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

摘要 近视是一种屈光不正类型的眼睛疾病，其中光聚焦在视网膜前面，需要光学矫正。 矫正以恢复由此造成的视力损失。这是一个广泛的重要健康状况：据估计， 到2050年，世界上50%的人将是近视眼。此外，即使近视得到补偿， 如果你戴眼镜、隐形眼镜或手术，高度近视与视网膜脱落、青光眼 白内障因此，迫切需要阻止近视进展的策略。近视是由 眼轴长度和屈光力之间的不匹配，但促使眼睛过度生长的信号是 没有被很好地理解。在为控制近视而开发的各种策略中，多焦点隐形眼镜的使用 (MCL)正在获得巨大的吸引力MCL设计背后的一般工作原理是诱导近视 周边视网膜中的散焦对中心凹轴向生长具有保护作用。初步临床试验报告令人鼓舞 减少安装MCL的儿童的近视进展（通常是中心距和高附加屈光度） 然而，它们仍然远远没有达到预期的效果。与用于老花眼的MCL不同，用于近视控制的MCL 都是开在能适应的科目上的然而，我们目前还没有很好地了解 调节如何与MCL相互作用以确定视网膜图像质量。这是一个关键的知识差距 因为调节影响MCL设计的非常核心的特征-视网膜散焦的程度和标志。 例如，根据MCL设计和个体生理参数，一些受试者可以依赖于 用于近视力的MCL的近区，潜在地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 光学模拟技术和心理物理学范例，将非侵入性MCL透镜图案映射到 主题的学生和系统地解决关键的突出问题之间的相互作用MCL设计， 年轻近视患者的调节、图像质量和视觉功能与MCL。本集团先前 开发了自适应光学技术来测试老视矫正，基于波前的新方法 感知以量化矫正反应，老视和心理物理范例的IOL设计 适合年轻人。我们现在正在使用这些能力，扩展到双目模拟和测试， 了解基于MCL的干预措施的潜在因素和双眼机制， 降低近视。长期目标是发展一种机械的理解，可以帮助指导设计， MCL近视控制干预的个性化。我们计划1）确定 年轻近视眼和正视眼的多焦点模式，2）量化各种多焦点设计的效果 3）测试儿童的解释性反应对结果成功的作用 在临床上用多焦点隐形眼镜治疗过的