Originally posted June 19, 2018
Updated October 4, 2020
In another post on多灶软镜头的折射和安全性，我讨论了同事如何经常问这个问题 - 您是否幸运能够访问多个多焦点，双重重点或控制隐形眼镜设计的近视，哪个最好？我首先讨论了考虑折射和安全性，在第二部分中，我将讨论这些镜头如何根据功效和视觉功能进行比较。为简单起见，我将使用具有多个光聚焦功率的任何镜头，将多焦点软接触镜（MFCL）的术语使用：包括：
- Aspherical multifocal (ie. CooperVision Biofinity or Proclear "D" centre distance; Visioneering Technologies Inc (VTI) NaturalVue is also this type of design, although also termed 'extended depth of focus' owing to its single high add design)
- Dual focus concentric (ie. CooperVision MiSight)
- Extended depth of focus (ie. Mark'ennovy Mylo and VTI NaturalVue) designs.
I'll focus in on designs which have been specifically researched for myopia control efficacy - which all of the above mentioned have - and will make note where mentioning a MFCL design which hasn't been researched in this way.
Comparing efficacy
At present, there is no study directly comparing the different MFCL types for their relative myopia control effects. As I’ve described previously tohelp understand myopia control efficacy, the percentage efficacy rates we see quoted in studies are difficult to directly compare to eachother, as the outcome depends on the control group – how old were they, what correction were they wearing, how much they progressed – and study factors such as duration and testing protocol. To keep things simple and evidence based, then, I refer to the 2016 meta-analysis which examined numerous lens designs, some commercially available and some not, which concluded that these lenses show an average of around 30-50% efficacy for refractive and axial length myopia control.1
别急,还有更多!自2016年,meta-analysis, we've had a raft of important MFCL studies published, including the误导three-year study, theBLINK three-year studyon CooperVision Biofinity centre distance multifocals以及研究的“扩展焦点（EDOF）设计”Sankaridurg et al.Again, while they haven't been directly compared in the same study, since the control groups of the three-year MiSight and BLINK studies showed similar axial length progression, we can make a comparison between the treatment groups. The MiSight dual focus concentric design appears to have come out slightly ahead, with around 0.2D more refractive control and 0.05mm more axial length control than the centre distance "D" multifocal design with +2.50 Add. The "D" lens with +1.50 Add had a small but non-significant influence on myopia progression.
相比之下，扩展焦点（EDOF）镜头的深度商业化马克'ennovy Mylo abso更大了lute progression in both their treatment and control groups - likely because all of the participant children were of Chinese origin compared to the multi-site MiSight (Singapore, UK, Canada and Portugal) and BLINK (US based) studies. In the two year study, it appeared to have a smaller absolute axial length effect than the MiSight or centre distance +2.50 Add did at two years; a similar refractive effect to centre distance +2.50 Add and a smaller effect than MiSight in comparison to their control groups.
VTI天然镜头已经提出clinical case series research而不是针对其他试验。这已经比较了儿童在安装天然案例之前的进展，同时穿着各种矫正，并穿着自然景色。虽然结果值得注意 - 但它似乎肯定会起作用！- 很难将结果与上述研究一起放置。
您可以阅读更多有关双重焦点，重点深度和多焦点隐形眼镜的最新和最伟大的研究通过链接。
视觉功能：最佳校正敏锐度
This is where things get really interesting, and where research will tell us more in future. While exact lens specifications are proprietary information, variation in the size of the distance central optic zones in these lenses could influence everything from acuity and over-refraction to accommodation. My previous post on多灶性隐形眼镜的折射和安全性描述了您为患者选择的最终镜头功率与最佳镜折射相比，镜头设计可能会有所不同。单击链接以查看此信息 - 某些镜头适合最佳视觉球形镜折射，而有些镜头可能需要更多的负量来获得大型学生的年轻佩戴者的良好敏锐度。
- 这mark'ennovy Mylo design, researched bySankaridurg et al, showed a drop in high contrast acuity of four to five letters and a drop in low contrast acuity of one to two lines. Subjective responses from the wearers on their vision, though, showed no significant difference between test and control groups.
- 这误导three-year studyreported that mean distance visual acuity with spherical over-refraction (to account for refractive changes on follow up) was within one letter of the single vision correction. Near visual acuity also remained within one letter for MiSight and control SV lenses.
- 这眨眼研究+1.50和+2.50添加CooperVision "D" (centre distance) MFCLs showed no significant difference between MFCL and the SV control groups for ihigh contrast distance or near acuity at their final visit. Low contrast acuity was less than 2 letters better with SV than the MFCLs, which the authors commented is 'not clinically meaningful'.
视觉功能：住宿
我们最近了解到a child does not accommodate normally in a MFCL this could influence their efficacy- 如果在这些镜头中使用“添加”，就像长老会一样，这可能会从镜头的距离部分/s产生远视散焦，这可能会导致近视控制中的不良光学效应。Modelling of this effectin a monocular situation indicates that smaller central optical zones could give higher likelihood of the child using the ‘add’ to read, causing hyperopic defocus in the central and peripheral retina. Larger optical zones could be more likely to encourage a normal accommodation response.
One key piece of research has shown that a 'positive spherical aberration' MFCL (think of this like a centre-distance design)test lens reduced accommodative response,and this reduced response was correlated with a reduced myopia control effect. Interestingly, this relationship wasn’t found in the single vision distance CL corrected control group, indicating a complex interaction between MFCL optics and accommodation specifically.
我在Arvo 2019上提出的研究compared the accommodative response of young adult myopes wearing MiSight, NaturalVue, the CooperVision "D" (centre-distance) +1.50 Add and +2.50 Add designs to single vision contact lenses. We found that the MiSight dual focus concentric design didn't influence accommodative response while the other three, continuous aspheric designs reduced the accommodative response by a similar amount, despite their differently labelled 'add' powers.
您可以在我们的科学博客中阅读有关此主题的更多信息spherical aberration, accommodation and multifocal soft contact lenses.
住宿响应能否有助于我们弥合MFCL研究中30-50％功效之间的差距，从而更好地效果？将来，也许我们将衡量住宿的某些方面（或多个措施），然后选择特定的镜头设计 - 也许是为普通容纳器的较小的区域镜头，而较大的区域镜头则用于不足的容纳器。时间和研究将证明。
哪个最好？
在意识到如上所述的直接比较的局限性时，看来Coopervision的误解可能对近视控制功效具有轻微的优势。但是，如果您不可用或适合您的患者，那么最好的镜头就是您可以使用的镜头，那不是单一的视觉隐形眼镜！
在视觉功能方面，单个镜头设计可能会影响敏锐度和适应性。当涉及到敏锐度时，各种MFCL的设计似乎都被儿童容忍了。我们仍然有很多关于这些镜头的知识，这就是使其成为研究和实践的引人入胜的领域。定制的MFCL拟合的未来将使我们了解更多有关哪种镜头设计最适合哪种患者，这些患者基于年龄，折射或双眼视力状态等各个因素。但是，直到发生这种情况，如果在同行评审的研究中评估了特定的设计，那么您足够合理地将所有可用的MFCL视为合理的近视控制选项。
