据统计,目前全球有近14亿近视人口,近视已成为全球主要的健康问题。近视不仅影响个人的视力健康,还可能引发多种严重的并发症,如高度近视相关的黄斑变性和视网膜脱离等,严重时可导致失明。除了对个人健康的影响,近视还带来了巨大的经济负担,包括直接医疗成本(如眼镜、隐形眼镜、矫正手术等费用)和间接成本(如生产力下降、学习能力降低和生活质量的下降)。在中国,近视的问题尤其显著,近视患病率居高不下,这不仅对个人健康构成威胁,也对社会和经济造成重大影响。国际上,近视的经济负担研究涵盖了医疗直接成本、患者时间成本及生产力损失等方面,可以帮助政府和卫生部门了解近视疾病的经济影响,从而制定合理的公共卫生政策和资源分配策略,优化医疗资源使用,减少社会成本。该文从近视疾病经济负担的构成及其测算方式、国内外经济负担现况等方面对近视疾病经济负担进行简要综述,旨在提供一个关于近视疾病经济负担的综合性认识,指出当前研究的方向和成果,以及预防近视和减轻其经济负担的重要性,为未来研究提供方向和基础。
It is estimated that there are nearly 1.4 billion myopic people in the world, and myopia becomes a significant global health problem. Myopia not only affects visual health, but also leads to serious complications such as macular degeneration and retinal detachment, which can cause blindness in severe cases. Apart from its impact on health, myopia also imposes a substantial economic burden. This burden includes direct medical costs (e.g., expenses for eyeglasses, contact lenses, and corrective surgeries) as well as indirect costs (e.g., reduced productivity, learning abilities, and quality of life). The prevalence of myopia is particularly high in China, posing a threat not only to individual health, but also to society and the economy. International studies on the economic burden of myopia have examined the direct medical costs, patient time costs and productivity loss. These studies help governments and health authorities understand the economic impact of myopia to develop effective public health and resource allocation strategies.. By optimizing medical resources and reducing social costs, these measures aim to alleviate the economic burden. This article provides an overview of the economic burden of myopia, including its definition, measurement, current status at home and abroad, and the importance of prevention and alleviation. It also highlights the current research directions and findings, to provide focusing fields and foundations for future research.
角膜基质透镜是带有一定屈光度的角膜组织,为利用激光或板层刀等在角膜基质层内雕刻出一个精确对焦点的光学透镜。随着角膜屈光手术的不断发展,术中产生了大量的角膜基质透镜, 越来越多的学者也将目光聚焦于此。我国角膜供体来源匮乏与手术量需求严重不匹配, 眼库严重缺乏供体角膜,而对角膜组织的需求却越来越大。角膜穿孔作为角膜疾病的终末阶段,严重威胁患者的视力,甚至要面临摘除眼球的风险, 是对患者身体与心理的双重打击。绝大多数的角膜穿孔需要紧急手术处理, 对于一些常规治疗无效或角膜病变更严重的,角膜移植术可能是唯一有效的手段。对原本废弃的透镜重新利用, 将其用于治疗角膜溃疡、修补角膜穿孔以及辅助治疗各类角膜疾病的危重阶段, 均观察到其取得了良好的效果, 这在一定程度上缓解了临床上角膜供体缺乏的现状。本文报道了2例由角膜白斑引起的角膜穿孔患者使用异体角膜基质透镜移植治疗的病例, 术后2名患者病情均得到稳定。同时探讨了角膜基质透镜移植的局限性, 本文并未观察到角膜透镜移植对于感染性、免疫性等其他原因造成的角膜穿孔的疗效, 因此在行角膜移植之前,要正确认识及处理原发病,尽量避免一些并发症和排斥反应的发生。
Corneal stromal lenses are corneal tissues with specific refractive power, created by precisely sculpting an optical lens within the corneal stromal layer using lasers or microkeratomes. With the ongoing development of corneal refractive surgery, a large amount of corneal stromal lenses are generated during procedures, drawing increasing attention from researchers. In China, there exists a severe mismatch between the scarcity of corneal donors and the high demand for surgical procedures. This has led to a critical shortage of donor corneas in eye banks, while the need for corneal tissue keeps rising. Corneal perforation, which is the end-stage of various corneal diseases, poses a significant threat to patients' vision and may even result in enucleation, causing considerable physical and psychological distress. Most cases of corneal perforation require urgent surgical intervention. For patients with severe conditions or those for whom conventional treatments are ineffective, corneal transplantation may be the only viable option. Reusing stromal lenses that were previously discarded to treat corneal ulcers, repair corneal perforations, and assist in managing critical stages of various corneal diseases has shown promising results. This, to some extent, helps alleviate the clinical shortage of donor corneas. This article presents two cases of corneal perforation caused by corneal leukoma, both of which were successfully treated with allogeneic corneal stromal lens transplantation. Both patients achieved stable conditions after the operation. Additionally, this paper discusses the limitations of corneal stromal lens transplantation. The efficacy of corneal lens transplantation for perforations caused by infectious or immunological etiologies was not observed in this study. Therefore, it is essential to accurately diagnose and manage the underlying disease before transplantation and to minimize the occurrence of complications and rejection reactions.
近视已成为全球性流行病,预计到2050年全球将有近半数人群发生近视,已成为全球性重大功能卫生问题。近视不仅影响视力,还增加黄斑病变、青光眼等致盲性疾病的风险。近视的发病机制尚未完全明确,但与环境、遗传因素及昼夜节律紊乱密切相关。昼夜节律通过调节光照、多巴胺代谢和视网膜信号传导等机制影响近视的发生和发展。光照是调节昼夜节律的关键,户外活动时的高光照强度能有效刺激多巴胺分泌,抑制眼轴增长,减少近视发生,而异常光照模式(如夜间光暴露)则会干扰此过程。其次,睡眠不足与儿童近视患病率呈负相关,眼部关键参数(如眼轴长度、玻璃体腔深度等)均呈现显著的昼夜节律性波动。多巴胺作为视网膜中的重要神经递质,受生物钟基因调控,具有抑制眼轴生长的作用。视网膜中的生物钟基因和光敏色素也参与调节眼球生长,自主神经系统则通过调节脉络膜厚度与血流灌注参与眼球生长调控。动物实验和临床研究表明,昼夜节律紊乱会导致眼轴增长和近视进展。未来研究应进一步探讨昼夜节律与近视的因果关系、多巴胺代谢的调控机制以及生物钟基因的功能,以制定有效的近视防控策略。
Myopia has become a global epidemic,with projections indicating that nearly half of the world’s population will be affected by myopia by 2050, positioning it has a significant global functional health concern.Beyond merely impairing vision, myopia also heightens the risk of blinding diseases such as macular degeneration and glaucoma. Although the pathogenesis of myopia is not yet fully elucidated, it is stongly associated with environmental factors, genetic predispositions, and circadian rhythm disruptions. The circadian rhythm plays a pivotal role in the onset and progression of myopia by goerning mechanism such as light exposure, dopamine metabolism, and retinal signaling. Light serves as a crucial regulator of the circadian rhythm. Specifically, high light intensity during outdoor activities can effectively stimulate dopamine secretion, thereby inhibiting axial elongaation and reducing the incidence of myopia. Conversely, abnormal light patterns, such as exposure to light at night, can disrupt this regulatory process. Moreover, insufficient sleep has been found to be negatively correlated with the incidence of myopia in children. Additionally, key ocular parameters, including axial length and vitreous cavity depth, exhibit pronounced diurnal rhythmic fluctuations. Dopamine, an important neurotransmitter in the retina, is regulated by circadian clock genes and functions to inhibit axial elongation. Both the circadian clock genes and photosensitive pigments within the retina are involved in regulating eye growth. Meanwhile, the autonomic nervous system contributes to this regulation by modulating choroidal thickness and blood flow perfusion. Animal experiments and clinical studies have consistently demonstrated that disrupted circadian rhythms can lead to axial elongation and the progression of myopia. Future research should delve deeper into the causal relationship between circadian rhythm and myopia, the regulatory mechanisms underlying dopamine metabolism, and the functions of circadian clock genes. Such investigation will pave the way for the development of effective strategies for myopia prevention and control.