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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">【今巻概要】<br>わが国では近視頻度が高く，生涯を通じて良好な視機能を保つためには小児期の近視化を抑制することが重要となってくる．本書では現在一般診療の一つの柱となりつつあるオルソケラトロジー，アトロピン点眼など小児の近視抑制について最新の情報を提供するとともに，黄斑変性，網膜剥離，緑内障，核白内障など成人の病的近視の診断・治療まですべての眼科医が知っておくべき知識を紹介している．<br><br>【シリーズ概要】<br>「日常臨床にすぐ役立つ」をコンセプトとした「眼科プラクティス」の最新シリーズ．<br>今シリーズでは図版をより効果的に示すことで，さらにビジュアル面を大幅強化．<br>直感的に理解できる「視る教科書」を目指した．<br></section><section class="preface">「新篇眼科プラクティス20 近視トータルマネジメント」序文<br><br>　近年，近視の世界的な増加が問題になっています．メタ解析によると，近視合併症（黄斑変性，網膜剝離，緑内障，核白内障）の頻度は，近視度数に応じて指数関数的に増加することが示されています．治療法として，たとえば近視性血管新生黄斑症に対しては，抗VEGF 療法が症状の安定化には有効ですが，長期的にみると網脈絡膜萎縮の進行は避けられず，合併症が出てからの治療には限界があります．近視の頻度の高いわが国において，生涯を通じてよい視機能を保つためには，小児期の近視化（眼軸伸長）を少しでも抑制するコンセプトが必要になります．<br>　本書は「近視トータルマネジメント」と題して，小児の近視抑制から成人の病的近視の診断・治療までオールインワンで扱うことを趣旨としました．<br>単純近視に関しては，光学的屈折矯正の基本を両眼視機能を含めて復習することが重要です．わが国においても小児および成人の眼鏡処方の手引きが作成されました．近視化には遺伝因子と環境因子が関与しますが，環境因子に関しては，動物実験で，網膜より後方に焦点を結ぶ網膜像のぼけがトリガーになって近視化が進むことが示され，臨床的には過矯正の眼鏡は近視進行を促すので避ける必要があります．網膜像のぼけが眼軸伸長をもたらす情報伝達系の分子機構，および近視化に関係する遺伝子に関しても研究が進みつつあり，現況をアップデートしました．<br>　小児の近視進行抑制に関しては，一般の眼科診療の柱の一つになりつつあり，現況を概説しました．<br>　病的近視に関しては，近年画像診断法の進歩があり，黄斑部病変のOCT による評価，網脈絡膜萎縮の眼底自発蛍光による評価など日常診療で知っておくべき点について言及しました．強度近視合併症の治療については，一般の眼科医が知っておくべき最新の情報を反映しました．眼疾患に合併した近視に関しては，器質的な障害に屈折異常による弱視の部分が重畳して視力低下をきたしているケースがあることに留意する必要があります．<br>　近視をトータルに考える本書が眼科の一般診療をするうえでお役に立てば幸いです．<br><br>2025年9月<br>大阪大学生命機能研究科　不二門　尚</section><section class="indexes">総説			<br>　近視で生涯を通じて良好な視機能を保つために　	<br><br>Ⅰ　単純近視(simple myopia)	<br>　1.近視の定義・分類		<br>　　1）近視の定義・分類	<br>　　2）近視の眼光学	<br>　　［C］PREMYOPIA	<br>　2.近視疫学		<br>　　1）近視の頻度　合併症の頻度	<br>　　2）屈折の加齢変化　	<br>　　3）正視化現象（眼軸長，角膜曲率，水晶体曲率の変化）	<br>　3.近視の検査		<br>　　1）他覚的屈折検査　	<br>　　2）自覚的屈折検査	<br>　　3）眼軸長検査	<br>　　［T］角膜曲率検査	<br>　　4）調節麻痺薬の選択	<br>　4.近視の屈折矯正		<br>　　1）眼鏡による矯正（学童期～老視期）	<br>　　2）眼鏡処方の手引き	<br>　　［T］不適切な眼鏡・コンタクト	<br>　　3）眼鏡による矯正（不同視）	<br>　　4）CLによる矯正<br>　　5）屈折矯正手術<br>　　6）屈折矯正手術ガイドライン	<br>Ⅱ   近視の病因・機構　近視化の機構，進行抑制法	<br>　1.実験近視から分かったこと		<br>　　1）網膜像のぼけと屈折変化	<br>　　2）網膜像のぼけと脈絡膜厚の変化	<br>　　［T］実験近視の分子メカニズム	<br>　　［C］実験近視と臨床近視との解離	<br>　　［T］近視とバイオメカニクス	<br>　2.近視と遺伝		<br>　　1）臨床的検討	<br>　　2）分子生物学的検討	<br>　3.近視進行抑制		<br>　　1）近視と環境因子	<br>　　［C］眼鏡開始時期，低矯正眼鏡装用と近視進行	<br>　　2）近視の光学的進行抑制　　　　　　　　　　　　	<br>　　　a.OK　<br>　　　b.特殊CL<br>　　　c.特殊眼鏡<br>　　［T］光の波長特性と近視進行抑制	<br>　　3）近視の薬理学的進行抑制	<br>　　［A］近視のMyopia calculatorによるマネジメント	<br>　　［C］近視進行予防治療の終了年齢、ＴＡＰＥＲ法	<br>　　4）諸外国における近視進行抑制の指針	<br>Ⅲ   病的近視			<br>　1.近視眼のイメージング		<br>　　1）眼底写真　オートフロー（眼底自発蛍光）	<br>　　［T］小児の強度近視	<br>　　2）OCT（後眼部）	<br>　　［A］後部ぶどう腫とマルチモーダルイメージング		<br>　2.近視合併症		<br>　　1）黄斑症	<br>　　2）網膜剥離	<br>　　3）緑内障	<br>　3.眼疾患と近視		<br>　　1）角膜疾患と近視	<br>　　2）水晶体疾患と近視	<br>　　3）先天性網膜疾患と近視	<br>　　4）斜視と近視	<br>　　5）全身疾患に合併した近視	<br>　4.近視とロービジョンケア<br><br>Advanced Techniques=［A］<br>Controversy=［C］<br>Topics=［T］		</section></article>
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