA improved from 20/78 (± 5 lines) to 20/32 (± 1 line). Binocular uncorrected visual acuity was at least 20/40 (distance and intermediate) and Jaeger 3 in 88.2% of patients, and it was at least 20/40 and Jaeger 5 in 100% of patients. Patient satisfaction was very good in 88% of patients (15 of 17); the remaining 2 patients reported moderate satisfaction. Conclusions: Promising results were obtained with the refractive multifocal phakic IOL prototype investigated in this pilot study for near and far visual correction in presbyopia associated with myopia and hyperopia. Multifocal phakic intraocular optics may be an option for presbyopia correction.展开更多
角膜外伤后瘢痕常导致不规则散光,因其不能用常规球、柱镜片矫正,患者最佳矫正视力下降,目前尚无有效治疗不规则散光的确定的手术方法.散光补充治疗,如散光性角膜切开或常规准分子激光原位角膜磨镶术（laser in situkeratomileusis,LASI...角膜外伤后瘢痕常导致不规则散光,因其不能用常规球、柱镜片矫正,患者最佳矫正视力下降,目前尚无有效治疗不规则散光的确定的手术方法.散光补充治疗,如散光性角膜切开或常规准分子激光原位角膜磨镶术（laser in situkeratomileusis,LASIK）对于不规则散光患者,其治疗的预测性较差.我院对1例外伤性角膜不规则散光病例进行了Oculvzer引导的准分子激光个体化角膜切削术治疗,展开更多
文摘Objective: To identify the baseline factors independently related to 3- year myopia progression and axial elongation in COMET. Methods: A total of 469 children were enrolled, randomly assigned to progressive addition lenses with a + 2.00 diopter (D) addition or to single vision lenses and observed for 3 years. Eligible children were 6 to 11 years old, with spherical equivalent myopia of-1.25 to-4.50 D, bilaterally. The primary and secondary outcomes, myopia progression by cycloplegic autorefraction and axial elongation by A-scan ultrasonography, were measured annually. Multiple linear regression was used to adjust for covariates, including treatment. Results: Younger baseline age (6- 7 vs 11 years, 8 vs 11 years, and 9 vs 11 years, P<.001; 10 vs 11 years, P=.04), female sex (P=.01), and each ethnic group compared with African Americans (Asian, P=.02; Hispanic, P=.002; mixed, P=.002; white, P=.001) were independently associated with faster 3- year progression. Children aged 6 to 7 years had the fastest progression of all age groups, progressing by a mean (± SD) of 1.31 D± 0.13 more than children aged 11 years. Females progressed 0.16 D more than the males. Children of mixed, Hispanic, Asian, and white ethnicity progressed more than African American children by 0.49 D± 0.16, 0.33 D± 0.11, 0.32 D± 0.13, 0.27 D ± 0.08, respectively. Age and ethnicity, but not sex, were independently associated with axial elongation. Among these myopic children, a 0.5 mm increase in axial length was associated with 1 D of myopia progression. Conclusions: Younger baseline age was the strongest factor independently associated with faster myopic progression and greater axial elongation at 3 years. African American children had less myopic progression and axial elongation than the other ethnic groups.
文摘Aim: To evaluate the acceptability, effectivity, and side effects of amonovision spectacle correction designed to reduce accommodation and myopia progression in schoolchildren. Methods: Dominant eyes of 11 year old children with myopia (- 1.00 to - 3.00 D mean spherical equivalent)were corrected for distance; fellow eyes were uncorrected or corrected to keep the refractive imbalance < 2.00 D. Myopia progression was followed with cycloplegic autorefraction and A-scan ultrasonography measures of vitreous chamber depth (VCD) for up to 30 months. Dynamic retinoscopy was used to assess accommodationwhile reading. Results: All children accommodated to read with the distance corrected (dominant) eye. Thus, the near corrected eye experienced myopic defocus at all levels of accommodation. Myopia progression in the near corrected eyes was significantly slower than in the distance corrected eyes (intereye difference=0.36 D/year (95% CI: 0.54 to 0.19, p=0.0015, n=13); difference in VCD elongation=0.13 mm/year (95% CI: 0.18 to 0.08, p=0.0003, n=13)). After refitting with conventional spectacles, the resultant anisometropia returned to baseline levels after 9- 18 months. Conclusions: Monovision is not effective in reducing accommodation in juvenile myopia. However, myopia progression was significantly reduced in the near corrected eye, suggesting that sustained myopic defocus slows axial elongation of the human eye.
文摘Purpose: To investigate in a pilot study the potential of an anterior chamber phakic refractive multifocal intraocular lens (IOL) prototype for the correction of near and far vision in those with myopic and hyperopic presbyopia. Design: A multicenter, open-label, prospective, noncomparative pilot evaluation. Participants: There were 17 patients (34 eyes), 16 women and 1 man, with a mean age of 52± 3.94 years (range, 46- 62 years). Six eyes were myopic (mean spherical equivalent [SE],-9.3± 3.83 diopters (D)) and 28 were hyperopic (mean SE, + 2.3± 0.77 D), with astigmatism less than 1.5 D. Methods: The prototype multifocal phakic IOL was implanted through a 6.5 mm temporal incision. The dominant eye was targeted for emmetropia and the nondominant eye for-1.0 D. Main Outcome Measures: The efficacy of the implant was assessed after surgery by measuring monocular and binocular uncorrected and distance-corrected visual acuity (VA) at distance, intermediate, and near, and distance-corrected near VA with near add. Distance-corrected distance and near VA also were determined in low contrast (25% ). The safety index and efficacy index were calculated, and patient satisfaction questionnaires also were administered. Follow-up was at 1- 3 days, 5- 9 days, 21 days, 3 months, 6 months, and 1 year after surgery. Results: Spherical equivalent refraction ranged from -11.75 to+ 4.25 D before surgery, and from -2.0 to + 1.85 D 1 year after surgery. The binocular efficacy index was 0.68 (near) and 1.0 (distance), and the binocular safety index was 1.0 for both near and distance. Mean binocular uncorrected distance VA improved from 20/59 (± 4 lines) before surgery to 20/18 (± 1 line) 1 year after surgery. Mean binocular uncorrected intermediate VA improved from 20/125 (± 10 lines) to 20/21 (± 1 line), and mean binocular uncorrected near VA improved from 20/78 (± 5 lines) to 20/32 (± 1 line). Binocular uncorrected visual acuity was at least 20/40 (distance and intermediate) and Jaeger 3 in 88.2% of patients, and it was at least 20/40 and Jaeger 5 in 100% of patients. Patient satisfaction was very good in 88% of patients (15 of 17); the remaining 2 patients reported moderate satisfaction. Conclusions: Promising results were obtained with the refractive multifocal phakic IOL prototype investigated in this pilot study for near and far visual correction in presbyopia associated with myopia and hyperopia. Multifocal phakic intraocular optics may be an option for presbyopia correction.
文摘角膜外伤后瘢痕常导致不规则散光,因其不能用常规球、柱镜片矫正,患者最佳矫正视力下降,目前尚无有效治疗不规则散光的确定的手术方法.散光补充治疗,如散光性角膜切开或常规准分子激光原位角膜磨镶术（laser in situkeratomileusis,LASIK）对于不规则散光患者,其治疗的预测性较差.我院对1例外伤性角膜不规则散光病例进行了Oculvzer引导的准分子激光个体化角膜切削术治疗,
