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近视的流行病学:病因与预防The epidemics of myopia: Aetiology and prevention

Morgan, I.G., French, A.N., Ashby, R.S., et al.

期刊名称:Progress in Retinal and Eye Research

卷期:2018年第62卷

关键词:
流行病学 病因

姚颖 沈阳兴齐眼药股份有限公司市场部医学经理

面对过去几十年来近视的增加,以及预计到本世纪末近视患病人数将达到25亿,迫切需要开展有效和安全的治疗干预措施,以减缓这种“红火”,并预防近视相关并发症和视力下降。

大量文献报道多巴胺(DA)是视网膜中重要的神经递质,可介导多种功能,包括视网膜发育,视觉信号传导和屈光发育。流行病学和动物研究支持户外活动与发生近视风险之间存在负相关关系,以及光照与多巴胺释放/信号之间存在密切生物学关系,DA在近视发展中的作用。关于DA调控近视光控制的关键点可能为1)细胞外视网膜DA水平的因果作用;2)多巴胺D1D2受体的作用机制; 3)细胞/循环视网膜通路的作用。我们使用药理学,转基因或视觉环境的方法通过改变DADA受体和视觉通路来进行显示因果关系的实验。

如何将DA信号传导和近视的基础知识从动物研究转化为儿童近视有效药理学治疗的关键问题和挑战。

如何减缓近视的发病,控制近视的流行发展, 迫在眉睫。

需要政府、学校、医生以及整个社会共同努力。



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摘要

摘要:近视多发于亚洲东部和东南部,其中年轻人的近视患病率约为80-90%,随之而来在年轻的成人中高度近视的患病率(10-20%)不断攀升。这可能预示着由于病理性近视导致的低视力和失明患病率的增加。这两种流行病学是有联系的,因为近视的发病越来越早,加上不断提高的发病率,自然会导致高度近视的流行,尤其在11-13岁左右青少年中“后天”近视的患病率很高。导致这一现象的主要的危险因素是高强度的室内教育和有限的户外活动时间。这种近视的区域化流行似乎是由于该地区的学校的高压教育以及学生被不断压缩的户外活动时间,而并不是因为他们基因对这些因素的敏感性升高。在户外进行的随机临床试验表明,增加学校户外活动时间可以防止近视的发生,这已经证明了其因果关系。针对高压教育这一因素与近视之间因果关系的证据来自于近视高患病率的以色列:将当地就读于正统学校的犹太男孩的高度近视率与他们就读于宗教学校的姐妹以及就读于一般学校的男孩和女孩的高度近视患病率作对比研究。在学校里增加户外时间与用临床方法减缓近视的发展两种方法结合在一起,减缓近视的发病应该能够控制近视的流行发展,否则将对人类健康构成重大挑战。对学校系统进行改革,以减少激烈的早期竞争,促进学习途径发展或许也很重要。

There is an epidemic of myopia in East and Southeast Asia, with the prevalence of myopia in young adults around 80-90%, and an accompanying high prevalence of high myopia in young adults (10-20%). This may foreshadow an increase in low vision and blindness due to pathological myopia. These two epidemics are linked, since the increasingly early onset of myopia, combined with high progression rates, naturally generates an epidemic of high myopia, with high prevalences of "acquired" high myopia appearing around the age of 11-13. The major risk factors identified are intensive education, and limited time outdoors. The localization of the epidemic appears to be due to the high educational pressures and limited time outdoors in the region, rather than to genetically elevated sensitivity to these factors. Causality has been demonstrated in the case of time outdoors through randomized clinical trials in which increased time outdoors in schools has prevented the onset of myopia. In the case of educational pressures, evidence of causality comes from the high prevalence of myopia and high myopia in Jewish boys attending Orthodox schools inIsraelcompared to their sisters attending religious schools, and boys and girls attending secular schools. Combining increased time outdoors in schools, to slow the onset of myopia, with clinical methods for slowing myopic progression, should lead to the control of this epidemic, which would otherwise pose a major health challenge. Reforms to the organization of school systems to reduce intense early competition for accelerated learning pathways may also be important.


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