在眼佩戴的波前像差巩膜镜对圆锥角膜眼的视觉矫正

Keratoconus is a degenerative cornea disease with large amount of wavefront errors. Wavefront theory provides new corrective solutions for keratoconic eyes. However, using current corrective solutions, the visual effect would be much less optimal if the wavefront guided contact lens move on the cornea, which is critical for the corneal health. Also the current corrective solutions are based on small sample size and the visual performance have not validated in the in vivo testing. Hereby we propose to develop a system which provides a satisfying and stable visual effect even when the lens move on the eye in a sufficient amount for the corneal health. The system would be developed using a larger sample size and be validated with in vivo testing. This study is composed of three parts: 1) to improve the mathematical model to better simulate visual acuity under lens movement by measuring scleral lens movement and residual wavefront errors both on keratoconic eyes; 2) to optimize the wavefront guided correction using SPGD algorithm, so that even under lens movement a good and stable visual acuity still be able to be achieved; and 3) validate the optimized wavefront guided correction by testing it on keratoconic eyes by lathe the scleral lens, so that the research would be translated from laboratory to clinical practice. Through this study the visual quality and stability in keratoconic eyes would be largely improved, achieving or at least almost achieving normal level.

圆锥角膜是高度不规则屈光异常的角膜退行性疾病。波前像差理论为圆锥角膜的视觉矫正提供了新途径。该方法依赖矫正镜位置，零滑动矫正镜可最大化补偿圆锥角膜眼的波前像差，但不利于角膜健康；当前圆锥角膜眼的像差矫正研究也多停留在视觉模拟阶段，样本量有限、缺乏在眼佩戴效果的临床验证。项目旨在发展一种平衡角膜健康和视觉质量矫正的新方法，在满足角膜健康所需的镜片滑动范围内，有效矫正波前像差、保证视觉质量稳定；开展大样本矫正镜的在眼视觉测试评估，实现医学转化。项目拟采集大样本圆锥角膜眼的矫正镜滑动数据和残留像差数据，建立和完善数学解析模型，预测滑动对圆锥角膜眼视力矫正的影响；应用随机并行梯度下降算法对波前像差矫正方案进行优化设计，以保证镜片滑动范围内的视力矫正和视力稳定；对视觉质量进行在眼测试评估和验证，将理论和模拟的研究成果应用于临床实践。本项目可提高圆锥角膜眼的视觉质量和稳定性，以期接近或达到正常眼水平。

本项目研究了半飞秒近视眼角膜切削术（Femto-LASIK）对人眼像差和成像质量的影响，测量了73名不同年龄、性别的患者共146只眼睛在Femto-LASIK手术前后的像差，对术后像差/像质进行了长达一年的跟踪随访，报告了左右眼在随访期间的差异，以及对视觉成像效果的影响。重要结果为发现了随访期间左右眼的差异随时间有缓慢降低的趋势。本项目通过实际的统计数据支持了基于医生经验的猜想，即：人眼双目视觉在受到外部因素改变后（如：屈光手术），具有自我修复和调节的功能，且左右眼的像差和像质会随着时间的推移而趋向对称性和一致性。此外，项目组和其他相关项目进行合作，为之提供了关键的数据和理论支持，帮助相关项目实现了突破性的进展：和医院眼科合作，通过对角膜Zernike像差的测量，对Femto-LASIK近视眼屈光手术带来的结构变化进行光学建模，建立了近视眼屈光手术的光学模型；和OCT-A项目组合作，提供人眼角膜测量参数用来进行OCT虹膜扫描透镜的设计，实现了对虹膜组织更强的穿透能力，实现了大视场虹膜组织完整、清晰的OCT-A血流造影成像；和角膜生物力学项目组合作，提供人眼角膜测量参数参与了微激励光学相干弹性成像的实验设计，实现了角膜固频在体测量。