目前,近视已是一个重要的公共卫生问题。随着知识的广泛普及,越来越多家长开始注重孩子的近视问题,各种控制近视手段也层出不穷,其中,角膜塑形镜成为目前备受瞩目的控制方法之一。
/////////////////////
01
角膜塑形镜控制原理是什么呢?

图1 角膜塑形后改善周边离焦示意图
研究表明,角膜塑形镜是通过减少周边远视离焦,从而增加了周边近视离焦,从而减少了眼轴延长和随后近视发展的刺激(图1)。在配戴塑形镜后,多也依据眼轴变化来观察近视度数变化。(噱头还是真香——角膜塑形镜真能控制近视么?)
02
角膜塑形镜真的有效吗?

图2 角膜塑形镜配戴者与对照者的轴向伸长比较
Molly J Smith等对多名角膜塑形镜研究者的结果进行统计(图2),在诸多学者的研究数据显示下,我们可以看出,角膜塑形镜对于眼轴增长的控制多在50%左右,我们可以简单地认为角膜塑形镜对于近视度数的控制程度在50%左右。
我国有研究通过比较配戴角膜塑形镜与配戴框架眼镜的低度近视(-3.00D<ES<-0.50D)、中度近视(-6.00D<ES≤-3.00D)、高度近视(ES≤-6.00D)组三组的眼轴增长情况发现,配戴角膜接触镜组较配戴框架眼镜组眼轴增长率分别慢49%、59%和46%,说明其控制近视效果不受屈光度影响,对高度近视也具有良好的控制效果。
03
小结
角膜塑型镜被认为是减缓儿童近视进展的最有效的非药物措施之一,并有定期随访以确保安全性,仍然是世界各地近视管理最有效的治疗方法之一。但是,角膜塑形镜控制近视增长效果较好,并不代表在配戴后就可以忽视用眼卫生和用眼习惯的管理。合理的用眼习惯和自我管理,有助于更好地控制孩子近视发展!
参考文献
Molly J Smith ,Jeffrey J Walline Controlling myopia progression in children and adolescents.Adolescent Health, Medicine and Therapeutics 2015:6 133–140
Charm J, Cho P. High myopia-partial reduction ortho-k: a 2-year ran- domized study. Optom Vis Sci. 2013;90(6):530–539.
Chen C, Cheung SW, Cho P. Myopia control using toric orthokeratology (TO-SEE study). Invest Ophthalmol Vis Sci. 2013;54(10):6510–6517.
Cho P, Cheung SW. Retardation of myopia in Orthokeratology (ROMIO) study: a 2-year randomized clinical trial. Invest Ophthalmol Vis Sci. 2012;53(11):7077–7085.
Santodomingo-Rubido J, Villa-Collar C, Gilmartin B, Gutierrez-Ortega R. Myopia control with orthokeratology contact lenses in spain (MCOS): refractive and biometric changes. Invest Ophthalmol Vis Sci. 2012; 53(8):5060–5065.
Walline JJ, Jones LA, Sinnott LT. Corneal reshaping and myopia pro- gression. Br J Ophthalmol. 2009;93(9):1181–1185.
Swarbrick HA, Alharbi A, Watt K, Lum E, Kang P. Myopia control during orthokeratology lens wear in children using a novel study design. Ophthalmology. 2015;122(3):620–630.
Hiraoka T, Kakita T, Okamoto F, Takahashi H, Oshika T. Long-term effect of overnight orthokeratology on axial length elongation in childhood myopia: a 5-year follow-up study. Invest Ophthalmol Vis Sci. 2012;53(7):3913–3919.
Kakita T, Hiraoka T, Oshika T. Influence of overnight orthokeratology on axial elongation in childhood myopia. Invest Ophthalmol Vis Sci. 2011;52(5):2170–2174.
Xintong Li, Ilana B. Friedman, Norman B. Medow, Cheng Zhang. Update on Orthokeratology in Managing Progressive Myopia in Children: Efficacy, Mechanisms, and Concerns. Journal of Pediatric Ophthalmology & Strabismus. 2017;54(3):142-148.
Meng-Jun Zhu, Hao-Yan Feng, Xian-Gui He, Hai-Dong Zou and Jian-Feng Zhu. The control effect of orthokeratology on axial length elongation in Chinese children with myopia. BMC Ophthalmology 2014, 14:141.

文字:安珂 子希吖
排版:子希吖
审核:芬儿哥