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ENGLISH ABSTRACT
关注低强度红光重复照射对近视进展防控的新方法
朱卓婷
何明光
作者及单位信息
·
DOI: 10.3760/cma.j.cn115989-20220127-00031
Repeated low-level red-light therapy: a novel method for myopia prevention and control
Zhu Zhuoting
He Mingguang
Authors Info & Affiliations
Zhu Zhuoting
State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
He Mingguang
State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
Centre for Eye Research Australia, University of Melbourne, Melbourne 3002, Australia
·
DOI: 10.3760/cma.j.cn115989-20220127-00031
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摘要

我国近视呈现高发病率、低龄化的严峻形势,儿童和青少年近视防控问题已上升为国家战略。近年来相关研究已提供了多种儿童近视进展防控措施和方法,如低浓度阿托品滴眼液点眼、角膜塑形镜配戴等,但均存在操作不便和一定的不良反应。大量证据已经表明,增加户外活动时间可有效降低儿童近视的发病率,其效应与光照量有关。然而,在实际工作和实践中,切实有效增加或控制儿童每天的户外活动时间存在各种困难,因此难以有效指导相关人群实施近视防控措施。一项由中山大学中山眼科中心主持的多中心随机临床试验(RCT)采用低强度红光重复照射(RLRL)对学龄儿童进行重复、短时、直接的视网膜照射,评估RLRL控制近视进展的疗效和安全性,证实了该疗法对学龄儿童轻中度近视进展有较好的防控作用,为RLRL安全、有效防控近视进展提供了高等级循证证据。本文对这项RCT研究的主要结果和可推广性进行解读,并提出了进一步探讨RLRL在近视防控中的实践要点,建议眼科工作者关注RLRL对近视防控的研究进展。

近视/治疗;疾病进展;防控;低强度红光疗法;学龄儿童
ABSTRACT

China has recently proposed a countrywide myopia control strategy for children and adolescents due to the rapidly increasing incidence and early onset of myopia.Recent studies have proposed interventions and methods for myopia prevention and control, such as low-dose atropine and orthokeratology lens, while the current strategies are subject to cause inconvenience and ineligible risks of side effects.Although accumulating evidence has shown that increased time outdoors is effective in reducing the risk of myopia development, its effect is closely related to light exposure.Interventions to enhance time spent outdoors or further increase on light exposure to prevent myopia are pragmatically challenging.A multicenter randomized controlled trial (RCT) led by Zhongshan Ophthalmic Center, adopted repeated low-level red-light (RLRL) to deliver light on the retina directly for a much shorter duration of exposure but repeatedly, and further assessed the efficacy and safety of RLRL therapy in myopia control among children.Findings from the RCT showed promising efficacy of RLRL therapy in slowing myopia progression among school-age children with mild to moderate myopia, providing high-level evidence for RLRL therapy as a safe and efficacious strategy for reducing myopia progression.This paper summarized the findings from the RCT, discussed how to adopt such a treatment for myopia control in clinical practice, and further suggested eye care service providers to follow the research progress of RLRL therapy for myopia prevention and control.

Myopia/therapy;Disease progression;Prevention and control;Low-level red-light therapy;School-age children
He Mingguang, Email: mocdef.oabohayeh_gnauggnim
引用本文

朱卓婷,何明光. 关注低强度红光重复照射对近视进展防控的新方法[J]. 中华实验眼科杂志,2022,40(06):487-490.

DOI:10.3760/cma.j.cn115989-20220127-00031

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我国近视呈现高发病率、低龄化的严峻形势,儿童和青少年近视防控问题已上升为国家战略。近年来,关于儿童近视进展控制的临床研究蓬勃开展,其中阿托品滴眼液点眼和角膜塑形镜配戴研究广泛。关于阿托品防控儿童近视的疗效和不良反应Meta分析结果显示,高浓度阿托品滴眼液点眼能有效控制近视进展,但畏光和视近模糊的发生率分别高达43.1%和11.6% [ 1 ]。低浓度阿托品滴眼液(质量分数0.1%和0.01%)控制近视有效率接近50%,但依然存在一定的药物不良反应 [ 1 ]。由于阿托品滴眼液相关的不良反应影响部分儿童的视功能和日常生活,导致患儿对阿托品滴眼液长期使用的依从性较低。近视防控的另一研究热点是角膜塑形镜配戴,临床研究显示其延缓学龄儿童眼轴增长的有效率为30%~59% [ 2 ],但低龄患儿配戴角膜塑形镜往往需要成人的帮助,导致在学龄儿童中角膜塑形镜的长期配戴存在一定的困难。此外,配戴角膜塑形镜有角膜感染的风险,据统计每10 000例患者中年感染例数为13.9 [ 3 ]。因此,近视防控方法的可行性和安全性均有进一步改善的空间。近年来国内外多项大规模随机对照临床试验(randomized controlled trial,RCT)研究结果证实,儿童的户外活动对近视的发生和发展可发挥防控作用 [ 4 , 5 , 6 ]。基于前期的研究结果,本研究组首次实施了大规模的RCT,证实增加儿童户外活动时间可以显著降低学龄儿童近视的发生率 [ 7 ]。此后的临床和动物研究进一步证实,户外活动对儿童近视的预防作用机制与光照作用有关且存在剂量-效应关系 [ 8 , 9 , 10 , 11 , 12 ]。然而,临床实践表明,在学校和家庭中有计划地增加儿童户外活动在推广和实施层面存在很大困难,主要是难以有效定量。因此,能否基于户外活动防控儿童近视以通过短时间的视网膜光照达到防控近视进展的目的成为儿童近视防控研究的新思路。一项低强度红光重复照射(repeated low-level red-light,RLRL)对学龄儿童近视防控的有效性和安全性RCT研究取得了令人振奋的结果 [ 13 ],本文对其方法、结果和可推广性进行解读,进一步探讨RLRL在近视防控中的临床实践要点。
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备注信息
A
何明光,Email: mocdef.oabohayeh_gnauggnim
B

何明光:参与选题、文章撰写和文章智力性内容修改及定稿;朱卓婷:参与文章撰写及修改

C
所有作者均声明不存在任何利益冲突
D
眼科学国家重点实验室自筹科研基金项目 (303060202400362)
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