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: 8748949
• 负责人: Heather Anne Anderson
• 金额: $ 31.34万
• 依托单位: UNIVERSITY OF HOUSTON
• 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 2019-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8748949
• 关键词: Accounting; Activities of Daily Living; Address; Advocate; Affect; Child; Clinical; Cognitive; Cognitive deficits; Communities; Corneal Diseases; Data; Disabled Persons; Down Syndrome; Equilibrium; Eye; Eyeglasses; Fostering; Goals; Health; Image; Impaired cognition; Individual; Lead; Left; Life; Measures; Methods; Metric; Mission; Modality; National Eye Institute; Operative Surgical Procedures; Optics; Outcome; Patients; Performance; Persons; Population; Printing; Process; Quality of life; Randomized; Readability; Reading; Refractive Errors; Research; Retinal; Simulate; Source; Structure; Techniques; Testing; Time; Traumatic Brain Injury; United States; Vision; Visit; Visual; Visual Acuity; Work; base; clinical practice; design; experience; improved; innovation; novel strategies; patient population; public health relevance; relating to nervous system; tool; treatment strategy; treatment trial

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.).

描述（由申请人提供）：众所周知，患有唐氏综合症（DS）的个体患有明显的眼部并发症，包括高水平的低阶折射误差（球体和圆柱体）和较高的较高畸变水平升高。这些光学因素可能导致在该人群中观察到的敏锐度不佳，并且是OU长期目标的重要目标，可以提供新的治疗策略来改善该组的视力。当前的临床处方实践在这个社区的范围内，因为该人群的主观折射顺序的认知需求很难，并且经常使临床医生从客观的临床发现中开出针对sphero-cylim-cylindrical dercracial fracacive误差的客观临床发现。考虑到完全低阶校正会加剧更差的眼睛中高阶畸变的影响，这种处方实践可能会导致低于标准的结果。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，然后在治疗试验中评估这些校正的性能，以优化DS患者的眼镜校正。中心假设是，可以使用视网膜图像质量（指标）的度量来识别替代性的低阶校正，以平衡较低和高阶畸变的影响以优化视力。这一假设通过初步数据证实，表明观察者阅读图表的视力改善，这些图表通过这些优化的校正模拟了DS眼的光学。这项工作将通过三个特定目的在这项工作中进一步证实这一目标处方策略：1）确定 根据控制观察者的判断，当最大化时，当最大化时，始终如一地对DS眼睛的全阶校正进行了改进。 2）在一项随机治疗试验中，测试了从AIM 1校正AIM 1的矫正能力。 3）评估AIM 2中的受试者是否通过比较来自DS的受试者的敏锐度提高到对控制图表的预测敏锐度提高，以查看图表的预测敏锐度提高，从而完全受益于公制的校正。这种方法具有创新性，因为它消除了折射过程的主观输入的障碍，并允许临床医生考虑针对整体的较低阶段校正 图像质量，而不是简单地减轻低阶折射误差的影响。这项拟议的研究非常重要，因为它建议以优化的方式使用该人群的患者（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。预计敏锐度的多行改善将增加获得传统印刷尺寸的机会，促进职业努力并协助日常生活活动，所有这些活动都可能促进更大的独立性。这项工作的应用是无法完全参与主观折射（幼儿，认知受损等）的其他患者，并且需要改善奇观表现（角膜疾病，手术不良等）的患者。