Longitudinal evaluation of optical and neural factors leading to juvenile myopia

摘要/摘要： 预测显示，到2050年，全球将有超过50%的人口患有近视。发展，发展 成功的近视预防方案，关键是首先要看清光学成像和视觉 近视儿童的加工特征。相当多的证据表明， 视觉形象和没有模糊是眼睛正常生长和正视化的主要驱动因素。人类 眼睛具有复杂的光学、视网膜和视觉处理结构和功能。所有这些因素中的任何一个 影响图像质量的感知，因此可能是无法控制眼睛的催化剂 延长与儿童近视发展的关系。更好地理解发展的机制(S) 对于近视，这些因素应该在同一个孩子身上进行纵向测量，在此之前和 近视发作后。 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 加工因素可能有助于近视的发展。我们将招募两批年轻的 儿童，限制只有高风险或低风险的儿童在 研究的持续时间。以下因素将在每个儿童身上每隔6个月进行一次评估 3年：(1)视网膜成像的光学质量。我们预测：动态调节较少 近视发展前稳定，导致视网膜图像退化；患有近视的儿童将 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 当受试者观察到不同类型和数量的模糊图像时，进行图形视网膜电检查 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。(3) 将使用模糊检测和辨别阈值以及对比敏感度来测量模糊处理 在视野中起作用的图像模糊类型与(2)中描述的类型相同。我们预测视觉效果 患有近视的儿童对模糊的处理能力会受到损害。 我们将创建三个指标之间相互作用的单独模型：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、视网膜功能和视力方面的缺陷 处理或它们的相互作用导致模糊的异常表示的循环，这反过来会导致 近视的发展。了解激活近视发展的信号将具有重要的意义 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。了解近视的发展机制(S)对于设计有效的近视是必不可少的 对有近视风险的儿童进行个性化干预，这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.