Identification of optimum spectacle prescriptions for patients with Down syndrome

唐氏综合症患者最佳眼镜处方的确定

• 批准号: 10436324
• 负责人: Heather Anne Anderson
• 金额: $ 38.06万
• 依托单位: OHIO STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-01 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10436324
• 关键词: Activities of Daily Living; Address; Adult; Advocate; Affect; Age; Amblyopia; Back; Child; Childhood; Clinical; Cognitive; Cornea; Corneal Topography; Crossover Design; Development; Disabled Persons; Down Syndrome; Early Intervention; Enrollment; Evaluation; Exposure to; Eye; Eyeglasses; Financial compensation; Fostering; Funding; Goals; Health; Hybrids; Hyperopia; Image; Impaired cognition; Individual; Lead; Measurement; Measures; Methodology; Methods; Mission; National Eye Institute; Optics; Outcome; Patients; Performance; Persons; Population; Process; Protocols documentation; Randomized; Reading; Refractive Errors; Research; Techniques; Testing; Time; United States; Update; Vision; Visit; Visual; Visual Acuity; Work; base; clinical examination; cohort; experience; expiration; follow-up; improved; innovation; monocular; patient population; prevent; primary outcome; public health relevance; rate of change; retinal imaging; simulation; stem; tool; treatment arm; treatment strategy; treatment trial

Project Summary/Abstract: It is known that individuals with Down syndrome (DS) have reduced visual acuity which may result from high levels of refractive error (sphere and cylinder) and elevated levels of higher-order aberrations that are present from childhood. Targeting optical aberrations through spectacle correction with refractions determined objectively from measures of wavefront aberrations is part of our long-term goal to provide new treatment strategies to improve vision in this group. The central hypothesis is that measures of visual and retinal image quality (metrics) can be used to identify sphere and cylinder corrections that optimize vision, resulting in multi-line acuity gains over traditional corrections. Our previous evaluation of these corrections in adults with DS found improvement in acuity, but not the multi-line levels predicted. We propose that this mismatch in acuity gains is attributed to decades of exposure to poorly corrected optical deficits that has resulted in a reduction in visual acuity potential (i.e. refractive amblyopia). Further, the method is inherently monocular, and does not prescribe refractions reflective of the two-eyed visual experience of the patient, as would occur in a clinical exam. The short-term goal of this work is to address these proposed barriers to multi- line acuity improvements with metric-optimized refractions through a randomized treatment trial conducted in children with DS who are within the optimal age for treatment of amblyopia. This trial will compare acuity outcomes for three refractive methods: 1) metric-optimized refractions, 2) clinical refractions, and 3) a hybrid method that allows for clinical refinement of the metric-optimized refraction. In addition, we seek to improve the objective refraction process by removing dilation prior to the wavefront imaging necessary to compute the metric values, as well as determining the rate of change in refraction during extended follow-up to guide patient recall times (i.e. follow-up intervals) for updated refraction. This work will be accomplished through three specific aims: Aim 1) Compare refractions and resultant visual acuity obtained from wavefront measures pre- and post-dilation. Aim 2) Compare visual acuity outcomes of metric-optimized, clinical, and clinically-refined metric-optimized refractions in a treatment trial of children with DS. Aim 3) Determine rate of change in refraction as a function of age and refractive error type annually over four years in children and adults with DS. Metric-optimized refraction is innovative in that it compensates for the absence of subjective input in the refraction process for the DS population and allows the clinician to consider corrections targeting overall image quality. This proposed research is significant in that it proposes to use spectacles in an optimized manner to remove visual barriers. Treatment of refractive amblyopia with multi-line acuity gains would lead to lifelong benefits, including access to traditional print size, facilitate educational efforts, and facilitate activities of daily living, all of which may promote greater independence. This work is similarly applicable to other patient populations who cannot fully participate in subjective refractions (young children, cognitively impaired, etc.).

项目摘要/摘要：众所周知，患有唐氏综合症（DS）的个体视力降低了 这可能是由于高水平的折射率（球体和圆柱）以及高阶水平造成的 从小就出现的畸变。通过奇观校正来靶向光差 从波前畸变的度量中客观确定的折射是我们长期目标的一部分 提供新的治疗策略来改善该组的视力。中心假设是 视觉和视网膜图像质量（指标）可用于识别优化的球体和气缸校正 视觉，导致多行敏锐度在传统校正上获得增长。我们以前对这些评估 DS成年人的校正发现了敏锐度的提高，但没有预测的多线水平。我们建议 这种敏锐度的不匹配归因于数十年来，易于纠正的光缺陷 导致敏锐度潜力降低（即折射弱视）。此外，该方法本质上是 单眼，并且不开处方反映患者双眼视觉体验的折射，因为 将在临床检查中发生。这项工作的短期目标是解决这些提议的障碍 通过在一项随机治疗试验中进行度量优化折射的线敏度改善 DS患有弱视治疗的最佳年龄的儿童。该试验将比较敏锐度 三种折射方法的结果：1）公制优化的折射，2）临床折射，3）杂交 允许度量优化折射的临床改进的方法。此外，我们试图改善 客观折射过程通过在必要的波前成像之前除去扩张来计算 公制值，并确定扩展随访期间折射率的变化率以指导患者 回忆时间（即后续间隔）以进行更新的折射。这项工作将通过三个 特定目的：目标1）比较从波前措施获得的折射和结果视力 和涂抹后。目标2）比较度量优化，临床和临床精确的视力结果 在患有DS儿童的治疗试验中，公制的折射折射。目标3）确定变更速率 在患有DS的儿童和成人中，折射是年龄和折射率类型的函数。 公制的折射具有创新性，因为它可以补偿没有主观输入 DS人群的折射过程，允许临床医生考虑针对整体图像的校正 质量。这项提出的研究很重要，因为它建议以优化的方式使用眼镜来 删除视觉障碍。用多线敏锐度获得折射弱视的治疗将导致终生 好处，包括获得传统印刷规模，促进教育努力，并促进日常活动 生活，所有这些都可能促进更大的独立性。这项工作类似于其他患者 无法完全参与主观折射的人群（幼儿，认知受损等）。