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Öèòàòà:
Some of this research by Dr Desmond Cheng, Dr George Woo and Dr Katrina Schmid was funded by Essilor International of France and Niche Areas Fund J-BB7P from The Hong Kong Polytechnic University. |
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Ïðîâåëè èññëåäîâàíèå ïî âëèÿíèþ òèìîëîëà íà ðåãðåññ ìèîïèè ïîñëå LASIK.
[Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] Effect of Timolol on Refractive Outcomes in Eyes With Myopic Regression After Laser In Situ Keratomileusis: A Prospective Randomized Clinical Trial Monday, October 22, 2012 American Journal of Ophthalmology Ahmad Shojaei, Medi Eslani, Yasaman Vali, Mohammad Mansouri, Nima Dadman, Mehdi Yaser 154(5): 790-798 November 2012 Purpose To compare the effects of timolol on refractive outcomes in eyes with myopic regression after laser in situ keratomileusis (LASIK) with a control-matched group. Design Prospective, randomized, parallel-controlled, double-masked clinical trial. A computer-generated randomization list based on random block permutation (length 4 to 8) was used for treatment allocation. Methods setting: Basir Eye Center, Tehran, Iran. Patient population: Of 124 eyes with myopic regression after LASIK using Technolas 217-Z, 45 eyes in each group were analyzed. Intervention: Patients were randomly assigned into either Group 1, who received timolol 0.5% eye drops, or Group 2, who received artificial tears for 6 months. Main outcome measure: Spherical equivalent (SE) at 6 months posttreatment. Results In Group 1, SE improved from −1.48 ± 0.99 diopter (D) before treatment to −0.88 ± 0.91 D and −0.86 ± 0.93 D 6 months after treatment and 6 months after timolol discontinuation, respectively (P < .001). In Group 2, it was −1.57 ± 0.67 D, −1.83 ± 0.76 D, and −1.91 ± 0.70 D, respectively (P < .001). SE was significantly better in Group 1 6 months after treatment and 6 months after discontinuation of treatment (P < .001 for both comparisons). There was a 0.26 D decrease in SE improvement every 4 months after the surgery in the Group 1 (P < .001). Conclusions Timolol application is effective for the treatment of myopic regression after LASIK compared with control group. Its effects last for at least 6 months after its discontinuation. |
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Èíòåðåñíûå ðåçóëüòàòû ïîëó÷åíû.
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Î÷åíü èíòåðåñíûé îáçîð ïî ïðè÷èíàì áëèçîðóêîñòè è ìåðàì åå ïðîôèëàêòèêè. Îïóáëèêîâàí â íîÿáðüñêîì æóðíàëå Clinical and Experimental Optometry çà 2012 ãîä.
Åñëè ÿ âñå ïðàâèëüíî ïîíÿëà, òî íè îäèí èç ñóùåñòâóþùèõ è èññëåäîâàííûõ ìåòîäîâ ïðîôèëàêòèêè áëèçîðóêîñòè (âñåâîçìîæíûå óïðàæíåíèÿ íà òðåíèðîâêó àêêîìîäàöèè; áèôîêàëüíûå, ìóëüòèôîêàëüíûå î÷êè, îðòîêåðàòîëîãèÿ, ëåêàðñòâåííûå öèêëîïëåãè÷åñêèå ïðåïàðàòû), ê ñîæàëåíèþ, èëè íå èìååò ýôôåêòà âîîáùå èëè äàåò î÷åíü ñêðîìíûå ðåçóëüòàòû ýôôåêòèâíîñòè. È, ò.î., íåîáõîäèìû äàëüíåéøèå èññëåäîâàíèÿ, î êîòîðûõ, êñòàòè, òîæå ãîâîðèòñÿ â ýòîé ñòàòüå. [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] |
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àãà, ÿ ÷èòàëà. Ýòî ñîáñòâåííî âñå ìû è ïðåäïîëàãàëè. Åùå ñêàæó ñþäà æå, ÷òî ê ñîæàëåíèþ, ïðèõîäèòñÿ êîíñòàòèðîâàòü ôàêò "íåäîòÿãèâàíèÿ" îïòè÷åñêîãî ýôåêòà îðòîêåðàòîëîãè÷åñêèõ ëèíç äî âå÷åðà óæå ïðè ìèîïèè âûøå -3,5Ä - ïðîâåëà èññëåäîâàíèå ó 9 ñïîðòñìåíîâ.
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Ïðîáîâàëè âûâåñòè -9. Ïîëó÷èëè çðåíèå 0,7 áåç êîððåêöèè â òå÷åíèå äíÿ. Ñ åæåäíåâíûì îäåâàíèåì. (Ïðîâåëè èññëåäîâàíèå íà 1 áîëüíîì )
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ß ïðî÷èòàë àáçàö ïðî ôàðìàêîëîãè÷åñêèå ñïîñîáû ñòàáèëèçàöèè ìèîïèè.
 ñòàòüå íàïèñàííîé â 2012 ãîäó åñòü äâå ññûëêè íà ðàáîòû âûïîëíåííûå â 85 è 91 ãîäó, êîòîðûå ñî ñëîâ àâòîðà ññûëàþòñÿ íà íå êîððåêòíî ïðîâåäåííûå èññëåäîâàíèÿ ( çà÷åì èõ ó ïîìèíàòü?) è áîëüøå óïîâàþò, ÷òî âîçìîæíî ìîãóò áûòü ïîáî÷íûå ñâîéñòâà öèêëîïëåãè÷åñêèõ ïðåïàðàòîâ ( áåç óòî÷íåíèÿ î êàêèõ èìåííî ïðåïàðàòàõ èäåò ðå÷ü).  èòîãå àâòîð ñòàòüè öèòèðóåò äðóãîãî àâòîðà ñòàòüè íàïèñàíîé 21 ãîä íàçàä, êîòîðàÿ ññûëàåòñÿ íà íåêîððåêòíûå ( ïî ñëîâàì ñàìîãî àâòîðà) äàííûå èññëåäîâàíèÿ, ãäå óòâåðæäàåò ÷òî: Çà÷åì èñïîëüçîâàòü ñîìíèòåëüíûå ìåòîäû ëå÷åíèÿ öèêëîïëåãè÷åñêèìè ïðåïàðàòàìè ( áåç óòî÷íåíèÿ ïðåïàðàòà), ðàäè ñîìíèòåëüíîãî ýôôåêòà, íå ëó÷øå ëè èñïîëüçîâàòü ÷òî òî òàê æå ñîìíèòåëüíîå òèïà áèôîêàëüíûõ î÷êîâ, ðàç ó âòîðîãî ñîìíèòåëüíîãî ìåíüøå ïîáî÷íûõ ýôôåêòîâ Âîçíèêàþò âîïðîñû: 1) Ïî÷åìó àâòîð îáçîðà èãíîðèðóåò èññëåäîâàíèÿ ïîëó÷åííûå â íóëåâûõ è äåñÿòûõ ãîäàõ íûíåøíåãî ñòîëåòèÿ? ( êðîìå îäíîãî), êîãäà îáñóæäàåò öèêëîïëåãèêè â ëå÷åíèè ïðîãðåññèðóþùåé ìèîïèè? Ïðè ýòîì îòäåëüíî âûäåëÿþòñÿ ðåçóëüòàòû ïî ïåðåíçåïèíó, õîòÿ ñàìûé îáñóæäàåìûé ïðåïàðàò àòðîïèí è ñ íèì ñâÿçûâàþò áîëüøèé ýôôåêò. Ò.å. õîòÿ áû èìåòü ïðåäñòàâëåíèå, ÷òî ýòà òåìà äèñêóòèðóåòñÿ è âûäåëèòü àòðîïèí â îòäåëüíóþ ãðóïïó ïðè îáñóæäåíèè òàêèõ âîïðîñîâ, à íå îáñóæäàòü ïðîñòî öèêëîïëåãèêè âîîáùå.  èññëåäîâàíèÿõ ïî ïåðåíçåïèíó ññûëàåòñÿ íà èññëåäîâàíèå, êîòîðîå ïîêàçûâàåòñÿ ÕÎÐÎØÀß ýôôåêòèâíîñòü ïåðåíçåïèíà è ïîòîì äåëàåòñÿ âûâîä, ÷òî öèêëîïëåãèêè â öåëîì íå î÷åíü õîðîøèé âûáîð. 2) Ïî÷åìó îí ññûëàåòñÿ íà òåõ, êòî ãîâîðèò, ÷òî ñêîðåå âñåãî äàííûå ñîáðàíû íå êîððåêòíî? 3) Ïî÷åìó îí íå óòî÷íÿåò, êàêèå èìåííî ïðåïàðàòû ñòîèò îáñóæäàòü, à îáñóæäàåò âñå ñðàçó? Âñå ÷òî áûñòðî áðîñèëîñü â ãëàçà. Ñåé÷àñ ïîåäó ñ ðàáîòû, äóìàþ ïî÷èòàþ îðòîêåðàòîëîãèþ. |
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Íó òàì è ïðî ãåëü Ïèðåíçèïèíà òîæå âðîäå íàïèñàíî, à ýòî âðîäå íåäàâíî èññëåäîâàííûé ïðåïàðàò. Êîíêðåòíî òàì íàïèñàíî, ÷òî íà âûõîäå ó äåòåé, ïîëó÷àâøèõ Ïèðåíçèïèí, ïîëó÷èëè ïðèðîñò ìèîïèè íà 0, 58D ïðîòèâ ïîëó÷àâøèõ ïëàöåáî -0,90D. Íî ìíîãèå íå ñìîãëè çàêîí÷èòü òåðàïèþ ïî êàêèì òî ïðè÷èíàì. Çàèíòåðåñîâàë ðàçäåë ïðî ïåðèôåðè÷åñêóþ ãèïåðìåòðîïèþ ó ìèîïîâ, êîòîðóþ îäíè èññëåäîâàòåëè íàçûâàþò ïðè÷èíîé âîçíèêíîâåíèÿ ìèîïèè, à äðóãèå- ñëåäñòâèåì. Âîò íå î÷åíü ïîíÿëà ïðî èññëåäîâàíèÿ íîøåíèÿ î÷êîâ +4,0D ÷àñ â äåíü.
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Íó ïðî ïåðåíçåïèí ÿ ïðî÷èòàë, ïðî íåãî è âîçìóùàþñü. Èññëåäîâàíèå ïîêàçûâàåò, ÷òî ïåðåíçåïèí äîñòàòî÷íî ýôôåêòèâåí, à àâòîð ññûëàÿñü íà ýòî èññëåäîâàíèå äåëàåò âûâîä , ÷òî íå÷åãî ñâÿçûâàòüñÿ. Ïðî àòðîïèí ( à îí íàðàâíå ñ îðòîêåðàòîëîãèåé è ïåðèôåðè÷åñêîé ãèïåðìåòðîïèåé) â òîïå ïî ýòîé òåìå àâòîð óïîìèíàåò âñêîëüçü è â ñâÿçè ñ ëàáîðàòîðíûìè æèâîòíûìè.
Ïî ïîâîäó ïåðèôåðè÷åñêîé ãèïåðìåòðîïèè, ÿ äóìàþ, ÷òî çà ýòèì áóäóùåå Åñòü î÷åíü èíòåðåñíûå ìûñëè [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] Èëè âîò îáúÿñíåíèå âîçìîæíîãî ýôôåêòà ÎÊ ëèíç, ñâÿçàíîãî ñ ïåðèôåðè÷åñêîé ãèïåðìåòðîïèåé. [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] Äóìàþ ñêîðî ìû ñòîëêíåìñÿ ñðàçó ñ íåñêîëüêèìè ýôôåêòèâíûìè ìåòîäàìè. 1) Êàïëè áëîêèðóþùèå Ì3 - õîëèíîðåöåïòîðû, íî íèêàê íå âëèÿþùèå íà àêêîìîäàöèþ è íà øèðèíó çðà÷êà. Ýòàêèé àíàëîã àòðîïèíà áåç äåéñòâèÿ íà ìûøöû ðàäóæêè è öèëèàðíîå òåëî, êîòîðûå áóäóò äåéñòâîâàòü òîëüêî íà ôèáðîáðàëñòû ñêëåðû 2) Êîððåêöèÿ àììåòðîïèè íå òîëüêî ïî öåíòðó, íî è ïî ïåðèôåðèè , âîçìîæíî ëèíçàìè, äóìàþ, âðÿä ëè îðòîêåðàòîëîãè÷åñêèìè  íàñòîÿùåå âðåìÿ, äóìàþ, àíàëîãîâ àòðîïèíó íåò ïî ñòåïåíè âîçäåéñòâèÿ íà ïðîãðåññèðîâàíèå ìèîïèè. |
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Åùå íà òåìó ïî ñîñòîÿíèþ íà ìàé:
Optometry. 2012 May 31;83(5):179-99. Current status on the development and treatment of myopia. Cooper J, Schulman E, Jamal N. Source State University of New York, State College of Optometry, 33 W. 42nd Street, New York, NY 10036. Email: [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]. Abstract This is a review of the current literature describing the effect of atropine, bifocals, and/or contact lenses on slowing the progression of myopia. Cumulative data from a number of studies have demonstrated atropine instilled once a day in myopic eyes resulted in a 90% average reduction of myopia progression, as compared to untreated eyes, i.e., from 0.50 D/year to 0.05 D/year. Pirenzepine, a muscarinic pharmacological agent, has a minimal effect on pupil size and accommodation, and it has been shown to slow myopia by 44%. Bifocals and progressive lenses, which have been used for years to slow the progression of myopia, have recently been shown to produce, on average, only small, clinically insignificant treatment effects. However, their effectiveness is increased in children who are esophoric and have a large lag of accommodation, reducing myopia progression to between 0.25 and 0.40 D/year. Traditional correcting soft and gas permeable contact lenses, as well as novel spectacle lens designs, have not been shown to be effective in reducing myopic progression. Under-correction of the refractive error has been shown not only to be ineffective in slowing myopia, but has also been associated with an increased rate of myopia progression. Orthokeratology, using reverse geometry designed lenses, has been shown to be moderately effective in decreasing the progression of myopia by between 30 to 50% in a number of short-term, well-controlled studies, reducing myopia progression to between -0.25 and -0.35 D/year. Recently, there have been pilot studies using novel peripherally correcting soft contact lenses to slow the progression of myopia. Two of those lens designs have been shown to be moderately effective in slowing the progression of myopia, both of which had a 30% efficacy, reducing myopia progression to 0.35 D/year. In summary, myopia control is entering a new era with the use of contact lenses and pharmaceutical agents to effectively slow its progression with minimal side effects. American Optometric Association. |
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Óâàæàåìûå êîëëåãè!
Èñïîëüçóÿ Âàøè íàâîäêè ïî ìåòîäàì ñòàáèëèçàöèè, îáçîð äîïîëíåí ñëåäóþùèì ìàòåðèàëîì. Ïåðèôåðè÷åñêàÿ ðåôðàêöèÿ è áëèçîðóêîñòü Smith è ñîàâò. (2005) [131] ïðåäïîëîæèëè, ÷òî ïåðèôåðèéíîå êà÷åñòâî èçîáðàæåíèÿ ìîæåò èñïîëüçîâàòüñÿ êàê äëÿ óïðàâëåíèÿ ðîñòîì ãëàçà è ôîðìèðîâàíèåì ðåôðàêöèè ãëàçà, îñíîâûâàÿñü íà äàííûõ Hoogerheide J. è ñîàâò., êîòîðûå èññëåäóÿ ìîëîäûõ ïèëîòîâ â 1971 ã. ïðåäïîëîæèëè, ÷òî ïåðèôåðè÷åñêàÿ ðåôðàêöèÿ ãëàçà ìîæåò áûòü èíäèêàòîðîì íà÷àëà áëèçîðóêîñòè [132].  2007 ãîäó Mutti è ñîàâò., íà îñíîâå äëèòåëüíîãî èññëåäîâàíèÿ 979 äåòåé, 605 èç êîòîðûõ ñòàëè áëèçîðóêèìè, ñäåëàë âûâîä, ÷òî íàëè÷èå ïåðèôåðè÷åñêîãî ãèïåðìåòðîïè÷åñêîãî äåôîêóñà, ìîæåò ñëóæèòü ñèìïòîìîì ðàçâèòèÿ áëèçîðóêîñòè ó äåòåé [133]. Äàëüíåéøèå èññëåäîâàíèÿ ïîêàçàëè, ÷òî áëèçîðóêèå äåòè è ìîëîäûå âçðîñëûå ïîêàçûâàþò îòíîñèòåëüíóþ ãèïåðìåòðîïèþ íà ïåðèôåðèè ñåò÷àòêè ãëàçà. [134-136] Mutti è ñîàâò., òàê æå ïðèøëè ê âûâîäó, ÷òî âûÿâëåíèå îòíîñèòåëüíîé ïåðèôåðè÷åñêîé ãèïåðìåòðîïèè ìîæåò áûòü ïîëåçíûì ñèìïòîìîì â ïðîãíîçèðîâàíèè ðàçâèòèÿ áëèçîðóêîñòè [133]. Îäíàêî, äâà íåäàâíèõ èññëåäîâàíèÿ 2011 ãîäà [137, 138], êîòîðûå îöåíèâàëè ïåðèôåðèéíóþ ðåôðàêöèþ, â òå÷åíèå äëèòåëüíîãî âðåìåíè ó äåòåé, íå íàøëè ïðîãíîñòè÷åñêîãî çíà÷åíèÿ èññëåäîâàíèÿ ýòîãî ïîêàçàòåëÿ. Âìåñòå ñ òåì, êëèíè÷åñêèå èññëåäîâàíèÿ ó äåòåé äåéñòâèòåëüíî óêàçûâàþò, ÷òî ïðîãðåññèðîâàíèå ìèîïèè ïî óðîâíþ ðåôðàêöèè è èçìåíåíèþ ÏÇÎ, ìîæåò áûòü çàìåäëåíà ïðè íîøåíèè ñïåöèàëüíûõ î÷êîâûõ ëèíç, êîòîðûå óñòðàíÿþò ïåðèôåðè÷åñêèé ãèïåðìåòðîïè÷åñêèé äåôîêóñ. Sankaridurg P. ñ ñîàâò. (2010) [139], èñïîëüçóÿ òðè âèäà ðàçëè÷íûõ ñïåöèàëèçèðîâàííûõ î÷êîâûõ ëèíç, ïðåäíàçíà÷åííûõ äëÿ, óìåíüøåíèÿ ïåðèôåðè÷åñêîãî äåôîêóñà, ïðîâîäèëè èññëåäîâàíèÿ 210 äåòåé, â òå÷åíèå 12 ìåñÿöåâ, íåêîòîðîå óìåíüøåíèå ñòåïåíè ïðîãðåññèðîâàíèÿ áûëî äîñòèãíóòî òîëüêî ó äåòåé, èìåþùèõ íåáëàãîïðèÿòíóþ íàñëåäñòâåííîñòü (ìèîïèþ ó ðîäèòåëåé).  2011 ãîäó çàâåðøåíû äâà èññëåäîâàíèÿ, ãäå èñïîëüçîâàëèñü ìóëüòèôîêàëüíûå êîíòàêòíûå ëèíçû, êîòîðûå êîððèãèðîâàëè, êàê öåíòðàëüíóþ çîíó, òàê è ïåðèôåðèþ.  Íîâîé Çåëàíäèè â ÐÊÈ ó 40 äåòåé íà îäèí ãëàç óñòàíàâëèâàëàñü ìóëüòèôîêàëüíàÿ ÌÊË, à íà äðóãîé ãëàç îáû÷íàÿ ÌÊË, à ÷åðåç 10 ìåñÿöåâ ëèíçû ìåíÿëèñü ìåñòàìè.  ðåçóëüòàòå íà ãëàçàõ ñ ìóëüòèôîêàëüíîé ÌÊË ïðîãðåññèðîâàíèå áëèçîðóêîñòè çàìåäëÿëîñü íà 30% [140].  äðóãîì èññëåäîâàíèè, ïðîâîäèâøåìñÿ â Êèòàå ó 45 äåòåé 7-14 ëåò, íîñèâøèõ ìóëüòèôîêàëüíûå ÌÊË, êîíòðîëåì ñëóæèëà ãðóïïà èç 40 äåòåé, íîñèâøèõ ñôåðîöèëèíäðè÷åñêèå î÷êè.  èòîãå 12- ìåñÿ÷íîãî íàáëþäåíèÿ, ñòåïåíü ïðîãðåññèðîâàíèÿ, ïðè íîøåíèè ìóëüòèôîêàëüíûõ ÌÊË áûëà óìåíüøåíà íà 34% [141]. Òàêèì îáðàçîì, ðåçþìèðóÿ èìåþùèåñÿ ðàáîòû ìîæíî ñäåëàòü âûâîä, ÷òî èñïîëüçîâàíèå ïîêàçàòåëåé ïåðèôåðè÷åñêîãî äåôîêóñà äëÿ ïðîãíîçà ðàçâèòèÿ ìèîïèè òðåáóåò äàëüíåéøåãî ïîäòâåðæäåíèÿ, à ïðèìåíåíèå ìóëüòèôîêàëüíûõ ÌÊË äàåò ïîëîæèòåëüíûé ýôôåêò ñ çàìåäëåíèè ïðîãðåññèðîâàíèÿ ìèîïèè, íî òðåáóåò äàëüíåéøåãî ïîäòâåðæäåíèÿ â áîëåå ìàñøòàáíûõ ðàíäîìèçèðîâàííûõ êëèíè÷åñêèõ èññëåäîâàíèÿõ. ÇÀÊËÞ×ÅÍÈÅ (Ñ.Í.Áàñèíñêèé) Äî íàñòîÿùåãî âðåìåíè, ãëàçíûå êàïëè àòðîïèíà è ïèðåíçåïèíà ÿâëÿëèñü íàèáîëåå ìíîãîîáåùàþùèìè. Èõ èñïîëüçîâàíèå çíà÷èòåëüíî óìåíüøàëî ïðîãðåññèðîâàíèå áëèçîðóêîñòè â íåñêîëüêèõ èññëåäîâàíèÿõ [34,68,69, 119,120]. Îäíàêî íàñòîðàæèâàþò ðåçóëüòàòû îöåíêè ñòåïåíè ïðîãðåññèðîâàíèÿ áëèçîðóêîñòè ïîñëå ïðåêðàùåíèÿ çàêàïûâàíèÿ àòðîïèíà. Ïîñëå ïðåêðàùåíèÿ ëå÷åíèÿ îòìå÷àåòñÿ áîëåå ñóùåñòâåííûé ïðèðîñò ìèîïèè è, â êîíå÷íîì èòîãå, íåçíà÷èòåëüíîå ïðåèìóùåñòâî ïî ñðàâíåíèþ ñ òåìè, êòî êàïàë ïëàöåáî, ïðèìåðíî, 1 D ïîñëå 3 ëåò íàáëþäåíèÿ [117]. Äðóãèå ìåòîäû, òèïà êîíòàêòíûõ ëèíç, êàïåëü òðîïèêàìèäà, ãëàçíûõ ãèïîòåíçèâíûõ ïðåïàðàòîâ, èëè òðàäèöèîííûõ êèòàéñêèõ ìåòîäîâ ëå÷åíèÿ íå íàøëè ïîäòâåðæäåíèÿ ñâîåé ýôôåêòèâíîñòè èëè íóæäàþòñÿ â äàëüíåéøåé îöåíêå â òùàòåëüíî ïðîâîäèìûõ ðàíäîìèçèðîâàííûõ êëèíè÷åñêèõ èññëåäîâàíèÿõ. Íàèáîëåå îáñóæäàåìûìè è ïåðñïåêòèâíûìè ìåòîäàìè ëå÷åíèÿ â íàñòîÿùåå âðåìÿ ÿâëÿþòñÿ - èñïðàâëåíèå ïåðèôåðè÷åñêîé àìåòðîïèè è àáåððàöèé. Ðàáîòû âûïîëíåííûå íà æèâîòíûõ ïîêàçûâàþò, ÷òî ñåíñîðíûå ñèãíàëû îò öåíòðàëüíîé ÿìêè íå ñòîëü ñóùåñòâåííû äëÿ íîðìàëüíîãî ðåôðàêòîãåíåçà è ðîñòà ãëàçíîãî ÿáëîêà, âîçìîæíî áîëåå ñóùåñòâåííîå çíà÷åíèå èìååò ïåðèôåðèéíàÿ ñåò÷àòêà, êîòîðàÿ â ñîñòîÿíèè ðåãóëèðîâàòü ýììåòðîïèçàöèþ è âûçâàòü áëèçîðóêîñòü â îòâåò íà íåïðàâèëüíûé çðèòåëüíûé îïûò [122,126,127,128]. Ðÿä àâòîðîâ [134-136] ïðåäïîëîæèëè, ÷òî âûÿâëåíèå îòíîñèòåëüíîé ïåðèôåðè÷åñêîé ãèïåðìåòðîïèè ìîæåò áûòü âàæíûì ñèìïòîìîì â ïðîãíîçèðîâàíèè ðàçâèòèÿ áëèçîðóêîñòè [135]. Îäíàêî, äâà íåäàâíèõ èññëåäîâàíèÿ (2011)[137, 138], êîòîðûå îöåíèâàëè ïåðèôåðèéíóþ ðåôðàêöèþ ó äåòåé, â òå÷åíèå äëèòåëüíîãî âðåìåíè, íå íàøëè ïðîãíîñòè÷åñêîãî çíà÷åíèÿ èññëåäîâàíèÿ ýòîãî ïîêàçàòåëÿ. Îòäåëüíûìè àâòîðàìè îáíàðóæåíû ñóùåñòâåííûå èçìåíåíèÿ ãèïåðìåòðîïè÷åñêîãî ïåðèôåðè÷åñêîãî äåôîêóñà â ñòîðîíó åãî ìèîïèçàöèè ïðè èñïîëüçîâàíèè îáû÷íûõ ÌÊË, íî, ó÷èòûâàÿ êëèíè÷åñêèé îïûò íàáëþäåíèÿ çà ïàöèåíòàìè, èñïîëüçóþùèìè ïðîñòûå êîíòàêòíûå ëèíçû, îíè íå ñ÷èòàþò ñóùåñòâåííûì âëèÿíèå ýòîãî ôàêòîðà íà ñòàáèëèçàöèþ ìèîïèèè [129]. Âìåñòå ñ òåì, ðÿä ÐÊÈ (2011) ïîêàçûâàåò, ÷òî èñïîëüçóÿ ñïåöèàëüíûå ìóëüòèôîêàëüíûå ÌÊË, èñïðàâëÿþùèå ïåðèôåðè÷åñêèé ãèïåðìåòðîïè÷åñêèé äåôîêóñ, ìîæíî çàìåäëÿòü ïðîãðåññèðîâàíèå ìèîïèè íà 30-34% â òå÷åíèå ãîäà [140,141]. ×òî âïîëíå ìîæåò ñðàâíèâàòü ñ ýôôåêòèâíîñòüþ èñïîëüçîâàíèåì àòðîïèíà, êîòîðûé ñóùåñòâåííî óõóäøàåò êà÷åñòâî æèçíè ïàöèåíòîâ. À ïðèìåíåíèå ìóëüòèôîêàëüíûõ ÌÊË â ñî÷åòàíèè ñ ïðåïàðàòàìè òèïà ïèðåíçåïèíà, çíà÷èòåëüíî ìåíüøå âëèÿþùåãî íà øèðèíó çðà÷êà, ìîæíî ïîòåíöèðîâàòü äåéñòâèå äâóõ ìåòîäîâ. Òàêèì îáðàçîì, ìîæíî ñäåëàòü âûâîä, ÷òî èñïîëüçîâàíèå ïîêàçàòåëåé ïåðèôåðè÷åñêîãî äåôîêóñà äëÿ ïðîãíîçà ðàçâèòèÿ ìèîïèè òðåáóåò äàëüíåéøåãî ïîäòâåðæäåíèÿ, à ïðèìåíåíèå ìóëüòèôîêàëüíûõ ÌÊË äàåò ïîëîæèòåëüíûé ýôôåêò ñ çàìåäëåíèåì ïðîãðåññèðîâàíèÿ ìèîïèè, íî òðåáóåò äàëüíåéøåãî ïîäòâåðæäåíèÿ â áîëåå ìàñøòàáíûõ ðàíäîìèçèðîâàííûõ êëèíè÷åñêèõ èññëåäîâàíèÿõ. |
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Ìàëåíüêèé ñåêðåò, ìóëüòèôîêàëüíûå ëèíçû äîëæíû áûòü ñ öåíòðàëüíîé çîíîé äëÿ äàëè è ïåðèôåðè÷åñêîé äëÿ áëèçè. Äóìàþ, ÷òî äî 3-4.0D êàê âàðèàíò êîððåêöèè ïðåäïî÷òèòåëüíåå ÎÊ-ëèíçû, ïðè áîëåå âûñîêîé - ÌÔË(CD) Íà êàðòèíêå 2 òîïîãðàììû: ïåðâàÿ ïðè èñïîëüçîâàíèè ÎÊ-ëèíç (õîòÿ ñíèìîê è íå î÷åíü óäà÷íûé), âòîðàÿ ñ ì/ô ëèíçîé ñ öåíòðîì äëÿ äàëè. |
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Âîò çíàòü áû åùå êàê èçìåðÿåòñÿ ýòà ñàìàÿ ïåðèôåðè÷åñêàÿ ðåôðàêöèÿ - "Íàèáîëåå îáñóæäàåìûìè è ïåðñïåêòèâíûìè ìåòîäàìè ëå÷åíèÿ â íàñòîÿùåå âðåìÿ ÿâëÿþòñÿ - èñïðàâëåíèå ïåðèôåðè÷åñêîé àìåòðîïèè è àáåððàöèé."
Òîãäà ìîæåò áóäåò âîçìîæíî òî÷íåå îáñóäèòü "ïëþñîâûå ëèíçû ïðîòèâ ìèîïèè". Ïîñêîëüêó ïîêà ìû èìåëè ìíåíèå ýêñïåðòà (ïî êðàéíåé ìåðå â ìîèõ ãëàçàõ âåñüìà âûñîêîãî óðîâíÿ) ñ äîñòîâåðíîñòüþ D óðîâíÿ. Êñòàòè, òåìà "Äèñêóññèÿ î âîçìîæíîñòè..." çàêðûòà ïîñïåøíî, íà ìîé âçãëÿä. Èçâèíèòå çà âîçìîæíóþ ñóáúåêòèâíîñòü ìíåíèÿ. |