Interplay between multifocal optics and accommodation: implications for myopia progression

摘要 近视是一种屈光不正类型的眼科疾病，光线集中在视网膜前面，需要光学 矫正以恢复由此造成的视力损失。这是一种广泛意义上的健康状况：据估计 到2050年，50%的世界人口将是近视。此外，即使近视得到补偿， 戴眼镜、隐形眼镜或手术、高度近视与视网膜脱离、青光眼、 还有白内障。因此，遏制近视发展的策略是当务之急。近视由近视引起 眼轴长度和光强不匹配，但促使眼睛过度生长的信号是 不是很清楚。在为控制近视而开发的各种策略中，使用多焦点隐形眼镜 (MCL)正在获得巨大的吸引力。MCL设计背后的一个普遍工作原理是诱导近视 周边视网膜的离焦对中心凹轴向生长有保护作用。初步临床试验报告令人鼓舞 配戴MCL的儿童近视进展的减少(一般为中心距和高附加值) 然而，它们仍远未达到预期的效果。与用于老花眼的MCL不同，用于近视控制的MCL 都是关于可以容纳的对象的。然而，我们目前对此并没有很好的认识。 调节与MCL在决定视网膜图像质量中的相互作用。这是一个严重的知识鸿沟 因为调节会影响MCL设计的核心特征--视网膜离焦的程度和体征。 例如，根据MCL的设计和个体生理参数，一些受试者可以依赖于 MCL的近视区，可能使视网膜暴露于远视性散焦并触发 眼睛长出来了。我们，一个由光学工程师、物理学家和神经科学家组成的不同团队将利用自适应 光学模拟技术和心理物理范式将非侵入性MCL透镜图案映射到 并系统地解决MCL设计、MCL设计、 青少年近视眼MCLs的调节、图像质量和视觉功能。该组织此前曾 开发了用于检测老视矫正的自适应光学技术，基于波前的新方法 感知以量化调节反应，人工晶状体设计用于老花眼和心理物理范例 适合年轻的受试者。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的干预措施减慢的调节和双眼机制的潜在因素 向下近视。长期目标是发展一种机械性的理解，以帮助指导设计和 MCL近视控制干预的个性化研究。我们计划1)确定适应性反应 利用青少年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)测试调节反应对儿童预后成功的作用 已经在临床上用多焦点隐形眼镜治疗过的人

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