如何控制近視?

「我可以選擇那一種近視控制方法?」

Correction
Options

Specialty
Eyeglasses

軟性控制近視
隱形眼鏡

Low Dose
Atropine

Combined
Treatment

DIMS 鏡片

多區正向離焦(DIMS)技術是第一個採用透鏡陣列設計控制近視的鏡片。它在中心區域周圍包含數百個小透镜。通過透鏡中心觀察可以提供清晰的視覺,而周圍區域的小透鏡使周圍光線聚焦在視網膜前面,形成離焦影像。多區正向離焦通過生理負反饋機制抑制眼球過度生長。一項隨機臨床實驗証明,最初2年,在參與實驗的兒童身上,發現它能有效地減慢近視度數加深和眼軸延長,並在第3年保持效果.

  • 2-year randomized, double-masked randomised clinical trial
  • 160 participants
  • 眼軸延長下降 62%
  • 近視加深延緩 52%

Lam, C. S. Y., Tang, W. C., Tse, D. Y. Y., Lee, R. P. K., Chun, R. K. M., Hasegawa, K., … & To, C. H.
(2020). Defocus Incorporated Multiple Segments (DIMS) spectacle lenses slow myopia progression: a 2-year randomised clinical trial. British Journal of Ophthalmology, 104(3), 363-368.

Lam, C. S., Tang, W. C., Lee, P. H., Zhang, H. Y., Qi, H., Hasegawa, K., & To, C. H. (2021). Myopia control effect of defocus incorporated multiple segments (DIMS) spectacle lens in Chinese children: results of a 3-year follow-up study. British Journal of Ophthalmology.

HALT 鏡片

H.A.L.T.(高度非球面微透鏡)技術是透鏡陣列設計的一種變種。它分別通過非球面透鏡的中心區域和11個同心環同時提供視覺校正和周邊離焦。一項隨機臨床實驗証明,最初1年,在參與實驗的兒童身上,發現它能有效地減慢近視度數加深和眼軸延長。

  • 為期1年的隨機雙盲臨床實驗
  • 109 Participants
  • 眼軸延長下降 64%
  • 近視加深延緩 67%

Bao, J., Yang, A., Huang, Y., Li, X., Pan, Y., Ding, C., … & Chen, H. (2021). One-year myopia control efficacy of spectacle lenses with aspherical lenslets. British Journal of Ophthalmology.

Executive Bifocals Lens

Q What is the executive bifocals lens?

A

The upper part of the lens contains a lens for far vision and the lower part contains a lens for near vision.

Prismatic Bifocal groups of lenslet can significantly reduce axial elongation with the difference of the top and bottom portion on the lenslet. The bottom portion reduces the amount of focusing effort required to see near objects clearly, which helps control myopia in some children by reducing the focusing demands of reading and near work.

  • 為期3年的隨機臨床實驗
  • 135 participants
  • 眼軸延長下降 39% (非棱鏡) 和 51% (棱鏡)
  • 近視發展延緩 30% (非棱鏡) 和 34% (棱鏡)

Cheng, D., Woo, G. C., Drobe, B., & Schmid, K. L. (2014). Effect of bifocal and prismatic bifocal spectacles on myopia progression in children: three-year results of a randomized clinical trial. JAMA ophthalmology, 132(3), 258-264.

PALS Lens

與雙光鏡片類似,漸進鏡片的下部分減少了看近物所需的對焦工作量,但是近視控制效果較差。

  • 為期3年的隨機臨床實驗
  • 469 participants
  • 眼軸延長下降 15%
  • 近視加深延緩 14%

Correction of Myopia Evaluation Trial 2 Study Group for the Pediatric Eye Disease Investigator Group. (2011). Progressive-addition lenses versus single-vision lenses for slowing progression of myopia in children with high accommodative lag and near esophoria. Investigative ophthalmology & visual science, 52(5), 2749-2757.

Peripheral Hyperopia Reduction Lens

利用改進的非球面透鏡設計調整周邊視網膜上的光學離焦輪廓。 2010年的一項為期12個月的隨機對照試驗發現,有效率高達30%左右。可是,最近一項對207名參與者進行的24個月隨機臨床試驗發現,這種透鏡設計在減緩眼軸延長或近視加深方面都沒有臨床顯著效果。

角膜矯形術

Also Known as OK Lens

角膜矯形術 (Ortho-K) 是一種在睡覺時佩戴硬性高透氧的隱形眼鏡。 在睡覺的時候改變角膜形狀令近視減少,以及減慢近視加深。這種方法有一個優點是夜間佩戴後,早上除掉後可以暫時令近視度數減少,有機會白天不需要戴眼鏡或隱形眼鏡。 許多臨床試實驗証明,這種治療方法可有效減慢眼球延長。 Ortho-K 的處理度數範圍有限。 佩戴角膜角膜矯形鏡時,適當的護理和良好的衛生是減少角膜感染風險的關鍵。不過要注意,有部分人不適合佩戴,必須向你的眼科視光師查詢。

  • 眼軸延長下降約 43% – 63%

Cho, P., & Cheung, S. W. (2012). Retardation of myopia in Orthokeratology (ROMIO) study: a 2-year randomized clinical trial. Investigative ophthalmology & visual science, 53(11), 7077-7085.
Cho, P., Cheung, S. W., & Edwards, M. (2005). The longitudinal orthokeratology research in children (LORIC) in Hong Kong: a pilot study on refractive changes and myopic control. Current eye research, 30(1), 71-80.

Walline, J. J., Jones, L. A., & Sinnott, L. T. (2009). Corneal reshaping and myopia progression. British Journal of Ophthalmology, 93(9), 1181-1185.
Charm, J., & Cho, P. (2013). High myopia–partial reduction ortho-k: a 2-year randomized study.
Optometry and Vision Science, 90(6), 530-539.

Si, J. K., Tang, K., Bi, H. S., Guo, D. D., Guo, J. G., & Wang, X. R. (2015). Orthokeratology for myopia control: a meta-analysis. Optometry and Vision Science, 92(3), 252-257.

雙焦點軟性隱形眼鏡

Specially designed soft contact lenses for slowing myopia progression have multiple concentric rings of different power. It causes a portion of light rays to focus in front of the retina, introducing a defocused image that inhibits excessive growth of the eye (axial length elongation) through a negative feedback mechanism.

These lenses correct the short-sighted prescription and are worn full-time during the day. They are available in daily disposable or three-month replacement options. Proper care and good hygiene are essential when wearing contact lenses to reduce the risk of corneal infection.

  • 為期2年和3年的隨機雙盲臨床實驗
  • 每天佩戴7小時+
  • 眼軸延長下降 52% – 58%
  • 近視加深延緩 58% – 59%

Chamberlain, P., Peixoto-de-Matos, S. C., Logan, N. S., Ngo, C., Jones, D., & Young, G. (2019). A 3-year randomized clinical trial of MiSight lenses for myopia control. Optometry and Vision Science, 96(8), 556-567.

Chamberlain, P., Arumugam, B., & Jones, D. (2020). Myopia progression in children wearing dual-focus contact lenses: 6-year findings. Optom Vis Sci, 97, 200038.

Lam, C. S. Y., Tang, W. C., Tse, D. Y. Y., Tang, Y. Y., & To, C. H. (2014). Defocus Incorporated Soft Contact (DISC) lens slows myopia progression in Hong Kong Chinese schoolchildren: a 2-year randomised clinical trial. British Journal of Ophthalmology, 98(1), 40-45.

Low Dose Atropine

滴入眼睛用低濃度 (0.01% – 0.05%) 的阿托品眼藥水 (Atropine),目前尚不完全了解這種藥物減慢近視加深的機制。就算每天使用,白天仍然需要佩戴眼鏡或隱形眼鏡進行度數矯正。

阿托品眼藥水常見的副作用包括,畏光和調節功能減弱,引致看近的東西感覺模糊。停用阿托品眼藥水後,增加近視加深的反彈效應在使用較高濃度眼藥水下為常見。相關的研究仍然進行中,為了確定最適合的濃度,達致平衡有效性和副作用。

  • 為期2年以上的隨機雙盲臨床實驗
  • 眼藥水濃度 0.05% – 近視加深延緩 64.5%
  • 眼藥水濃度 0.025% – 近視加深延緩 45.2%
  • 眼藥水濃度 0.01% – 近視加深延緩27.7%

Yam, J. C., Li, F. F., Zhang, X., Tang, S. M., Yip, B. H., Kam, K. W., … & Pang, C. P. (2020). Two-year clinical trial of the low-concentration atropine for myopia progression (LAMP) study: phase 2 report. Ophthalmology, 127(7), 910-919.

Combined Treatment

For many children, a single intervention is often adequate to control their myopia. A combination of optical and atropine interventions may be indicated when monotherapy could not provide a satisfactory result. Please consult your eye care practitioner whether your child is suitable for a combination treatment.
截至2021年8月,有幾項已發表的臨床試實驗顯示角膜塑形術和阿托品眼藥水,混合療法有潜在益處。至於特殊設計鏡片或雙焦點隱形眼鏡療法中添加阿托品眼藥水的效果正在研究中。

Kinoshita, N., Konno, Y., Hamada, N., Kanda, Y., Shimmura-Tomita, M., Kaburaki, T., & Kakehashi, A. (2020). Efficacy of combined orthokeratology and 0.01% atropine solution for slowing axial elongation in children with myopia: a 2-year randomised trial. Scientific Reports, 10(1), 1-11.

Tan, Q., Ng, A. L., Choy, B. N., Cheng, G. P., Woo, V. C., & Cho, P. (2020). One‐year results of 0.01% atropine with orthokeratology (AOK) study: a randomised clinical trial. Ophthalmic and Physiological Optics, 40(5), 557-566.