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ЗАКЛЮЧЕНИЕ. Несмотря на усилия, которые были предприняты для оценки эффективности методов лечения миопии, выделить из них те

Несмотря на усилия, которые были предприняты для оценки эффективности методов лечения миопии, выделить из них те, которые могут действительно замедлить прогрессирование близорукости, оказалось невозможно, т.к. большая часть из проведенных исследований имели серьезные методологические недостатки. Рандомизированные с двойным слепым, плацебо контролем исследования высокого качества необходимы для проверки эффективности любого метода лечения.

До настоящего времени, глазные капли атропина и пирензепина являлись наиболее многообещающими. Их использование значительно уменьшало прогрессирование близорукости в нескольких исследованиях [34,68,69, 119,120].

Однако настораживают результаты оценки степени прогрессирования близорукости после прекращения закапывания атропина. После прекращения лечения отмечается более существенный прирост миопии и, в конечном итоге, незначительное преимущество по сравнению с теми, кто капал плацебо, примерно, 1 D после 3 лет наблюдения [117].

Другие методы, типа контактных линз, капель тропикамида, глазных гипотензивных препаратов, или традиционных китайских методов лечения не нашли подтверждения своей эффективности или нуждаются в дальнейшей оценке в тщательно проводимых рандомизированных клинических исследованиях.

Наиболее обсуждаемыми и перспективными методами лечения в настоящее время являются - исправление периферической аметропии/аберраций и влияние на прогрессирование занятие спортом и длительность пребывания на открытом воздухе. Недавно выполненная на животных работа показала, что сенсорные сигналы от центральной ямки не столь существенны для нормального рефрактогенеза и роста глазного яблока, возможно более существенное значение имеет периферийная сетчатка, которая в состоянии регулировать эмметропизацию и вызвать близорукость в ответ на неправильный зрительный опыт [122,126,127,128]. Исправление периферийной аметропии/аберраций, может быть достигнуто контактными линзами специального дизайна или ортокератологическими линзами. Влияние этих факторов на прогрессирование миопии требует оценки в рандомизированных клинических исследованиях.

В нескольких крупных исследованиях, проведенных в различных странах, сообщается, что развитие близорукости у детей, имеющих родителей с миопией, занятия спортом и более длительное пребывание на открытом воздухе снижает риск развития близорукости [123-125], при этом складывается впечатление, что просто пребывание на открытом воздухе более важно, чем занятия спортом[123].

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