角膜塑形术的光学变化和视觉表现。

PubMed ID
发表日期 2020年01月

原始出处 临床与实验验光
Clinical & experimental optometry
作者 Nti  Augustine N  Berntsen  David A 

文献标题 角膜塑形术的光学变化和视觉表现。
Optical changes and visual performance with orthokeratology.

文献摘要

角膜塑形术自20世纪60年代初首次被描述以来经历了巨大的变化。最初的角膜塑形手术需要一系列的镜片来压平中央角膜,结果不一。可通宵佩戴的高透氧性镜片材料、角膜地形图和逆向几何镜片设计的引入彻底改变了这一过程。现代整夜角膜塑形术能迅速、可靠、可逆地减少屈光不正。采用现代设计,患者可以隔夜佩戴镜片,早上取下镜片,一整天都看得很清楚,而无需白天进行屈光矫正。现代的反向几何透镜设计导致中央角膜变平和中周边角膜变陡,从而提供清晰的中心凹视野,同时导致周边视网膜离焦的近视转移。角膜塑形术引起的周边性近视视网膜离焦被认为是配戴这些镜片的儿童近视进展减少的原因。本文回顾了角膜塑形术中镜片设计的变化,这些变化导致了目前使用的反几何角膜塑形术镜片以及这些镜片所产生的光学变化。本文回顾了屈光不正及其时程的变化、高对比度和低对比度视力的变化、高阶像差和视觉质量指标的变化、调节功能的变化以及角膜塑形术引起的周边离焦的变化。本文还回顾了角膜塑形术在儿童近视控制中的应用,以及角膜塑形术引起的儿童近视周边离焦和近视进展减慢与配戴晶状体相关的安全性和并发症之间的假设联系。更好地了解角膜塑形术中发生的眼部和光学变化将有助于临床医生和患者做出有关角膜塑形术应用的明智决定。讨论了这种透镜形式的未来研究方向。


Orthokeratology has undergone drastic changes since first described in the early 1960s. The original orthokeratology procedure involved a series of lenses to flatten the central cornea and was plagued by variable results. The introduction of highly oxygen-permeable lens materials that can be worn overnight, corneal topography, and reverse-geometry lens designs revolutionised this procedure. Modern overnight orthokeratology causes rapid, reliable, and reversible reductions in refractive error. With modern designs, patients can wear lenses overnight, remove them in the morning, and see clearly throughout the day without the need for daytime refractive correction. Modern reverse-geometry lens designs cause central corneal flattening and mid-peripheral corneal steepening that provides clear foveal vision while simultaneously causing a myopic shift in peripheral retinal defocus. The peripheral myopic retinal defocus caused by orthokeratology is hypothesised to be responsible for reductions in myopia progression in children fitted with these lenses. This paper reviews the changes in orthokeratology lens design that led to the reverse-geometry orthokeratology lenses that are used today and the optical changes these lenses produce. The optical changes reviewed include changes in refractive error and their time course, high- and low-contrast visual acuity changes, changes in higher-order aberrations and visual quality metrics, changes in accommodation, and changes in peripheral defocus caused by orthokeratology. The use of orthokeratology for myopia control in children is also reviewed, as are hypothesised connections between orthokeratology-induced myopic peripheral defocus and slowed myopia progression in children, and safety and complications associated with lens wear. A better understanding of the ocular and optical changes that occur with orthokeratology will be beneficial to both clinicians and patients in making informed decisions regarding the utilisation of orthokeratology. Future research directions with this lens modality are also discussed.


获取全文 10.1111/cxo.12947