Interplay between multifocal optics and accommodation: implications for myopia progression

多焦点光学器件与调节之间的相互作用：对近视进展的影响

• 批准号: 10637313
• 负责人: Susana Marcos
• 金额: $ 53.7万
• 依托单位: UNIVERSITY OF ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-07-01 至 2028-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10637313
• 关键词: Address; Affect; Asian; Blindness; Cataract; Child; Clinical; Clinical Trials; Compensation; Contact Lenses; Crystalline Lens; Custom; Data; Diameter; Effectiveness; Engineering; Eye; Eye diseases; Eyeglasses; Failure; Focal Adhesions; Future; Glaucoma; Goals; Grant; Growth; Health; Image; Individual; Intervention; Knowledge; Length; Light; Link; Location; Macular degeneration; Maps; Measurement; Methods; Monitor; Myopia; Operative Surgical Procedures; Optics; Outcome; Pattern; Peripheral; Physiological; Population; Presbyopia; Psychophysics; Pupil; Refractive Errors; Relaxation; Reporting; Retina; Retinal Detachment; Role; Schools; Signal Transduction; Societies; Technology; Testing; Traction; Vision; Visual; Visual Acuity; Work; adaptive optics; design; experimental study; high risk; improved; innovation; lens; novel; operation; personalized strategies; response; retinal imaging; simulation; success; visual optics; young adult

ABSTRACT Myopia is a refractive error type of eye disorder where light is focused in front of the retina, requiring optical corrections to recover the resulting loss in visual acuity. It is a broadly significant health condition: it is estimated that by 2050 50% of the world population will be myopic. Moreover, even if myopia is compensated with spectacles, contact lenses or surgery, high myopia is linked to a higher risk of retinal detachment, glaucoma, and cataract. Strategies to halt the progression of myopia are therefore an urgent need. Myopia arises from a mismatch between ocular axial length and optical power, but the signals that prompt excessive eye growth are not well understood. Among various strategies developed for myopia control, the use of multifocal contact lenses (MCL) is gaining significant traction. A generalized working principle behind MCL design is that induced myopic defocus in the peripheral retina is protective for foveal axial growth. Initial clinical trials report encouraging reduction of myopia progression in children fitted with MCLs (generally, center-distance and high add powers) however they are still far from the desired effectiveness. Unlike MCL for presbyopia, MCLs for myopia control are prescribed on subjects that can accommodate. However, we currently do not have a good understanding of how accommodation interacts with MCLs in determining retinal image quality. This is a critical gap in knowledge as accommodation affects the very central feature of MCL design — the degree and the sign of retinal defocus. For example, depending on MCL design and individual physiological parameters, some subjects could rely on the near zones of the MCL for near vision, potentially exposing the retina to hyperopic defocus and triggering eye growth. We, a diverse team of optical engineers, physicists and neuroscientists will make use of adaptive optics simulation technologies and psychophysical paradigms to map non-invasively MCL lens patterns onto the subject’s pupil and systematically address key outstanding questions on the interplay between MCL design, accommodation, image quality and visual function with MCLs in young myopes. The group has previously developed adaptive optics technologies to test presbyopia corrections, novel methods based on wavefront sensing to quantify the accommodative response, IOL designs for presbyopia and psychophysical paradigms suited for young subjects. We are now using these capabilities, expanded to binocular simulation and testing, to understand factors underlying accommodative and binocular mechanisms of MCL-based interventions to slow down myopia. The long-term goal is to develop a mechanistic understanding that can help guide the design and personalization of MCL myopia control interventions. We plan to 1) determine the accommodative response with multifocal patterns in young myopes and emmetropes, 2) quantify the effects of various multifocal designs on foveal visual function and 3) test the role of accommodative response on the outcome success in children that have been clinically treated with multifocal contact lenses

抽象的 近视是一种屈光不正类型的眼睛疾病，光线聚焦在视网膜前面，需要光学 矫正以恢复由此造成的视力损失。这是一种广泛重要的健康状况：据估计 到 2050 年，世界人口的 50% 将成为近视眼。而且，即使近视得到了补偿 眼镜、隐形眼镜或手术，高度近视与视网膜脱离、青光眼、 和白内障。因此，迫切需要采取策略来阻止近视的发展。近视产生于 眼轴长度和光焦度不匹配，但促使眼睛过度生长的信号是 不太理解。在控制近视的各种策略中，使用多焦点隐形眼镜 (MCL) 正在获得巨大的关注。 MCL 设计背后的一般工作原理是诱发近视 周边视网膜的散焦可以保护中心凹的轴向生长。初步临床试验报告令人鼓舞 减少佩戴 MCL 的儿童的近视进展（通常是中心距和高附加度数） 然而，它们距离预期的效果还很远。与用于老花眼的 MCL 不同，用于控制近视的 MCL 规定了可以容纳的科目。然而我们目前还没有很好的了解 调节如何与 MCL 相互作用来确定视网膜图像质量。这是知识上的一个关键差距 因为调节影响 MCL 设计的核心特征——视网膜散焦的程度和迹象。 例如，根据 MCL 设计和个人生理参数，一些受试者可以依赖 MCL 的近区用于近视力，可能使视网膜暴露于远视散焦并触发 眼睛生长。我们，一个由光学工程师、物理学家和神经科学家组成的多元化团队将利用自适应技术 光学模拟技术和心理物理学范式将非侵入性 MCL 镜片图案映射到 受试者的学生并系统地解决有关 MCL 设计之间相互作用的关键悬而未决的问题， 年轻近视患者 MCL 的调节、图像质量和视觉功能。该集团此前已 开发了自适应光学技术来测试老花眼矫正，基于波前的新颖方法 用于量化调节反应的传感、老花眼人工晶状体设计和心理物理学范式 适合年轻的科目。我们现在正在使用这些功能，扩展到双目模拟和测试，以 了解基于 MCL 的干预措施的调节和双眼机制的潜在因素，以减缓 降低近视度数。长期目标是形成一种机制理解，以帮助指导设计和 MCL 近视控制干预措施的个性化。我们计划 1) 确定适应性反应 年轻近视眼和正视眼患者的多焦点模式，2) 量化各种多焦点设计的效果 中央凹视觉功能和 3) 测试调节反应对儿童成功结果的作用 已接受多焦点隐形眼镜临床治疗的