Identification of optimum spectacle prescriptions for patients with Down syndrome

描述（由申请人提供）：众所周知，患有唐氏综合征（DS）的个体患有严重的眼部并发症，包括高水平的低阶屈光不正（球面和柱面）和高水平的高阶像差。这些光学因素可能导致在该人群中观察到的视力差，并且是提供新的治疗策略以改善该人群视力的长期目标的重要目标。目前的临床处方实践服务不足，因为主观验光序列的认知需求对这一人群来说很困难，并且通常让临床医生根据目标为完全矫正球柱镜屈光不正的客观临床结果开处方。这种处方实践可能导致低于标准的结果，因为完全低阶矫正可能会加剧高阶像差对更多像差眼睛的影响。这项工作的短期目标是通过考虑每只眼睛的独特像差结构来优化DS患者的眼镜矫正，然后在治疗试验中评估这些矫正的性能。中心假设是视网膜图像质量的测量（度量）可以用于识别替代的低阶校正，其平衡低阶和高阶像差的影响以优化视觉。初步数据证实了这一假设，表明观察者阅读图表，模拟DS眼睛的光学与这些优化的校正视力的多线改善。这项工作将通过三个具体目标进一步证实这一客观的处方策略：1）确定 指标，当最大化时，一致地提供对DS眼睛的全低阶校正的改进，如由控制观察员判断的。2)在一项随机治疗试验中，测试目标1的度量校正优于DS患者临床校正的能力。3)通过比较DS受试者的实测视力增量与对照观察表（模拟DS受试者每次矫正的光学）的预测视力增量，评价目标2中的受试者是否完全受益于度量导出的矫正。这种方法是创新的，因为它消除了主观输入屈光过程的障碍，并允许临床医生考虑低阶校正， 图像质量，而不是简单地减轻低阶屈光不正的影响。这项拟议的研究意义重大，因为它建议以优化的方式为这一患者人群（眼镜）使用最容易获得的治疗策略，以消除DS患者的重大障碍。多线的敏锐度的改善预计将增加获得传统的打印尺寸，促进职业努力，并协助日常生活的活动，所有这些都可能促进更大的独立性。这项工作的应用是深远的其他病人谁不能完全参与主观验光（幼儿，认知障碍等）以及那些像差水平升高、需要改善眼镜性能的人（角膜疾病、手术效果不佳等）。

DESCRIPTION (provided by applicant): It is well known that individuals with Down syndrome (DS) suffer from significant ocular complications including high levels of lower-order refractive error (sphere and cylinder) and elevated levels of higher-order aberrations. These optical factors likely contribute to the poor acuity observed in this population and are a substantial target of ou long-term goal to provide new treatment strategies to improve vision in this group. Current clinical prescribing practices under-serve this community, as the cognitive demands of the subjective refraction sequence are difficult for this population and often leave clinicians to prescribe from objective clinical findings that target full correction of sphero-cylindrical refracive error. This prescribing practice can lead to sub-par outcomes given the fact that full lower-order corrections can exacerbate the effects of higher-order aberrations in more aberrated eyes. The short-term goal of this work is to optimize spectacle corrections for patients with DS by considering the unique aberration structure of each eye and then evaluate the performance of these corrections in a treatment trial. The central hypothesis is that measures of retinal image quality (metrics) can be used to identify alternative lower-order corrections that balance the effects of lower and higher-order aberrations to optimize vision. This hypothesis is substantiated by preliminary data demonstrating multi-line improvements in visual acuity of observers reading charts that simulate the optics of DS eyes with these optimized corrections. This objective prescribing strategy will be further substantiated in this work by three specific aims: 1) Identify metrics that, when maximized, consistently provide improvements over full lower-order corrections for DS eyes, as judged by control observers. 2) Test the ability of metric-derived corrections from Aim 1 to outperform clinically derived corrections in patients with DS in a randomized treatment trial. 3) Evaluate whether subjects in Aim 2 fully benefitted from metric-derived corrections by comparing measured acuity gains from subjects with DS to predicted acuity gains from controls viewing charts simulating the optics for subjects with DS for each correction. This approach is innovative in that it removes the barrier of subjective input to the refraction process and allows the clinician to consider lower-order corrections that target overall image quality, rather than simply mitigating the effects of lower-order refractive error. This proposed research is significant in that it proposes to use the most accessible treatment strategy for this population of patients (spectacles) in an optimized manner to remove a significant barrier for individuals with DS. Multi-line improvements in acuity are anticipated to increase access to traditional print sizes, facilitate vocational efforts, and assist in activitiesof daily living, all of which may promote greater independence. The application of this work is far-reaching to other patients who cannot fully participate in subjective refractions (young children, cognitively impaired, etc.) and those with elevated levels of aberrations who require improved spectacle performance (corneal disease, poor surgical outcomes, etc.).