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<meta name="description" content="好評書『クリニックではじめる 学童の近視抑制治療』の実践編．　いざ，臨床で近視抑制治療を始めた際に，教科書通りにいかない場面に困る場面は珍しくありません．本書は，そんな近視抑制で遭遇するトラブルについて解決までの道すじを，写真とポイントで丁寧に示した症例解説集です．　トラブル解決の道のりは一つとは限りません．そこで，例えば「レンズがずれる」というトラブルでは３つの解決法を紹介しています．近視抑制の">

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		<div class="headers"><h3 class="current content">内容</h3><h3 class="preface">序文</h3><h3 class="indexes">主要目次</h3></div><section class="current content">好評書『クリニックではじめる 学童の近視抑制治療』の実践編．<br>いざ，臨床で近視抑制治療を始めた際に，教科書通りにいかない場面に困る場面は珍しくありません．本書は，そんな近視抑制で遭遇するトラブルについて解決までの道すじを，写真とポイントで丁寧に示した症例解説集です．<br>トラブル解決の道のりは一つとは限りません．そこで，例えば「レンズがずれる」というトラブルでは３つの解決法を紹介しています．近視抑制のエキスパートだからこそ書ける多面的なアプローチは必見！<br>また，本書では表題のオルソケラトロジーフィッティング以外にも，2025年に大きな転換点を迎えた，低濃度AT点眼・多焦点SCL・近視管理用眼鏡・レッドライト治療などの近視抑制最前線の情報も盛り込みました．<br>近視抑制に関わる全ての方が，「こんな本が欲しかった！」と思えるような，トラブル解消に直結するハウツー本です．<br></section><section class="preface">序文<br><br>　2021年5月に刊行した姉妹本『クリニックではじめる 学童の近視抑制治療―最新エビデン<br>スとエキスパートから学ぶ実用メソッド』は，本当にたくさんの方々にお読みいただき，また<br>予想を超える反響をいただいた．読者は眼科医にとどまらず，視能訓練士や眼科スタッフ，眼<br>鏡作製技能士，さらには近視研究に携わる研究者や企業の方，学生さんにまで広がりをみせ，<br>多職種の皆様に手に取っていただけたことを，心からうれしく思う．そして本書をきっかけに<br>「近視抑制を始めてみよう」と行動に移された方が少なくなかったことは，著者一同にとって<br>望外の喜びであった．<br>　一方で診療の現場で近視抑制を行ってみると，理論やエビデンスだけでは乗り越えられない<br>壁にぶつかるという意見も頂戴した．「教科書どおりにいかないケースが多々ある」といった<br>実臨床ならではのご苦労も数多く寄せられた．特にオルソケラトロジーは，レンズフィッティ<br>ングや経過観察の過程で思わぬトラブルに直面することが少なくない．処方やレンズ変更の判<br>断や合併症の対応に迷った経験をおもちの先生も多いのではなかろうか．そこで「より実践的<br>でトラブル解決に直結するHow to 本」を求める声が大きくなってきたのだと感じている．<br>　実臨床では，トラブルの解決方法は必ずしも一つではない．たとえば，偏心矯正の必要が生<br>じた場合，レンズ直径を拡大することで解決を図ることもあれば，アライメントカーブ<br>（フィッティングカーブ）を微調整してセンタリングが改善する場合もある．どちらを行って<br>も類似の改善効果が得られるといったケースも珍しくない．また，レンズメーカーごとに設計<br>思想や特徴が異なるため，同じ事象であっても推奨される対応策が異なることもありうる．つ<br>まり「唯一の正解」があるのではなく，「複数の解決策が存在する」ことを前提に，柔軟かつ多<br>角的な視点をもつことが大切である．<br>　そこで本書『写真でわかる！ オルソケラトロジーフィッティング―学童の近視抑制 お悩<br>み相談室』では，一人の専門家の見解に偏ることなく，多彩なエキスパートに症例をご提示い<br>ただくことで，実臨床で直面しやすい課題に対して多面的なアプローチを紹介できる構成とし<br>た．また，匠の技をできるだけわかりやすく，かつ具体的にご指南いただくため，単なる「解<br>答の提示」にとどまらず，「その解決策に至るまでのプロセス」を重視した解説をお願いした．<br>その結果，非常に充実した内容が揃い，理想に近い「お悩み相談室」を形にすることができた<br>のではないかと自負している．さらに本書では，オルソケラトロジーにとどまらず，低濃度ア<br>トロピン点眼，多焦点ソフトコンタクトレンズ，レッドライト治療，そしてそれらの併用療法<br>に関しても，多くの先生方から寄せられた疑問や相談事を反映したつもりである．近視抑制の<br>実臨床に幅広くご活用いただけるコンテンツとなっている点も強調させていただきたい．<br>　本書が，日々の診療で直面する困難やお悩みを解消し，診療レベル向上に寄与することを<br>願ってやまない．そして，近視抑制治療を受ける患者さんとそのご家族が確かな喜びと満足を<br>実感できることこそ，私たちにとって最大の喜びである．本書がその一助となれば幸いである．<br><br>2025年9月吉日 平岡孝浩，二宮さゆり</section><section class="indexes">Ⅰ章　オルソケラトロジー<br>　(1)オルソケラトロジー処方の基礎知識<br>　　①角膜形状解析──トポグラフィーとトモグラフィー<br>　　②角膜形状解析装置の特徴<br>　　③トポグラフィーの見方<br>　　④フルオレセインパターンの見方<br>　　⑤各社オルソケラトロジーレンズの特徴<br>　　⑥オルソケラトロジーレンズ処方のフローチャート<br>　　⑦近視抑制に関する略語集<br>　　⑧近視抑制治療を希望する保護者への対応<br>　(2)フィッティングのトラブル<br>　　①基本のトラブルシューティング<br>　　②レンズフィッティングの基本的な考え方と処方のコツ<br>　　③理想的なフルオレセインパターンにならない<br>　　④レンズがずれる，偏心する──ACを広げる<br>　　⑤レンズがずれる，偏心する──サイズを変える<br>　　⑥レンズがずれる，偏心する──経過観察<br>　　⑦乱視眼の処方がうまくいかない──ACをフラットに<br>　　⑧乱視眼の処方がうまくいかない──トーリックデザインレンズを選択<br>　　⑨乱視眼の処方がうまくいかない──差分マップを活用<br>　　⑩強度近視の処方がうまくいかない──メーカーを変更<br>　　⑪強度近視かつ乱視眼の処方がうまくいかない──トーリックデザインレンズを選択<br>　　⑫e値(離心率)が小さい<br>　　⑬e値(離心率)が大きい<br>　　⑭トライアル評価と処方レンズ結果に差異がある<br>　　⑮メーカーによる適，不適がある──MOK→BOC<br>　　⑯メーカーによる適，不適がある──BOC→MOK<br>　(3)トポグラフィーに関するトラブル<br>　　①セントラルアイランドの鑑別と対応<br>　　②セントラルアイランドが解消しない<br>　　③Bull`s eye patternにならない──レンズ径を調整<br>　　④Bull`s eye patternにならない──トーリックデザインレンズを選択<br>　　⑤フィッティングでは問題ないのに偏心している？──瞼の形状が原因となり不適合<br>　(4)角膜に関するトラブル<br>　　①SPKができやすい──タイトフィッティング<br>　　②SPKができやすい──レンズの汚れや傷<br>　　③SPKができやすい──ドライアイ<br>　　④SPKができやすい──ハイパワーレンズ<br>　　⑤充血が強い──ポビドンヨードアレルギーの疑い<br>　　⑥角膜炎や角膜浸潤を生じる<br>　　⑦アレルギー性結膜炎にまつわるトラブル──季節性アレルギー<br>　　⑧アレルギー性結膜炎にまつわるトラブル──SPK集積<br>　　⑨レンズ固着による障害<br>　(5)見え方に関するトラブル<br>　　①なぜか視力が出ない<br>　　②片方だけ視力が出ない<br>　　③羞明を訴える<br>　(6)レンズに関するトラブル<br>　　①レンズが汚れている<br>　　②よくレンズを割ってしまう<br>　　③よくレンズを失くしてしまう<br>　　④正しいレンズケアを行わない<br>　　⑤レンズ交換を渋る──交換の必要性を説明<br>　　⑥レンズ交換を渋る──定額制の活用<br>　　⑦レンズの左右逆転／兄弟間での取り違い<br>　(7)その他のトラブル<br>　　①オルソケラトロジーのリバウンドの確認方法は？<br>　　②レンズスティーブのためフラットに変更したらSPKが出現した<br>　　③片眼の近視に対してオルソケラトロジーを装用するとどうなる？<br><br>Ⅱ章　アトロピン点眼<br>　①濃度の選択の仕方がわからない<br>　②低濃度アトロピン点眼による羞明<br>　③低濃度アトロピン点眼による調節障害<br>　④患者が止めたいと訴えたときどうする？<br>　⑤費用の説明と注意点<br>　⑥参天0.025％製剤のみですべての患者に対応できるのか？<br><br>Ⅲ章　多焦点SCL<br>　①どの程度の焦点深度にすればよいかわからない<br>　②最強度近視に対する処方はどうする？<br>　③強度乱視に対する処方はどうする？<br>　④マイサイトの承認の見通しは？ 日常生活での注意点は？<br>　⑤オルソK→マイサイトへの切り替えはどうする？<br>　⑥マイサイト→オルソKへの切り替えはどうする？<br>　⑦焦点深度拡張型SCLを装用したところ、眼軸長の短縮を認めた症例<br><br>Ⅳ章　近視管理用眼鏡の現状<br>　①二重焦点眼鏡は有効か？<br>　②多分割眼鏡レンズの現況と実際の効果は？<br>　③近視管理用眼鏡の承認の見通しは？<br><br>Ⅴ章　レッドライト治療の現状<br>　①報告されている合併症は？<br>　②リバウンド対策は？<br>　③中国での現状は？<br><br>Ⅵ章　併用療法<br>　①併用療法を考えるタイミング<br>　②低濃度アトロピン点眼の併用療法は行うべきか？<br>　③オルソケラトロジーとアトロピン点眼，どちらが先がいい？または同時に処方したほうがよい？<br>　④オルソケラトロジーとアトロピン点眼，止める時はどちらが先？<br>　⑤どんな時に途中からアトロピン点眼を追加する？<br>　⑥いつまで続ければよい？<br>　⑦多焦点SCLとアトロピン点眼の相性は？<br>　⑧オルソケラトロジーとレッドライト治療の相性は？<br>　⑨多分割眼鏡レンズとレッドライト治療の相性は？<br>　⑩アトロピン点眼を追加したら，羞明を訴えた<br>　⑪アトロピン点眼とレッドライト治療の併用が禁忌の理由は？<br><br>文献<br>索引</section></article>
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