儿童近视之治疗无效或有副作用


  【24drs.com】根据Cochrane Library的随机临床试验回顾,现有的延缓儿童近视病程的治疗不是没效就是因为副作用而不实际。
  
  这篇报告在线发表于12月7日,登载于12月的考科蓝实证医学资料库,报告指出,使用角膜重塑隐形眼镜或双焦软性隐形眼镜等新方法是有效的,不过,研究者无法评估这些新治疗方法,因为都未经随机临床试验研究。
  
  研究者写道,近视者看远方时会模糊,深度近视者发生视力相关致命问题的风险比较高,例如视网膜剥离、脉络膜萎缩、白内障或青光眼。
  
  研究者指出,当孩子在学校视力筛检有问题、或家长老师发现孩子眯眯眼看东西或难以看到远方物体时,通常会找视力专家谘商。
  
  为了评估针对延缓孩童近视病程的可能治疗,包括双焦点眼镜、眼药水、降眼压药物、隐形眼镜等,研究者分析了23篇研究、共4,696名研究对象的资料。
  
  他们发现,双焦点眼镜是最常用的治疗方式,因为它们可以刺激眼睛生长,使近视病程略为延缓。这次回顾分析的第一作者、俄亥俄州立大学验光学院Jeffrey J. Walline医师表示,虽然双焦点眼镜少有副作用,它们其实没啥效果。
  
  相对的,眼药水最有效,但是有副作用,包括对光敏感以及近距离视力模糊。纳入回顾分析的研究显示,1年时,接受pirenzepine凝胶、cyclopentolate眼药水或atropine眼药水的孩童,比接受安慰剂的孩童显著较少近视恶化(平均差异分别是0.31 [95%信心区间(CI) [0.17 - 0.44];0.34 [95% CI, 0.08 - 0.60]和0.80 [95% CI,0.70 - 0.90])。
  
  Walline医师表示,不过,这些校正效果不足以保证一定可以处方眼药水,基本上,最有效的治疗方法有副作用:散瞳,所以,它们并不好用。此外,这些药水在市面上并不普及,所以使用上有限且不实际。
  
  不过,许多新方法有效。研究者结论指出,需要其它控制近视方法的进一步信息,例如使用角膜重塑隐形眼镜或双焦软性隐形眼镜,在改善焦点距离下有其效果,只是目前还没有随机临床试验。
  
  俄亥俄州立大学验光学院副院长Karla Zadnik医师未参与此次回顾,但是同意这些结果,她表示,除了双焦软性隐形眼镜,一种针对外围视网膜屈光异常的光学校正方法也证明有效。
  
  她指出,眼科医师和病患应对此保持关注。
  
  另外,麻州眼科暨耳科研究院眼科部儿童医院医疗主任Melanie Kazlas医师同意现有的治疗无效,她表示,小儿眼科医师不主张隔夜使用隐形眼镜来暂时改善近视。
  
  她写道,角膜重塑,也就是角膜塑形术,需要求病患整夜配戴硬式透气镜片,在日间取下而有短暂的近视改善。角膜塑形术已知会有一些并发症,包括角膜擦伤和角膜溃疡并永久性的角膜结疤。
  
  资料来源:http://www.24drs.com/professional/list/content.asp?x_idno=6676&x_classno=0&x_chkdelpoint=Y
  

Therapies for Myopic Kids Do Not Work or Have Adverse Effects

By Tinker Ready
Medscape Medical News

December 9, 2011 — Existing treatments to slow the progression of nearsightedness, or myopia, in children are either ineffective or impractical because of side effects, according to a Cochrane Library review of randomized clinical trials.

The report, published online December 7 and in the December issue of the Cochrane Database of Systematic Reviews, notes that several new approaches, including the use of corneal reshaping contact lenses or bifocal soft contact lenses, are promising. However, the reviewers were unable to evaluate either treatment because the approaches have not been studied in randomized clinical trials.

Nearsightedness (myopia) causes blurry long-distance vision. Highly nearsighted people are at "greater risk of several vision-threatening problems such as retinal detachments, choroidal atrophy, cataracts and glaucoma," the reviewers write.

Parents often consult with a vision specialist when children fail a vision screening at school or a parent or teacher notices the child "squinting or having difficulty seeing distant objects," the review notes

To assess potential treatments aimed at slowing progression of myopia in children, including bifocal glasses, eye drops, intraocular pressure–lowering drugs, and contact lenses, the reviewers analyzed data from 23 studies with 4696 total participants.

They found that bifocals, which are the most common treatment because they may act as a stimulus for increased eye growth, yielded "a small slowing of myopia progression." Although bifocals have few adverse effects, "they are just not effective," the review's lead author, Jeffrey J. Walline, OD, from the College of Optometry at Ohio State University in Columbus, said to Medscape Medical News.

In contrast, eye drops offer the most effective treatment but have adverse effects, including "light sensitivity and near blur." The studies included in the review showed that at 1 year, children receiving pirenzepine gel, cyclopentolate eye drops, or atropine eye drops had significantly less myopic progression compared with children receiving placebo (mean differences, 0.31 [95% confidence interval (CI), 0.17 - 0.44]; 0.34 [95% CI, 0.08 - 0.60]; and 0.80 [95% CI, 0.70 - 0.90], respectively).

However, these corrections are not effective enough to warrant routinely prescribing the drops, Dr. Walline said. "Basically, the most effective treatment has side effects: your eyes are dilated," he said. "So they are just not good to use."

In addition, the drops are not yet commercially available, so their use is "limited and not practical," the reviewers write.

However, several new approaches are promising. "Further information is required for other methods of myopia control, such as the use of corneal reshaping contact lenses or bifocal soft contact lenses...with a distance center are promising, but currently no published randomized clinical trials exist," the review concludes.

Karla Zadnik, OD, the associate dean at the Ohio State University College of Optometry, was not involved in the review but agrees with the results. Beyond soft bifocals, an approach looking at optical correction to the refractive error in the peripheral retina could also prove effective, she said in an email to Medscape Medical News.

"Eye doctors and their patients should stay tuned," she noted.

Melanie Kazlas, MD, the medical director of the Children's Hospital, Ophthalmology, at the Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, who was also not involved in the review, agrees that existing treatments are not effective. Furthermore, she said in an email to Medscape Medical News, pediatric ophthalmologists do not advocate the overnight use of contacts to temporarily improve myopia.

"Corneal reshaping, a technique known as orthokeratology, requires the patient to wear [rigid gas-permeable] lenses overnight and gives a temporary improvement in myopia that wears off during the day." she wrote. "There are also well-documented complications of orthokeratology including corneal abrasion and corneal ulceration with permanent corneal scarring."

Support for this research was provided by Ohio State University College of Optometry; Johns Hopkins University, Baltimore, Maryland; the National Eye Institute, National Institutes of Health; and Research to Prevent Blindness. Dr. Walline was the principal investigator of the Contact Lens and Myopia Progression Study to examine the effects of rigid gas-permeable contact lenses on myopia progression in children. Dr. Walline reports receiving research funding, consulting for companies, and receiving honoraria from companies, all relating to myopia and/or myopia progression. Dr. Kazlas and Dr. Zadnik have disclosed no relevant financial relationships.

Cochrane Database Syst Rev. Published online December 7, 2011.

    
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