完善白内障手术前后视功能评价--适应屈光性白内障手术要求

白内障手术不仅是复明手术,更是一种屈光性手术。在改良IOL设计、完善白内障手术技术的同时,在手术前后除检查远近视力外,应加强对比敏感度和眩光敏感度、调节能力、双眼视觉、波前像差等视功能的客观评价,力争使患者取得更完美的视觉效果。     

合理矫正像差提高视觉质量——CANON STAAR非球面预装式折叠人工晶状体

现代白内障手术完全解决了视力重建的问题，基本满足了患者恢复视力的要求。但是若用屈光手术的标准来要求，患者术后的视觉质量还存在如暗视力差、主观视物模糊等现象。研究表明，上述现象产生的主要原因是像差，消除像差就可以提高患者的对比敏感度，提高患者的全天候、各种环境下的功能性视力，从而全面提高患者的视觉质量。     

现代视功能检查在微创白内障手术中的应用意义

随着微创白内障手术的发展和日趋增多的新型人工晶状体(IOL)的临床应用,患者的功能性视力得到越来越大的提高。以往临床上一直作为评价术后疗效的主要指标——裸眼及最佳矫正视力,已很难涵盖视觉质量的全部内容。本文介绍功能性视力、波前像差、视网膜散射光、点扩散函数、调制传递函数、对比敏感度等现代视功能检查及其在白内障手术中的应用原理和临床意义。这些检查不仅对白内障的早期诊断、手术适应证把握、手术并发症处理、个性化IOL选择及植入术后视觉质量的评价有重要指导意义,而且有助于客观分析白内障术后患者主观视觉质量差的原因并加以处理。熟悉围术期视觉质量评价的内容和意义,有助于提高白内障的手术水平,使患者获得更好的术后视觉质量。     

白内障早期患者术前及术后的眩光测试

目的　对白内障患者早期最明显的症状之一———眩光失能进行定量测量与研究。方法　门诊早期白内障患者 18例 2 3眼 ,裸眼视力或矫正视力≥ 0 5 ,并自愿进行白内障超声乳化术者 ,分别测量术前、术后 1个月的无眩光时的对比敏感度和加眩光后的对比敏感度。结果　白内障患者早期对比敏感度值就明显下降 ,眩光实验更加明显 ,各频段加眩光前后有显著性差异 (P <0 0 1)。CSF值在较低频率下降更明显 ,在 6c/d下降程度最大。术后 1个月对比敏感度值接近恢复到正常范围 ,眩光实验对比敏感度无显著性改变 (P >0 0 5 )。结论　早期白内障患者的功能性视力低于标准视力表视力 ,对比敏感度视力可更准确地反映患者的真实视力 ;眩光实验可定量检测早期白内障患者的眩光失能程度     

年龄相关性白内障患者术后视觉功能的评价

晶状体的混浊可造成光线散射,导致视网膜成像的对比度和清晰度下降,影响白内障患者的正常工作和生活。进行白内障手术后,部分患者虽然视力检查良好,但仍反映视觉质量很差。寻求一种能够相对客观地反映屈光介质和视网膜成像的检测系统来评价视觉质量显得尤为重要。目前临床上常用的方法为对比敏感度（CS）检查和视觉问卷调查,通过测量CS可以判断白内障患者视觉质量和生活质量下降的程度,且对白内障术后疗效的评价有重要价值。通过文献回顾,就年龄相关性白内障患者术前及术后CS特征的研究进展进行综休。     

原发性闭角型青光眼合并白内障术后视觉质量变化及影响因素

近年来,白内障超声乳化吸除加人工晶状体植入联合房角分离手术逐渐成为治疗原发性闭角型青光眼合并白内障的主要有效手段,然而随着医疗技术不断进步,术后眼压的控制不再是唯一的追求,患者对术后的视觉质量期望越来越高。为了使患者术后拥有更好的屈光状态和更高的视觉质量,需减少因原发性闭角型青光眼所带来的负面影响,个性化选择不同人工晶状体或计算公式等。视觉质量评价指标包括视力、对比敏感度、高阶像差、主观感受等。因此,本文就原发性闭角型青光眼合并白内障患者行白内障超声乳化吸除加人工晶状体植入联合房角分离手术术后屈光漂移、高阶像差、对比敏感度变化及其影响因素以及人工晶状体的选择做出综述。     

影响白内障术后人工晶状体眼视觉质量的因素分析

提高白内障的手术质量,使患者不仅脱盲、脱残,而且能达到理想的视觉质量是白内障复明工作所面临的新的挑战.除了手术设备和手术操作,人工晶状体的材料、设计及功能是决定人工晶状体眼视觉质量的关键所在.评价人工晶状体眼视觉质量不仅包括视力检查,而且需结合对比敏感度、眩光和像差等一系列综合评价指标.为了同时获得较好的远、近视力,植入多焦点人工晶状体是一种有效的方法.     

区域折射多焦点人工晶状体SBL-3的临床应用

目的：探讨区域折射多焦点人工晶状体SBL-3的临床应用效果。

方法：选取2016-02/2017-06于本院行白内障超声乳化摘除术联合多焦点人工晶状体SBL-3植入的26例26眼年龄相关性白内障患者纳入SBL-3组; 选取同期于本院行白内障超声乳化摘除术联合单焦点人工晶状体TecnisZA9003植入的28例28眼年龄相关性白内障患者纳入对照组。比较两组患者术后3mo的裸眼视力、矫正视力、对比敏感度及患者满意度。

结果：术前两组患者的裸眼远、中、近视力相比差异均无统计学意义(P>0.05)。术后3mo,两组患者的裸眼远、中、近视力较术前均得到明显改善(P<0.05); SBL-3组患者裸眼中近视力、最佳矫正远视力下中视力和近视力均显著优于对照组(P<0.05); SBL-3组患者在明光、暗光、明光眩光和暗光眩光下不同空间频率(3、6、12、18c/d)的对比敏感度以及视觉质量满意度均显著优于对照组(P<0.05)。

结论：区域折射多焦点人工晶状体SBL-3不仅可以提供较好的远视力,还可提供更佳的中视力、近视力以及对比敏感度,极大地提高了患者术后的视觉质量满意度。     

多焦点人工晶状体在近视合并白内障患者中的远期疗效评价

目的评价近视合并白内障患者在白内障超声乳化联合多焦点人工晶状体（multifocal intraocular lens，MIOL）植入术后的视觉质量。方法近视眼白内障患者行小切口超声乳化术，植入MIOL（Array SA-40N，AMO）14眼，单焦点人工晶状体（monofocal or single-focal intraocular lens，SIOL）（SA60AT，Alcon）20眼。手术后6个月，观察两组的术后视力、对比敏感度及视觉不良症状．使用Hartmann-Shack波前像差仪测定患者术后高阶像差，Pentacam检测两组人工晶状体（intraocular lens，IOL）的居中性（偏心值和倾斜度）。结果MIOL组术后裸眼近视力≥4．7的患者占64．29％，矫正远视度数下的近视力≥4．7的患者占85．71％，MIOL组裸眼近视力及矫正远视力下的近视力明显好于SIOL组（P〈0．05）。MIOL组在低、中、高频段对比敏感度及眩光对比敏感度与SIOL组差异均无统计学意义（P〉0．05）。分析孔径为5mm时，SIOL组球差显著高于MIOL组（P〈0．05），两组总高阶像差、余各阶像差的差异均无统计学意义（P〉0．05）。两组IOL居中性（偏心值和倾斜度）差异无统计学意义（P〉0．05）。结论MIOL植入治疗近视白内障，可为患者提供较好的全程视力和良好的视觉质量，显著减少了术后对于框架眼镜的依赖。其远期的对比敏感度及眩光对比敏感度均在正常范围,球差低于SIOL。     

高度近视伴后巩膜葡萄肿超声乳化术后视觉质量分析

目的：评价高度近视伴后巩膜葡萄肿的白内障患者行白内障超声乳化摘除联合人工晶状体(intraocular lens,IOL)植入术后的视觉质量,并分析其原因。 方法：本研究根据患者术前屈光状态以及有无后巩膜葡萄肿分为三组：A组为高度近视伴有后巩膜葡萄肿的白内障患者;B组为高度近视无后巩膜葡萄肿的白内障患者;C组为正视眼的白内障患者。于手术后3d观察A、B、C三组裸眼远视力(uncorrected distance visual acuity,UCDVA)和最佳矫正远视力(best-corrected distance visual acuity,BCDVA),术后6mo观察A组视力与眼轴的关系、A、B、C三组UCDVA和BCDVA、对比敏感度、眼底检查及患者术后满意度调查。 结果：在本实验收集的472例患者（545眼）中,A组患者74例（91眼）;B、C组各199例（227眼）。术后3d及6mo,B、C组的UCDVA及BCDVA均优于A组,差异有统计学意义（均P<0.05）;术后3d,C组的裸眼远视力及最佳矫正远视力优于B组,差异有统计学意义（P<0.05）;术后6mo患者UCDVA及BCDVA在B、C两组间的差异无统计学意义。 A组和B组在4种状态5种空间频率下的对比敏感度的差异均有统计学意义（均P<0.05）,C组的对比敏感度高于A、B组,B组的对比敏感度要高于A组,差异有统计学意义（均P<0.05）。经统计学检验,高度近视伴后巩膜葡萄肿白内障患者超声乳化术后视力与眼轴长短之间呈负相关性。 A、B组患者术后视觉质量满意度高于C组,差异有统计学意义（均P<0.05）,但A、B组间患者术后质量满意度无明显差异。 结论：高度近视伴后巩膜葡萄肿的白内障患者行白内障超声乳化摘除联合IOL植入术后的视觉质量较高度近视不伴有后巩膜葡萄肿的白内障及正视眼的白内障患者差,这与高度近视眼底病变有直接关系。     

LVC程序视野检查在白内障手术中的应用

目的　探讨中央低视力(lowvisioncenter ,LVC)程序视野检查在术前评估白内障低视力患者视功能的价值。方法　白内障低视力患者共30例30眼,其中合并青光眼、入院后行青白联合术者2 1例2 1眼;无青光眼史、单纯行白内障手术者9例9眼。术前1日及术后3月内行LVC程序视野检查。术前同时行视网膜潜视力测定。结果　所有患者在术后总的平均阈值敏感度(meansensi tivity,MS)均有显著提高(P <0. 0 1) ,而颞侧的MS值较鼻侧的MS值改善更为明显。术前视野已有绝对暗点形成的区域,术后仍存在。与视网膜潜视力测定相比,LVC程序视野检查的MS值与术后最佳矫正视力间存在更好的对应关系。结论　术前LVC程序视野检查对于白内障尤其是合并青光眼低视力患者有特殊价值,有助于术者判断该类患者术后的视力、视野的情况,可作为术前估计其潜在视功能的新方法之一     

Functional complaints, visual acuity, spatial contrast sensitivity, and glare disability in preoperative and postoperative cataract patients

PURPOSE: To quantify cataract patients' functional visual complaints and correlate them with their objective glare disability and spatial contrast sensitivity (SCS) scores. SETTING: Sir Mortimer B. Davis Jewish General Hospital. Montreal, Quebec, Canada. METHODS: Thirty patients scheduled for cataract surgery with a visual acuity of 20/70 or better at the time of patient selection and no other ocular pathology were evaluated objectively and subjectively for visual function preoperatively and within 3 months postoperatively. Objective measures of SCS and visual acuity in the presence and absence of glare were obtained with the Optec 3000 vision tester. Subjective visual function was evaluated with the Activities of Daily Vision Scale (ADVS), a questionnaire that evaluates patients' visual function by assessing the degree of difficulty they experience in performing tasks involving distance vision, near vision, and glare conditions. RESULTS: Preoperatively, patients had decreased visual acuity and SCS in the presence of glare. The ADVS scores were correlated with visual performance. Postoperatively, there was a statistically significant improvement in all dependent measures (i.e., visual acuity and SCS in the presence of glare) as well as in the subjective report of visual performance assessed by the ADVS. CONCLUSION: Spatial contrast sensitivity, glare disability, and the ADVS questionnaire should be considered as adjuncts to visual acuity testing in evaluating certain cataract patients.     

Improvements in measures of vision and self-reported visual function after cataract extraction in patients with late-stage age-related maculopathy.

PURPOSE: A recent study indicated that patients with cataracts and early age-related maculopathy may benefit from cataract extraction. To ascertain whether cataract extraction in the presence of concurrent advanced age-related maculopathy was also associated with a clear benefit, we studied visual function and self-reported visual functioning in a cohort of 12 patients pre- and post-phakoemulsification. METHODS. All 12 patients had a diagnosis of advanced age-related maculopathy in the eye scheduled for cataract surgery. Preoperative assessment included refraction and recording of best corrected distance and near acuity and contrast sensitivity in both eyes. The Daily Living Tasks Dependent on Vision questionnaire was administered. After phakoemulsification and intraocular lens implantation, all patients were reviewed and assessed. RESULTS: After surgery, improvement in acuity was recorded in nine operated eyes, whereas acuity remained unchanged in three eyes. Improvement in contrast sensitivity in the operated eye occurred in 10 patients, but in two patients contrast was reduced postoperatively. In terms of self-reported visual functioning, improvement in the ability to undertake many daily living tasks dependent on vision was recorded after cataract surgery. CONCLUSIONS: Significant improvements in specific areas of self-reported visual functioning and measures of vision were recorded after cataract surgery. During the follow-up period, none of the operated eyes suffered a fall in visual acuity. There was also no evidence of worsening of the pre-existing macular lesion as judged by clinical examination and fundus photography.     

高度近视并发白内障的视功能

随着高度近视患者的增多,高度近视并发的白内障日益受到重视。另外,以往临床上一直作为评价术后疗效主要指标的裸眼及最佳矫正视力,已很难涵盖视觉质量的全部内容。本文介绍调节集合功能、立体视功能、对比敏感度等现代视功能检查及其在高度近视并发白内障中的应用和临床意义,以及手术对视功能的影响。这些检查不仅对白内障的早期诊断、手术适应证把握、个体化IOL选择及植入术后视觉质量的评价有重要指导意义,而且有助于客观分析术后患者主观视觉质量差的原因并加以处理。熟悉视功能评价的内容和意义,有助于提高此类白内障的手术水平,使患者获得更好的术后视觉质量。     

Focus on the evaluation of visual quality in cataract patients北大核心CSCD

With the improvement of cataract examination methods, intraocular lens (IOL) design and process, surgical equipments and techniques, cataract surgery was gradually developed from vision rehabilitation to refractive surgery. Therefore, the assessment of visual quality is getting more attention. Clinically, in addition to the extension of concept of visual acuity, contrast sensitivity function (CSF), modulation transfer function (MTF), point spread function (PSF), wavefront aberration and scattering index are also used, with a view to making a comprehensive assessment of visual quality of cataract patients preoperatively and postoperatively. Ophthalmologists should pay attention to the methods and results of evaluation on the visual quality, to provide support for the design of personalized surgery and the improvement of visual quality. Copyright © 2018 by the Chinese Medical Association.     

Glare measurement as a predictor of outdoor vision among cataract patients

Eighty-four cataractous eyes of 52 consecutive patients and 81 normal eyes of 48 subjects were evaluated with a commercially availability glare tester. Tests results were compared to visual acuity determinations in the refracting lane for ability to predict vision outdoors under daylight conditions. Among cataract patients, predictability of the two methods of measurement was not significantly different when subjects faced away from the sun. Glare scores were significantly better predictors (nearly twice as predictive) of outdoor visual acuity among cataract subjects facing the sun. These results demonstrate that measurement of sensitivity to glare is an important clinical procedure for evaluating functional visual disability in cataract patients under glare-producing conditions.     

老年性白内障术后早期的对比敏感度变化

目的：探讨老年性白内障术后早期的对比敏感度（CSF）变化。方法：对行超声乳化白内障吸附联合折叠型IOL植入手术的老年性白内障术后患者87例（95眼），早期应用对比敏感度测试卡（FACT）进行CSF测定。结果：以术后矫正视力为标准，分成A（0．8－），B（0．4－0．6），C（0．2－0．3）三组。A（0．8－）组患者CSF曲线大多在正常范围区域；B（0．4－0．6）组患者CSF曲线主要为中，高空间频率异常，尤其在高频区，如：D和E排； C（0．2－0．3）组患者CSF曲线随着视力下降，中、高、低空间频率异常，以致个人的对比值曲线落在正常范围之下，结论：老年性白内障术后早期的CSF变化与视力因素明显相关，与植入的折叠型IOL无关。     

Creation and testing of a practical visual function assessment for use in Africa: correlation with visual acuity, contrast sensitivity, and near vision in Malawian adults

AIM: To develop and test a practical visual function assessment for use in developing countries. METHODS: Using focus group discussions and interviews with eyecare workers and low vision specialists in Malawi, 13 questions related to visual characteristics of activities of daily living were designed. Patients presenting to an eye clinic were recruited and interviewed. Visual acuity, near vision, and contrast sensitivity were measured. Analysis sought to determine the degree of correlation between the vision indices and visual function. RESULTS: The visual function questionnaire was easy to administer. Visual function correlated with visual acuity, contrast sensitivity, near vision, and patient reported visual problem. People with a higher frequency of "not applicable" responses had lower visual function scores. Multivariate modelling revealed that visual acuity and number of questions felt to be applicable were independently associated with visual function. Reducing the questionnaire to nine questions did not affect the degree of correlation with any of the visual indices. CONCLUSION: The authors' visual function assessment correlates well with different measures of visual acuity. People with reduced vision for a prolonged period may no longer consider doing certain tasks and the number of questions considered appropriate by an individual may be an additional measure of visual function. Assessment of visual function by health workers may be a valuable tool in improving surgical uptake by encouraging both health personnel and patients to recognise that they have difficulties undertaking activities of daily living as well as a measure of monitoring and evaluating cataract outcomes.