Longitudinal evaluation of optical and neural factors leading to juvenile myopia

总结/摘要： 预测表明，到2050年，超过50%的世界人口将患有近视。发展 成功的近视预防计划，关键是首先辨别光学图像的形成和视觉 近视儿童的加工特征。大量证据表明， 视觉图像和不存在模糊是正常眼生长和正视化的主要驱动力。人类 眼睛具有复杂的光学、视网膜和视觉处理结构和功能。所有这些因素 影响对图像质量的感知，因此可能是无法控制视觉的催化剂。 延长和儿童近视发展。为了更好地了解开发的机制， 近视，这些因素应该在同一个孩子在一个纵向的时间，之前和 在近视发生后。 这项前瞻性纵向研究的直接目标是梳理出视网膜图像质量和视觉 可能导致近视发展的加工因素。我们将招募两组年轻人 儿童，将资格限制在只有在高风险或低风险发展近视的儿童， 研究的持续时间。以下因素将在每6个月的时间内对每个儿童进行评估， 3年：（1）在视网膜上形成的图像的光学质量。我们预测：动态调节较少 在近视发展之前稳定，导致视网膜图像退化;发展近视的儿童将 显示整个视网膜的图像质量下降。(2)视网膜对图像模糊的反应将使用 当受试者观察被各种类型和数量的视网膜电图模糊的图像时， 模拟光学模糊。我们预测，视网膜反应受损的儿童将发展为近视。（三） 将使用模糊检测和辨别阈值以及对比敏感度来测量模糊的处理 在整个视野中对（2）中描述的相同类型的图像模糊起作用。我们预测， 在发展成近视的儿童中，模糊的处理将受损。 我们将创建三个指标之间的相互作用的个人模型：光学图像质量，视网膜 功能和视觉处理。我们预测，视网膜图像质量、视网膜功能和视觉功能的缺陷， 处理或它们的相互作用导致模糊的异常表示的循环，这反过来又会导致 近视的发展。了解激活近视发展的信号将对近视的发展产生重大影响。 影响，并将帮助我们和其他研究人员设计未来的临床研究，以预防和控制 近视对于近视发展的机制的知识对于设计有效的治疗方案是至关重要的。 在有近视风险的儿童中进行个体化干预，可以在随后的临床试验中进行评估。

Summary/Abstract: Projections indicate that over 50% of the world’s population will have myopia by the year 2050. To develop successful myopia prevention programs, it is critical to first discern the optical image formation and visual processing characteristics in children who develop myopia. Considerable evidence points to the quality of the visual image and absence of blur as the main drivers for normal ocular growth and emmetropization. Human eyes have complex optical, retinal and visual processing structures and functions. Any and all of these factors affect the perception of image quality, and may, therefore, be catalysts of the failure to control ocular elongation and myopia development in children. To better understand the mechanism(s) for the development of myopia, these factors ought to be measured in the same children over a longitudinal period, prior to and after the onset of myopia. The immediate objective of this prospective longitudinal study is to tease out retinal image quality and visual processing factors that may contribute to the development of myopia. We will recruit two groups of young children, limiting eligibility to only children who are either at high risk or low risk to develop myopia during the duration of the study. The following factors will be assessed in each child at 6-month intervals over a period of 3 years: (1) Optical quality of the image formed at the retina. We predict that: dynamic accommodation is less stable prior to myopia development, causing degraded retinal images; and children who develop myopia will show degraded image quality across the retina. (2) Retinal responses to image blur will be measured using pattern electroretinography while subjects observe images blurred with various types and amounts of simulated optical blur. We predict that children with impaired retinal responses will develop myopia. (3) Processing of blur will be measured using blur detection and discrimination thresholds and contrast sensitivity functions across the visual field to the same types of image blur described in (2). We predict that visual processing of blur will be impaired in children who develop myopia. We will create individual models of interactions between the three measures: optical image quality, retinal function and visual processing. We predict that deficits in retinal image quality, retinal function and visual processing or their interactions lead to a cycle of abnormal representation of blur, which would in turn cause the development of myopia. Understanding the signals that activate myopia development will have a significant impact and will help us and other researchers to design future clinical studies for the prevention and control of myopia. Knowledge of the mechanism(s) for myopia development is essential for the design of effective individualized interventions in children at risk for myopia, which can be assessed in subsequent clinical trials.