Identification of optimum spectacle prescriptions for patients with Down syndrome

描述(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(球镜和柱面)和高水平的高阶像差。这些光学因素很可能是导致这一人群中观察到的视力低下的原因，也是我们长期目标的一个重要目标，即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，因为主观屈光序列的认知需求对这一人群来说是困难的，而且往往让临床医生根据客观的临床结果开出处方，目标是完全矫正球柱形屈光不正。这种处方做法可能会导致低于平均水平的结果，因为事实是，完整的低阶矫正可能会加剧更多像差眼睛的高阶像差的影响。这项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(度量值)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，以优化视力。这一假设得到了初步数据的证实，这些数据表明，观察者阅读带有这些优化校正的模拟DS眼睛光学的图表时，视力有了多线改善。这一目标处方策略将通过三个具体目标在这项工作中得到进一步充实：1)确定 当最大化时，根据控制观察者的判断，一致地提供对DS眼睛的完全低阶校正的改进。2)在随机治疗试验中，测试来自目标1的度量派生矫正在DS患者中的表现优于临床派生矫正的能力。3)评估目标2中的受试者是否完全受益于度量式矫正，方法是比较患有DS的受试者在每次矫正时测量的视力增益与来自对照观察图的预测视力增益，这些对照观察图模拟了患有DS的受试者的光学特性。这种方法是创新的，因为它消除了主观输入到屈光过程的障碍，并允许临床医生考虑总体目标的低阶矫正 图像质量，而不是简单地减轻低阶屈光误差的影响。这项拟议的研究具有重要意义，因为它建议以优化的方式为这类患者(眼镜)使用最容易获得的治疗策略，以消除DS患者的一个重要障碍。多行锐度的改善预计将增加对传统印刷尺寸的使用，促进职业努力，并协助日常生活中的活动，所有这些都可能促进更大的独立性。这项工作的应用对其他不能完全参与主观屈光的患者(幼儿、认知障碍等)影响深远。以及那些需要改善眼镜性能的像差水平升高的患者(角膜疾病、手术结果不佳等)。

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.).