虚拟远像装置在近视防控中的研究进展

Research Progress of Virtual Distant Viewing Device in Myopia Prevention and Control

摘要: 虚拟远像装置(virtual distant viewing device, VDVD)基于数字光学重构技术，通过模拟4~8米等效视距场景，在近视防控中展现出多维度调控作用。其核心机制包括：(1) 光谱–神经调控：450~480 nm短波长光可激活自感光视网膜神经节细胞(ipRGC)，通过黑视蛋白(melanopsin)信号通路调控视网膜多巴胺释放，进而影响脉络膜厚度；(2) 动态视标运动(0.5~1.2 Hz)维持睫状肌微波动(0.25~0.75 D)，减少调节滞后；(3) 激活eNOS/cGMP通路提升脉络膜血流灌注，延缓巩膜缺氧性改变。临床研究显示，规范应用可使近视进展减缓58% (等效球镜变化干预组−0.38 D/y vs. 对照组−0.91 D/y，P < 0.001)，联合抗VEGF治疗可能通过改善脉络膜微环境协同增效，但目前仍需临床试验验证，为病理性近视管理提供新思路。本文整合21项关键研究(含3项多中心RCT)，通过“光学离焦–神经信号传导–组织重塑”多维作用机制的系统分析，阐明VDVD的近视调控路径，为优化近视精准防控策略提供新理论依据。

Abstract: The virtual distant viewing device (VDVD), based on digital optical reconstruction technology, demonstrates multidimensional regulatory effects in myopia prevention and control by simulating 4~8 meters equivalent viewing distance scenarios. Its core mechanisms include: (1) Spectral-Neural Modulation: Short-wavelength light (450~480 nm) activates intrinsically photosensitive retinal ganglion cells (ipRGCs) via the melanopsin signaling pathway, regulating retinal dopamine release and subsequently influencing choroidal thickness; (2) Dynamic Visual Target Motion (0.5~1.2 Hz): Maintaining ciliary muscle microfluctuations (0.25~0.75 D), reducing accommodative lag; (3) Activation of the eNOS/cGMP Pathway: Enhancing choroidal blood flow perfusion, thereby delaying hypoxia-induced scleral remodeling. Clinical studies indicate that standardized application of VDVD can slow myopia progression by 58% (spherical equivalent change: intervention group −0.38 D/y vs. control group −0.91 D/y, P < 0.001). Combined use with anti-VEGF therapy may synergistically improve choroidal microenvironments, though clinical trials are still needed for validation, offering novel insights into pathologic myopia management. This review integrates 21 key studies (including 3 multicenter RCTs) and systematically analyzes the multidimensional mechanisms of “optical defocus, neural signal transduction, and tissue remodeling” to elucidate the myopia regulatory pathways of VDVD, providing new theoretical foundations for optimizing precision myopia control strategies.