Identification of optimum spectacle prescriptions for patients with Down syndrome

项目概要/摘要：众所周知，唐氏综合征（DS）患者的视力下降， 这可能是由于高度的屈光不正（球面和柱面）和高阶屈光不正的升高 从童年就存在的异常。通过眼镜矫正瞄准光学像差， 从波前像差的测量中客观地确定屈光度是我们长期目标的一部分， 提供新的治疗策略，以改善这一群体的视力。核心假设是， 视觉和视网膜图像质量（度量）可用于识别球面和柱面校正 视力，导致多线敏锐度增益超过传统的矫正。我们之前对这些的评估 成年DS患者的矫正发现了敏锐度的改善，但不是预测的多线水平。我们提出 这种敏锐度增益的不匹配归因于数十年来暴露于矫正不良的光学缺陷， 导致视力潜能降低（即屈光性弱视）。此外，该方法固有地 单眼，并且不规定反映患者双眼视觉体验的屈光度， 这项工作的短期目标是解决这些提出的障碍，多- 通过一项随机治疗试验，使用度量优化的屈光度改善线敏度， 在弱视治疗的最佳年龄范围内的DS儿童。这项试验将比较 三种屈光方法的结果：1）度量优化屈光，2）临床屈光，和3）混合 该方法允许临床改进度量优化屈光。此外，我们亦致力改善 通过在波前成像之前去除计算所需的膨胀， 度量值，以及确定延长随访期间的屈光变化率，以指导患者 更新验光的召回时间（即随访间隔）。这项工作将通过三个 具体目的：目的1）比较术前波前测量获得的屈光度和最终视力。 和后扩张。目的2）比较度量优化、临床和临床改进的视力结果 在DS儿童的治疗试验中进行度量优化的屈光度。目标3）确定变化率 在患有DS的儿童和成人中，在四年内每年将屈光作为年龄和屈光不正类型的函数。 度量优化的屈光是创新的，因为它补偿了主观输入的缺失， DS人群的屈光过程，并允许临床医生考虑针对整体图像的矫正 质量.这项研究的重要性在于，它提出了以优化的方式使用眼镜， 消除视觉障碍。治疗屈光性弱视的多线视力增益将导致终身 好处，包括获得传统的打印尺寸，促进教育工作，并促进日常活动 生活，所有这些都可以促进更大的独立性。这项工作同样适用于其他病人 不能完全参与主观验光的人群（幼儿、认知障碍等）。

Project Summary/Abstract: It is known that individuals with Down syndrome (DS) have reduced visual acuity which may result from high levels of refractive error (sphere and cylinder) and elevated levels of higher-order aberrations that are present from childhood. Targeting optical aberrations through spectacle correction with refractions determined objectively from measures of wavefront aberrations is part of our long-term goal to provide new treatment strategies to improve vision in this group. The central hypothesis is that measures of visual and retinal image quality (metrics) can be used to identify sphere and cylinder corrections that optimize vision, resulting in multi-line acuity gains over traditional corrections. Our previous evaluation of these corrections in adults with DS found improvement in acuity, but not the multi-line levels predicted. We propose that this mismatch in acuity gains is attributed to decades of exposure to poorly corrected optical deficits that has resulted in a reduction in visual acuity potential (i.e. refractive amblyopia). Further, the method is inherently monocular, and does not prescribe refractions reflective of the two-eyed visual experience of the patient, as would occur in a clinical exam. The short-term goal of this work is to address these proposed barriers to multi- line acuity improvements with metric-optimized refractions through a randomized treatment trial conducted in children with DS who are within the optimal age for treatment of amblyopia. This trial will compare acuity outcomes for three refractive methods: 1) metric-optimized refractions, 2) clinical refractions, and 3) a hybrid method that allows for clinical refinement of the metric-optimized refraction. In addition, we seek to improve the objective refraction process by removing dilation prior to the wavefront imaging necessary to compute the metric values, as well as determining the rate of change in refraction during extended follow-up to guide patient recall times (i.e. follow-up intervals) for updated refraction. This work will be accomplished through three specific aims: Aim 1) Compare refractions and resultant visual acuity obtained from wavefront measures pre- and post-dilation. Aim 2) Compare visual acuity outcomes of metric-optimized, clinical, and clinically-refined metric-optimized refractions in a treatment trial of children with DS. Aim 3) Determine rate of change in refraction as a function of age and refractive error type annually over four years in children and adults with DS. Metric-optimized refraction is innovative in that it compensates for the absence of subjective input in the refraction process for the DS population and allows the clinician to consider corrections targeting overall image quality. This proposed research is significant in that it proposes to use spectacles in an optimized manner to remove visual barriers. Treatment of refractive amblyopia with multi-line acuity gains would lead to lifelong benefits, including access to traditional print size, facilitate educational efforts, and facilitate activities of daily living, all of which may promote greater independence. This work is similarly applicable to other patient populations who cannot fully participate in subjective refractions (young children, cognitively impaired, etc.).