漸進多焦(兒童控制近視)與單光鏡片對於高度調節遲緩及近方內斜位兒童近視減緩的比較

http://www.iovs.org/content/early/2011/01/31/iovs.10-6631.abstract

熱騰騰，2011年一月發表的論文。

根據理論，漸進多焦鏡片(用於兒童時，稱兒童控制近視鏡片)，對於某些特定兒童，具有較好的近視控制效果，也就是調節遲緩與近方內斜位的兒童對兒控鏡片的反應會比較好。

以下這篇今年的論文提供了更多的證據。

對象選取為118位年齡在8~12歲，等值球面在-0.75D~-2.50D，且近方內斜位大於2個稜鏡度以上者，進行雙盲、多中心、隨機試驗。

調節遲緩的量一開始定義為至少0.50D，後來修改為至少1.00D。104個兒童調節遲緩高於1.00D，14個孩童調節遲緩在0.50D~0.99D。

兒童隨機分為接受加入度+2.00D的漸進多焦鏡片或標準單焦鏡片，且家長及兒童並不知道所配戴的鏡片種類。

6個月間隔的隨訪持續了三年。每年年度的檢查都採用散瞳後的電腦驗光數據作為比較。

結果三年後漸進多焦組的等值球面平均變化為-0.87D，單焦鏡片組為-1.15D，差距為0.28D。

結論是有統計上的差異，但臨床上的效果並不是非常明顯。

Progressive Addition Lenses versus Single Vision Lenses for Slowing Progression of Myopia in Children with High Accommodative Lag and Near Esophoria

1. Correction of Myopia Evaluation Trial 2 Study Group for the Pediatric Eye Disease Investigator Group

1. Correspondence and reprint requests to: Jane E. Gwiazda, PhD., c/o Jaeb Center for Health Research, 15310 Amberly Drive, Suite 350, Tampa, FL 33647; Phone:(813) 975-8690, Fax: (813) 975-8761, E-mail: pedig@jaeb.org

Abstract

Purpose: To determine if progressive addition lenses (PALs) relative to single vision lenses (SVLs) slow the progression of low myopia in children with high accommodative lag and near esophoria.

Methods: One hundred eighteen children aged 8 to <12 years with spherical equivalent refraction (SER) from -0.75 to -2.50D and near esophoria ≥ 2PD were enrolled in this double-masked, multi-center, randomized trial. A key additional eligibility criterion was high accommodative lag, initially defined as at least 0.50D (accommodative response less than 2.50D for a 3.00D demand) and later restricted further to at least 1.00D. One hundred four subjects had accommodative lags at least 1.00D and 14 had lags between 0.50 and 0.99D. Children were randomized to receive either PALs (Essilor Ellipse) with a +2.00D addition or standard SVLs. The clinicians performing the outcome testing, as well as the children and their families, were masked to treatment group. Follow-up visits occurred every 6 months for 3 years. At annual visits, refractive error was assessed in each eye using cycloplegic autorefraction. The main outcome measure was change from baseline to three years in SER by cycloplegic autorefraction.

Results: The mean change in SER between baseline and the 3-year primary outcome visit was -0.87D in the PAL group and -1.15D in the SVL group, for a difference of 0.28D (95% confidence interval = 0.01 to 0.55D).

Conclusion: The PALs used in this study were found to have a statistically but not clinically significant effect on slowing myopia progression in children with high accommodative lag and near esophoria.