国际眼科时讯

老视形成机制有哪些新发现？且听Paul L. Kaufman教授娓娓道来

2023-05-11 17:40:53
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老视是每个人在年龄增长过程中几乎都会遇到的一种生理现象。随着人们平均寿命的延长，老视人群的数量也逐渐增加。老视的相关研究也就成为了人们探索的热点。在今年的ARVO会议上，来自美国威斯康星大学麦迪逊分校的Paul L. Kaufman教授接受了《国际眼科时讯》记者的采访，分享了老视形成机制方面的新发现，为深入了解老视这种疾病提供了理论支持。

Paul L. Kaufman教授：老视是如何形成的？,国际眼科时讯,03:00 进度条 8%

1老视是如何形成的？

晶状体就像一个镜片，完美的镜片是有弹性的，并可以随着肌肉的收缩发生前后运动。随着年龄的增长，镜片会变得僵硬。同时，当两端的肌腱因不再是有弹性的胶原组织而变得僵硬，肌肉便不能运动，人也就无法相应调整自己的视力清晰度。如果将其取出并进行器官培养，它在人的整个生命周期中都能很好地运动，无论是20岁还是60岁。如果失去弹性，就像一个有刚性的链条固定无法活动。

在所有机制都弄清楚之前，除非有人找到恢复弹性的方法，否则老视患者可能都无法像现在这样拥有一个可以随时在瞬间完成远近调节聚焦的视觉，必须要借助眼镜。当然，大脑可以起到辅助协调作用，使人们获得清晰的视力，就像炮兵的炮手不断调整，最终命中目标一样。

There's a lens aspect of presbyopia and the lens gets stiffer with age. But even if you had a perfect lens, that wasn't stiff. And that was flexible, still wouldn't do any good because the muscle is frozen. Muscle that moves forward and backward to control. The lens is no longer able to move forward and backward because the tendons at either end are now stiff instead of being elastic tissue, the collagenous tissue. And if the muscle can't move, then you can't adjust your vision. And the thing that makes you want to bang your head on the table is that the muscle itself is okay. It has the capability to move and all of its biochemical things that it still works. If you take it out of the eye and put it in strain gauges in an organ culture, it moves just fine and all across the lifespan. Whether you're twenty years old or sixty years old, that muscle can still move. But if it were not tethered, so instead of elastic banded, either, and it's like you have a chain that's a rigid chain and you can't, you can't move either way.And until we figure that out, we'll never have really good ocular lenses that give you the same kind of vision that you have now where you can focus up there, you can focus up here, and you can do it in a millisecond. And right now, if I wanted to do that, I have to look in another part of my glass, you know, this is distance, and of course, you know, your brain daps, but it's not the same as when you're young and you just look and your brain is constantly back and forth, back and forth, back and forth. And it's like an artillery gunner, a little too far, a little too near, and finally you get on the target. And even if the target is moving, you can still get it. That's how good your brain would be at doing this. But until somebody figures out how to restore the elasticity to the system, we're always going to be struggling.

Paul L. Kaufman教授：衰老与性别在老视形成中的作用,国际眼科时讯,02:08 进度条 21%

2衰老与性别在老视形成中的作用

现在生物学上的性别差异广泛存在，但有趣的是，老视在一定程度上没有性别差异。有个别研究显示，女性发生老视的时间要比男性早。然而，由于近距离工作的需要，女性眼部肌肉的变化与男性不同。另一方面，由于女性的身材相对更矮小，她们的手臂相对较短，无法把物体移得更远、看得更清楚，这就是老视又叫“短手臂”病的由来。

硬化是目前发现的老视形成新机制，现在的学者可以测量肌肉活动的每一项指标，也可以确定酶的改变，但如何改善肌肉的弹性则超出了学者们现在的能力范围，此刻无人知晓应当如何破局。There are a lot of things that people do now begin to realize that men and women are different, but now there are real biological differences that cover most things. And it's ironic that presbyopia, at least the part of presbyopia that I was talking about, and we're not talking about now, those seem to be the same. For men and women, I mean, and there's little few studies that say that all women get presbyopia a little bit earlier, it isn't that that. Muscle is changing differently than men. It's because they're working at closer distances and they can't help that. I mean it if they're sewing, they have to be at a closer distance and if they're trying to read something, and their arm is too sure they can't get it far out enough to see it clearly. I mean, when they were young, they could just bring it in with the apparatus, but now I want to see it well. This is why it's called the my arms are too short disease. But women being a smaller body and you know, man's going to be able to look out here, and woman, her arm only goes out this far, so she's penalized for having a short arm.
But the new part of the mechanism, is the stiffening. And the hard part is that the muscle itself is fine by every metric that we can measure muscular activity. I pretty sure the slides that I put up with all the thing about the enzymes, and if maxes it's all good, just ready to go. If you could get some elasticity into the system and that's above my pay grade. I don't know how to do that. And at the moment, nobody else knows how to do it either. So we'll see. Maybe someday you'll be interviewing somebody who's figuring out how to do that. I really to yes.

3小结

Paul L. Kaufman教授希望有一天能有人在目前的发现的基础上增加眼肌的弹性从而改善或治疗老视。他相信，未来随着对老视机制探索的深入，必将有更多新的发现，并为老视的治疗提供理论依据，造福更多老视患者。