Identification of optimum spectacle prescriptions for patients with Down syndrome

描述（由申请人提供）：众所周知，唐氏综合征（DS）患者患有严重的眼部并发症，包括高水平的低阶屈光不正（球体和圆柱体）和高阶像差水平升高。这些光学因素可能导致这一人群的视力不佳，我们的长期目标是提供新的治疗策略来改善这一群体的视力。目前的临床处方实践不能很好地服务于这一群体，因为主观屈光顺序的认知需求对这一人群来说是困难的，并且往往使临床医生根据客观的临床结果来开处方，目标是完全纠正球柱屈光误差。这种处方的做法可能会导致低于标准的结果，因为充分的低阶矫正会加剧高阶像差对更多像差眼睛的影响。本工作的短期目标是通过考虑每只眼睛独特的像差结构来优化退行性椎体滑移患者的眼镜矫正，然后在治疗试验中评估这些矫正的效果。中心假设是，测量视网膜图像质量（指标）可以用来确定替代的低阶校正，以平衡低阶和高阶像差的影响，以优化视觉。这一假设得到了初步数据的证实，这些数据表明，通过这些优化的校正，模拟DS眼睛的光学，阅读图表的观察者的视力会有多线改善。这一客观处方策略将在本工作中进一步证实三个具体目标：1)识别

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.).