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: 10661743
• 负责人: Heather Anne Anderson
• 金额: $ 39.24万
• 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/10661743
• 关键词: Activities of Daily Living; Address; Adult; Advocate; Affect; Age; Amblyopia; Back; Child; Childhood; Clinical; Cognitive; Compensation; Cornea; Corneal Topography; Crossover Design; Development; Disabled Persons; Down Syndrome; Early Intervention; Education; Enrollment; Evaluation; Exposure to; Eye; Eyeglasses; Fostering; Funding; Goals; Health; Hybrids; Hyperopia; Image; Impaired cognition; Individual; Lead; Measurement; Measures; Methodology; Methods; Mission; National Eye Institute; Optics; Outcome; Patients; Persons; Population; Printing; Process; Protocols documentation; Randomized; Reading; Refractive Errors; Research; Techniques; Testing; United States; Update; Vision; Visit; Visual; Visual Acuity; Work; clinical examination; cohort; experience; expiration; follow-up; improved; innovation; monocular; novel therapeutic intervention; patient population; prevent; primary outcome; public health relevance; rate of change; retinal imaging; simulation; stem; tool; treatment arm; treatment trial; visual performance

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，唐氏综合症(DS)患者视力下降 这可能是由于高水平的屈光误差(球面和柱面)和更高阶的水平升高造成的 从童年起就存在的畸形。通过眼镜矫正瞄准光学像差 从波前像差的测量中客观地确定屈光度是我们长期目标的一部分 为改善这一群体的视力提供新的治疗策略。中心假设是，衡量 视觉和视网膜图像质量(度量)可用于识别优化的球面和柱面校正 与传统矫正相比，多行矫正带来了更好的视觉效果。我们之前对这些的评估 在患有DS的成年人中，矫正发现视力有所改善，但并不是预测的多线水平。我们建议 视力提高的这种不匹配归因于几十年来暴露在矫正不佳的光学缺陷中 导致视力潜力降低(即屈光性弱视)。此外，该方法本身就是 单眼，而不是规定折射患者的双眼视觉体验，如 会发生在临床检查中。这项工作的短期目标是解决这些拟议的障碍，以实现 通过在中国进行的一项随机治疗试验，使用度数优化屈光度提高了线敏感度 弱视治疗的最佳年龄范围内的DS儿童。这项试验将比较敏锐度 三种屈光方法的结果：1)度数优化屈光，2)临床屈光，3)混合屈光 允许临床改进度数优化屈光状态的方法。此外，我们亦致力改善 通过在计算波前成像之前去除膨胀来进行客观屈光过程 度量值，以及在延长的随访期间确定屈光度的变化率来指导患者 更新的屈光恢复时间(即后续时间间隔)。这项工作将通过三个阶段完成 具体目标：目标1)比较通过波前测量获得的屈光度和结果视力 和扩张后。目的2)比较度量值优化、临床和临床改进的视力结果 DS儿童治疗试验中的度数优化屈光度。目标3)确定变化率 儿童和成人DS患者四年内的屈光状态与年龄和屈光不正类型的关系。 度规优化的折射是创新的，因为它补偿了在 DS人群的屈光过程，并允许临床医生考虑针对整体图像的矫正 质量。这项拟议的研究具有重要意义，因为它提出了以优化的方式使用眼镜来 消除视觉障碍。多线视力提高治疗屈光性弱视将导致终生 好处，包括获得传统印刷尺寸，促进教育工作，并促进日常活动 生活，所有这些都可能促进更大的独立性。这项工作同样适用于其他患者 不能完全参与主观屈光的人群(幼儿、认知障碍等)。

项目成果

A Randomized Trial of Objective Spectacle Prescriptions for Adults with Down Syndrome: Baseline Data and Methods.

• DOI: 10.1097/opx.0000000000001631
• 发表时间: 2021-01-01
• 期刊: Optometry and vision science : official publication of the American Academy of Optometry
• 作者: Anderson HA;Benoit JS;Marsack JD;Manny RE;Ravikumar A;Fern KD;Trast KR
• 通讯作者: Trast KR

Ciliary muscle thickness in adults with Down syndrome.

• DOI: 10.1111/opo.12974
• 发表时间: 2022-07
• 期刊: OPHTHALMIC AND PHYSIOLOGICAL OPTICS
• 影响因子: 2.9
• 作者: Anderson, Heather A.;Bailey, Melissa D.;Manny, Ruth E.;Kao, Chiu-Yen
• 通讯作者: Kao, Chiu-Yen