近视管理入门：我需要什么设备？

发布：

随着近视控制中的临床和研究活动的增加，从业者开始在近视管理方面的重要推动力。但是，如果您开始使用，您需要什么设备？什么是要点？

如在国际近视研究所（IMI）临床管理指南报告，，，，1船上有一些关键的设备，还有一些没有关键但有帮助的设备。

Measuring acuity and refraction

Our key role in primary eye care is to measure and correct vision. Don't forget, however, that in myopia we're not just looking for a minus refraction. Hyperopia which is too low for a child's age can indicate莫匹亚前。未来近视的最大危险因素是6-7岁时的+0.50或更少，可以表明进入近视的初始阶段。2在我们的博客中阅读有关此信息的更多信息How to identify and manage pre-myopes。

管理accommo折射的一个关键方面dation in children. This may be especially critical in younger children or those with apparent large changes in their refraction. Show caution when using autorefractors for the same reason.

IMI临床管理指南报告并不需要在临床环境中所有近视折射的所有近视折射，但解释说，它是使用“如指示”的重要工具。“如图所示”允许一个事实，即在“眼睛住宿放松”的情况下可能不可用或适合该孩子，或者可能不需要。IMI定义和分类近视报告。3

有关测量敏锐度和折射，技术和周围的更多信息，请阅读我们的博客How to achieve accurate refractions for children.A helpful tip? Retinoscopy is best. It is the best screening tool for detection of refractive error in children and is recommended by numerous professional organizations. Non-cycloplegic retinoscopy using contralateral eye fogging has also been found to be within 0.30D accuracy of cycloplegic retinoscopy.4

Equipment you need: a child-suitable acuity chart and a retinoscope.

双眼视力评估

这IMI Clinical Management Guidelines Report，，，，1describes accommodation and vergence testing as an important component of the myopia picture. For more information on the link between myopia and binocular vision function, read our blog双眼视力在近视管理中重要的四个原因。最近出版了IMI Accommodation and Binocular Vision in Myopia Development and Progression Reportprovides a scientific exploration for the relationships between accommodation (specifically accommodative lag), retinal blur, closer working distance and potential mechanisms of myopia development and progression.

在临床方面，IMI临床管理指南报告报告，虽然没有商定或“黄金标准”方法来评估双眼视觉1includes two tables which describe the various accommodative function and vergence function tests used in clinical studies. Rarely would a clinical study include each one of these tests - the recommendation was that tests of both systems be employed at baseline and the same tests at follow-up consultations.

Accommodative function:

  • Accommodative accuracy (lag or lead) - open field autorefractors, retinoscopy techniques, photorefractors and non-clinical methods such as aberrometers.
  • 适应性振幅 - 减去镜头技术或俯卧撑测试
  • 适应性设施 - 用加 /减脚弹器测量。

gergence函数：

  • Distance and near heterophorias - Risley prism and Maddox rod, Von Graefe method, alternating cover test, Howell near phoria card, Saladin near point balance card
  • 固定差异近距离 - 沙拉蛋白近点平衡卡
  • AC/A比率 - 计算方法和梯度技术。

如果您对双眼视力测量不自信，则可以从中学到更多扩展我的临床技能portal on this website. There are also freely available videos on accommodation and vergence measurement techniques, and a one-hour lecture entitled 'Binocular Vision - easier than you think' on the近视概况YouTube channel.

To take the next steps, our双眼视觉基础课程简化了如何通过易于遵循视频说明，演示和可下载的参考信息图表评估，诊断和管理BV疾病。这项全面的六小时课程的第一小时可以免费试用。

您需要的设备：用于测量住宿和格式的方法。视网膜镜，加/减脚弹器和棱镜棒将涵盖双眼视力评估的大多数方面。

Corneal Topography

地形对于安全，准确的正常角色拟合至关重要。5关于其他矫正或治疗中的患者，IMI临床管理指南1推荐角膜地形“如果指示（例如，用于隐形眼镜拟合）”。

童年时代的一个值得注意的方面是，尽管儿童的近视进展是典型的，但散光的进展却不是。各种种族的多个大型研究6-8已经表明，随着近视的增加，散光症的增加是很少见的。在6-12岁的儿童中，三年内的0.50dc或更高的进展是不寻常的。如果您观察到这一点，则测量角膜测定法和/或角膜地形对于排除角膜扩张很有用。

当然，视网膜镜检查的角膜反射不规则也需要进一步检查角膜 - 视网膜镜检查具有高灵敏度，以检测到圆锥角膜的早期阶段。9

Equipment you need: a way to measure corneal curvature and shape where indicated - for orthokeratology and/or contact lens fitting, in cases of progressive astigmatism or where an irregular retinoscopy reflex is noted. If access to this equipment is limited for you, consider referral and co-management pathways with primary eye care colleagues and/or ophthalmologists.

轴向长度测量

轴向长度测量is a crucial element of myopia control research studies, and interferometry measurement techniques can be 10 times more accurate than refraction for detecting myopia progression.10

临床ly, axial length measurement is not yet widely employed in primary eye care, with newer instrumentation and research outcomes guiding the way for this to likely become a standard of care.

这IMI Clinical Management Guidelines Report1指出：“在这一点上，在给定个体中尚无针对正常或加速轴向伸长的确定标准。”建议对轴向长度测量“在可用的情况下，使用非接触装置的[和]测量是理想的。”

作为绝对度量，轴向长度似乎是近距离近视级别带来的终身眼健康风险的关键指标。轴向长度大于26mm是风险的关键阈值，11因此，单一衡量孩子的轴向长度（即使无法定期重复）可以指示风险，因此应该多么主动地肌无累的管理策略。

As a relative measure,从考试到外观，轴向长度通常会变化多少？轴向长度正常在整个儿童期润肤膜化过程中增加。同样，IMI：“已证明大约0.1 mm/yr的增加与正常的眼睛生长有关，而0.2至0.3 mm/yr的增加与近视的增加有关，尽管近视进展可能会随着个体的较小的AL变化而发生。“1

Judgement of axial length measures in future will likely involve comparison of the measure against validated percentile growth charts - examples for Chinese and Dutch children have been published. This would mean taking a child’s axial length measurement, comparing it against a chart specific to their age, ethnicity and gender, and determining what percentile of eye length they currently represent. The 50Th百分位数代表平均值，对此的早期研究表明75岁的儿童Th百分位数或更高是最大的近视风险。12Over time, if a child’s percentile decreases with time, this would indicate a successful myopia management strategy. Read more about this latest science inA tale of two studies measuring change to axial length in myopia.

Equipment you need: ideally, a way to access axial length measurement for your myopic patients, and non-contact (interferometry) methods are most accurate. Consider co-management with suitably equipped colleagues and/or ophthalmologists to gain measurements, even if only annually, as this extra data can indicate long-term eye health risk and influence management.

视网膜检查和成像

这IMI Clinical Management Guidelines Report1建议“每年在高肌层和其他指示中对中央和周围视网膜进行检查。功能和/或异常。”

视网膜检查能力和设备的访问因国家和练习环境而异。如果在您的国家使用该技术是典型的，则可以被视为近视护理的标准。如果没有，请遵循您的实践指南范围，以确保年轻近视的视网膜健康每年都会以任何年龄的高肌关（5D或更高）的身份进行审查，并按照您对他人的专业标准表明。最好的做法是确保所有近视都在可能的情况下进行年度眼睛健康检查。

您需要的设备：这取决于您的范围和练习设置。无论您是在进行视网膜健康检查还是参考眼科，请确保您的高肌层每年进行全面的视网膜健康检查，并按照您的专业标准表明。

不要让设备成为入门的障碍

现在有足够多的证据表明，无需采取任何措施来控制近视 - 继续适合童年近视的单一视力校正 - 不是护理的标准。尽管您可能没有所有设备，临床能力或流程来采用上述近视测试和管理的各个方面，但在与同事，眼科和您所在地区的专业标准范围内合作时，可以使用途径。记住这一点每个屈光度在控制近视方面都很重要，因此请保持最新状态，并开始使用可用的工具和指南。

Cassandra Haines Bio Image 2019_white背景“itemprop=

关于卡桑德拉

卡桑德拉·海恩斯（Cassandra Haines）是一名临床验光师，研究人员和作家，具有澳大利亚阿德莱德的政策和倡导背景。她对儿童的视野和近视控制充满兴趣。

凯特个人资料缩略图“itemprop=

关于凯特

凯特·吉福德博士is a clinical optometrist, researcher, peer educator and professional leader from Brisbane, Australia, and a co-founder of Myopia Profile.

This educational content is brought to you thanks to unrestricted educational grant from

References

  1. Gifford KL, Richdale K, Kang P, Aller TA, Lam CS, Liu YM, Michaud L, Mulder J, Orr JB, Rose KA, Saunders KJ, Seidel D, Tideman JWL, Sankaridurg P. IMI - Clinical Management Guidelines Report. Invest Ophthalmol Vis Sci. 2019;60(3):M184-M203.（关联）
  2. Zadnik K，Sinnott LT，Cotter SA，Jones-Jordan LA，Kleinstein RN，Manny RE，Twelker JD，Mutti DO；种族和折射率误差（CLEERE）研究小组的协作纵向评估。预测少年发作的近视。JAMA OPHTHALMOL。2015年6月； 133（6）：683-9。（关联）
  3. Flitcroft Di，He M，Jonas JB，Jong M，Naidoo K，Ohno -Matsui K，Rahi J，Resnikoff S，Vitale S，Yannuzzi L. Imi-定义和分类近视：拟议的临床和流行病学研究标准套。投资Ophthalmol Vis Sci。2019年2月28日； 60（3）：M20-M30。（关联）
  4. Yeotikar NS，Bakaraju RC，Roopa Reddy PS，PrasadK.（2007）Cycloplegic refraction and non-cycloplegic refraction using contralateral fogging: a comparative study,Journal of Modern Optics,54:9,1317-1324（2007）。（关联）
  5. Cho P, Cheung SW, Mountford J, White P. Good clinical practice in orthokeratology. Cont Lens Anterior Eye. 2008 Feb;31(1):17-28.（关联）
  6. O'Donoghue L, Breslin KM, Saunders KJ. The Changing Profile of Astigmatism in Childhood: The NICER Study.投资Ophthalmol Vis Sci。2015;56(5):2917-2925.（关联）
  7. Huynh SC, Kifley A, Rose KA, Morgan IG, Mitchell P. Astigmatism in 12-Year-Old Australian Children: Comparisons with a 6-Year-Old Population.投资Ophthalmol Vis Sci。2007; 48（1）：73-82。（关联）
  8. Tong L，Saw S-M，Lin Y，Chia K-S，Koh D，TanD。新加坡儿童散光的发生率和进展。投资Ophthalmol Vis Sci。2004; 45（11）：3914-3918。（关联）
  9. Al-Mahrouqi H，Oraba SB，Al-Habsi S等。视网膜镜检查作为圆锥角膜的筛查工具。角膜。2019; 38：442-445。（关联）
  10. Wolffsohn JS，Kollbaum PS，Berntsen DA，Atchison DA，Benavente A，Bradley A，Buckhurst H，Collins M，Fujikado T，Hiraoka T，Hirota M，Hirota M，Jones M，Jones D，Logan NS，Logan NS，Lundstrstrorm L，LundströmL，Toriii H，Naidoo Haido Haidoo H，Naidoo Haidoo H，IMI-临床近视控制试验和仪器报告。投资Ophthalmol Vis Sci。2019; 60（3）：M132-M160。（关联）
  11. Tideman JW，Snabel MC，Tedja MS，Van Rijn GA，Wong KT，Kuijpers RW，Vingerling JR，Hofman A，Buitendijk GH，Keunen JE，Boon CJ，Geerards AJ，Luyten AJ，Luyten GP，Verhoeven VJ，Klaver CC。轴向长度与近视与欧洲人的视觉障碍的风险相关联。JAMA OPHTHALMOL。2016; 134（12）：1355-1363。（关联）
  12. Klaver C, Polling JR; Erasmus Myopia Research Group. Myopia management in the Netherlands. Ophthalmic Physiol Opt. 2020 Mar;40(2):230-240. (关联）[Link to Myopia Profile Science Brief这是给予的