角膜塑形镜和脑视觉神经可塑在减缓近视进展中的协同作用研究

The Synergistic Effect of Orthokeratology Lens and Brain Optic Neuroplasticity in Slowing Myopia Progression

摘要: 目的：探讨以角膜塑形镜为主，双眼视觉信息处理效率的检查和训练的脑视觉生物模型为辅助，两者在临床眼科协调应用对减缓近视进展的作用效果评估。方法：100名8~14岁的近视青少年参加了前瞻性、自我对照研究。收集了一般信息，并在基线和换用角膜塑形镜片后1、3、6和12个月进行了检查。检查包括评估双眼视觉信息处理层面的信噪比平衡点，眼轴长度和屈光度，对3个月的复查患者且存在双眼视不平衡情况的进行二次分类，一组为观察组，根据其双眼间缺损情况进行个性化视觉训练(9个月)，即从脑视觉神经可塑层面提高患者的双眼视觉信息处理效率。一组为对照组，不进行相关视觉训练。实验结束后对两组进行临床近视防控效果评估。结果：100名角膜塑形镜患者在第三个月进行复查时，有82人存在双眼不平衡情况，按双眼相差等级严重程度从大到小选出60人进行二次分类，结果观察组的屈光度前后状态为–2.51 ± 1.23 (D)到–2.42 ± 1.19 (D)，前后均差为–0.09 ± 0.06 (D)，眼轴长度前后状态为24.67 ± 0.090 (MM)到24.62 ± 0.1 (MM)，前后均差为0.05 ± 0.02，对照组屈光度前后状态为–2.53 ± 1.21 (D)到–2.60 ± 1.09 (D)，前后均差为0.07 ± 0.03 (D)，眼轴长度前后状态为24.65 ± 0.100 (MM)到24.69 ± 0.08 (MM)，前后均差为–0.04 ± 0.03。观察组前后双眼视信噪比平衡点等级差显著变小(P < 0.05)，对照组基本没改变，两组之间的屈光度前后变化和眼轴前后变化有统计学意义(P < 0.05)。结论：近视患者佩戴角膜塑形镜3个月稳定期之后，脑视觉层面的双眼视信噪比平衡点大部分存在一定问题，通过匹配的视觉训练模型能够提高双眼信号噪声分离能力，在消除双眼间平衡点信噪比等级差后，患者的双眼视觉信息处理层面的干扰得到解决，配合角膜塑形镜能够更好的控制近视的屈光度和眼轴发展。

Abstract: Objective: To investigate the effect of orthokeratology lens, the evaluation of binocular visual in-formation processing efficiency and the training of brain vision biological model as the auxiliary, and the coordinated application of the two in clinical ophthalmology to slow down the progression of myopia. Methods: 100 myopic adolescents aged 8 to 14 participated in a prospective, self- con-trolled study. General information was collected and reviewed at baseline and at 1, 3, 6, and 12 months after switching to orthokeratology lenses. The examination includes evaluating the balance point of signal-to-noise ratio at the level of binocular visual information processing, axial length and diopter, and secondary classification of patients with binocular vision imbalance after 3 months of reexamination. One group is the observation group. Individualized visual training (9 months) was performed on the condition of interstitial defect, that is, the efficiency of binocular visual information processing was improved from the level of brain optic neuroplasticity. One group was the control group and did not receive relevant visual training. After the experiment, the clinical efficacy of myopia prevention and control was evaluated in the two groups. Results: When the 100 orthokeratology patients were reexamined in the third month, 82 patients had bilateral imbalance, and 60 patients were selected for secondary classification according to the severity of the difference between the eyes. Anterior and posterior states of diopter ranged from –2.51 ± 1.23 (D) to –2.42 ± 1.19 (D), anterior and posterior mean difference was –0.09 ± 0.06 (D), and anterior and posterior states of axial length ranged from 24.67 ± 0.090 (MM) to 24.62 ± 0.1 (MM ), the ante-rior-posterior mean difference was 0.05 ± 0.02, the anterior-posterior state of the diopter in the control group was –2.53 ± 1.21 (D) to –2.60 ± 1.09 (D), the anterior-posterior mean difference was 0.07 ± 0.03 (D), and the anterior-posterior state of the axial length was 24.65 ± 0.100 (MM) to 24.69 ± 0.08 (MM), with a mean difference of –0.04 ± 0.03 before and after. The level difference of binocular visual signal-to-noise ratio before and after the observation group was significantly smaller (P < 0.05), while the control group did not change. Conclusion: After wearing orthokeratol-ogy lenses for 3 months, there are some problems in the balance point of binocular visual sig-nal-to-noise ratio at the level of brain vision in myopia patients. The matching visual training model can improve the separation ability of binocular signal and noise. After the level of signal-to-noise ratio at the balance point is poor, the interference of the patient's binocular visual information processing level is resolved, and the combination of orthokeratology lens can better control the di-opter and axial development of myopia.