弱视儿童瞬态图形视觉诱发电位视力与国际标准视力的比较

目的研究弱视儿童瞬态图形视觉诱发电位（pattern visual evoked potential．PVEP）视力与国际标准视力表视力之间的相关性．探讨用视觉诱发电位技术检测弱视儿童客观视力的可行性及临床实用性。方法检测32例（64眼）3-11岁的弱视患儿的瞬态图形视觉诱发电位视力（PVEP视力）及国际标准视力表视力并进行相关分析。PVEP检测使用美国LKC公司生产的UTAS—E3000电生理诊断系统。使用5个不同空间频率的水平条栅作为刺激,时间频率为2Hz,将能够观察到典型PVEP波形的最高空间频率作为患儿的PVEP视力。结果瞬态图形视觉诱发电位视力与国际标准视力表视力之间有良好的相关性（r=0．712,P〈0．05）;弱视程度不同．瞬态图形视觉诱发电位视力的分布亦有显著差异：国际标准视力表视力与瞬态图形视觉诱发电位视力存在一定数值对应规律。重度弱视组,PVEP视力100％在0．85cpd（最低空间频率）;中度弱视组,PVEP视力分布相对较分散,集中分布在3．40cpd和6．80cpd,无1眼达13．60cpd;轻度弱视组．PVEP视力集中分布在3．40cpd和6．80cpd两个空间频率．其中达6．80cpd者占71．2％;视力≥0．9组．全部PVEP视力≥6．80cpd。四组PVEP视力呈相对集中分布。随国际标准视力提高．PVEP视力也相应提高。结论在无法使用国际标准视力表检查弱视儿童视力时,可以运用瞬态图形视觉诱发电位技术进行客观视力评估．尤其是低龄弱视儿童。     

Psychometric视力表对弱视儿童视力的评估作用

目的评价Psychometric视力表在弱视儿童诊治中的应用价值．拥挤现象对正常视力儿童和弱视儿童的影响是否相同。方法我院门诊5～15岁儿童113人，男65人，女48人，平均年龄（7.42±2．03）岁，用标准对数视力表和包含拥挤现象的Psychometric视力表分别检查左右眼的两种视力，比较正常眼和弱视眼两种视力的差别。结果正常视力儿童和弱视儿童的两种视力差异都有显著性（P〈0．05）。对数视力比P视力高。弱视儿童的两种视力差别比正常儿童大。不同弱视类型之间视力差别不大．不同弱视程度之间两种视力有差别。结论儿童都受拥挤现象的影响，但是弱视儿童的拥挤现象更明显。拥挤现象影响程度与弱视程度有关。与弱视类型关系不大。Psychometric视力表适合弱视患者的视力检查。     

目前我国弱视临床防治中亟待解决的问题

多年来,矫正视力低于0.9(≤0.8)一直是我国眼科临床诊断弱视的视力标准,没有不同年龄儿童正常视力的参考值,出现了弱视诊断扩大化的现象.目前在弱视诊断中存在两个"单一"弊病:忽视形成弱视的诸多相关因素,只考虑视力单一因素;忽视视觉发育规律,不分年龄大小只用0.9一个视力标准诊断弱视.因此.对学龄前不同年龄组儿童应采用不同的视力标准,同时强调诊断弱视须具有弱视形成的相关因素.     

弱视儿童干涉条纹视力测定分析

目的测定分析弱视儿童干涉条纹视力。方法25例(43眼)弱视儿童通过手持式的Heine视网膜视力计进行干涉条纹视力的检查,其结果与最佳矫正视力进行对比。结果43只弱视眼干涉条纹视力平均为4．57±0．2。干涉条纹视力与最佳矫正视力呈正直线相关(r=0．650,P＜0．001),回归方程(?)=0．736x+1．171。中度弱视组干涉条纹视力检查的准确性低于轻度弱视组(X~2=2．471,P=0．166)。结论弱视儿童干涉条纹视力与其最佳矫正视力呈正直线相关,在轻度弱视儿童中两者比较接近。干涉条纹视力的检查可以帮助诊断弱视。     

海口市8326名3～6岁儿童弱视调查

目的　调查海口市 3～ 6岁儿童弱视患病率 ,为弱视的防治提供客观依据。方法　对海口市 3～ 6岁的 83 2 6名儿童进行视力调查 ,将裸眼视力低于 1 0列为视力低常。对视力低常和有斜视者进行散瞳验光 ,将眼部无器质性病变 ,无斜视 ,双眼矫正视力平衡 ,而 4～ 5岁矫正远视力在 0 6～0 8之间 ,3岁在 0 5～ 0 8之间 ,且屈光度 <+ 2 2 5D者定为可疑弱视。将眼部无器质性病变而矫正远视力低于上述标准者定为弱视。结果　视力低常率为 12 83 % ,可疑弱视发生率为 0 81% ,弱视患病率为 2 0 2 %。视力低常和可疑弱视的病因以屈光不正为主 ,弱视病因以屈光不正和斜视为主。初次诊断弱视者为 90 48%。结论　海口市 3～ 6岁儿童弱视的患病率与全国平均水平相符 ,但漏诊、漏治情况相当严重 ,应对其产生的严重后果有足够认识 ,早期治疗弱视患儿     

儿童弱视综合疗法临床分析

目的:探讨儿童弱视治疗方法及疗效.方法:从2011-01/2013-12我院斜视弱视治疗中心共治疗儿童弱视234例332眼,诊断标准:年龄4～12岁、视力低于正常同龄儿童、矫正远视力低于相应年龄的视力、眼部无器质性病变并确诊为弱视的患儿.其中随机选择200例322眼弱视儿童作为研究对象,按不同原因引起的弱视,分别采用不同方法进行综合治疗,其弱视儿童疗效与儿童的年龄、治疗时间、弱视类型、弱视程度有密切的关系,观察并定期检查视力恢复情况.结果:通过对200例322眼儿童弱视综合治疗,随访2a,其中基本治愈265眼,进步53眼,无效4眼.结论:综合疗法治疗不同类型弱视疗效显著.     

眼底门诊中非弱视儿童低常视力的病因分析

目的通过眼底检查和视觉电生理检查，研究眼底内科门诊中学龄儿童非弱视性视力低于正常的病因。方法对2006年7月～2006年10月期间．单眼或双眼矫正视力低于4．9．排除弱视的86例（156眼）儿童病例进行前瞻性病因分析，其中男55例，女31例，平均年龄（11±3．1）岁。全部病例均接受了眼前节和眼底检查，48例行视网膜电图（ERG）检查。30例行视觉诱发电位（VEP）检查。结果86例中，视力异常病因按解剖部位分类依次为：视网膜脉络膜疾病40例（46．51％），视神经病变23例（26．74％），青光眼5例（5．81％），原因不明的低常视力有18例（20．93％）。以上病例通过眼底检查确诊26例（30．23％），结合眼底检查和电生理检查确诊29例（33．72％）。本组病例中有16例（18．60％）曾被诊断为弱视。结论非弱视性儿童矫正视力低于正常的病例中．以脉络膜视网膜疾病和视神经疾病为主．原因不明的低常视力仍有一定比例．常规眼底检查必要时需结合视觉电生理检查对于正确的诊断非常重要。     

基于视觉噪声理论的知觉学习对大脑可塑性影响的临床研究

目的本系列实验通过研究弱视噪声视功能的缺损和感知觉学习对弱视视觉功能的恢复作用,进一步证实大脑可塑性和感知觉学习对大脑可塑性的影响。方法随机选择屈光不正性弱视50例88眼和裸眼或矫正视力正常儿童40例80眼。正常组屈光不正儿童和弱视组戴镜1个月后,进行噪声视功能检查,将弱视组噪声视力与无噪声视力之差异常的病例分为治疗组和对照组,治疗组给予戴镜、遮盖并行知觉学习,对照组仅戴镜、遮盖。3个月后对两组进行视力及噪声视功能测试,比较结果。结果弱视组：噪声视力与无噪声视力之差异常率（80．7％）,明显高于正常组（18．8％）。X^2=64．328,P〈O．05。弱视组71眼噪声视力与无噪声视力之差大于2行。治疗组知觉学习后视力0．89±0．02与对照组视力0．56±0．02比较,经t检验,P〈0．05,差别有统计学意义,治疗组噪声视力与无噪声视力之差1．55±0．11,与对照组3．45±0．19比较,经t检验,P〈0．05差异有显著性。结论屈光不正性弱视不仅视力低下,他们排除外部噪声的能力也是降低的。知觉学习可促进屈光不正性弱视儿童噪声视功能的恢复,即知觉学习降低了屈光不正性弱视视觉系统的内部噪声和提高了视觉信息加工效率。     

屈光手术治疗儿童单眼高度近视性弱视的初步报告

目的探讨应用PRK治疗儿童单眼高度近视屈光参差性弱视的可行性、有效性。方法回顾性分析12例5-10岁的儿童单眼高度近视屈光参差性弱视的患儿,对近视度数较高的12眼进行PRK手术治疗,术后再进行系统的脑力影像网络弱视治疗,随访6-12个月。观察手术前后双眼屈光参差差距变化、术眼视力、屈光度、对比敏感度和立体视改善情况。结果手术眼屈光度从术前平均等效球镜-9．77±3．64D降至术后-2．79±2．33D,手术前后屈光度降幅平均为6．98±3．09D。术前双跟屈光参差差距平均为8．65±4．06D,术后双眼屈光参差平均降幅8．25±4．23D。矫正视力从术前0．36±0．24提高到术后的0．45±0．28,术后视力改善的占96．6％,其中提高1行的占36％,提高2行或以上者占62％,未见视力减退病例。在所有术前屈光参差性弱视眼中,2眼术后1个月矫正视力即达到1．0,其他10眼矫正视力均较术前持平或有不同程度改善（提高1-3行）。术后戴镜条件下的对比敏感度和立体视功能与术前持平或有不同程度的改善,其中具有立体视功能的比例从术前的15．3％提高至术后的55．4％。所有病例未见有别于成人PRK的并发症。结论对于单眼高度近视屈光参差性弱视的低龄儿童患者施行PRK手术治疗是一种可选择的安全有效的治疗手段,不仅可以迅速有效地矫正屈光不正,提高视力,而且更为后期弱视治疗提供有利的条件。     

运用综合疗法治疗弱视的初步探讨

目的 观察综合疗法治疗弱视的临床效果。方法 对1997年6月-2004年6月期间，接受综合疗法治疗弱视的5—12岁患儿450例（780眼）的临床效果进行回顾性分析。经阿托品睫状肌麻痹检影验光，矫正视力低于0．8或双眼视力差异2行者，先配戴矫正镜，再行遮盖治疗，同时辅以视刺激疗法、增视疗法、红色滤光片疗法以及海丁格刷、同视机、穿针、穿珠描绘等精细作业综合治疗，分析临床疗效，对比治疗前后视力、眼压、立体视觉以及随诊疗效的巩固情况。结果 治疗效果按视力提高程度分为4级：（1）无效：视力退步、不变或提高仅1行；（2）有效：视力提高2行或2行以上；（3）显效：视力提高4行或4行以上；（4）基本治愈：视力提高至矫正视力0．9以上。其中5—8岁组基本治愈454眼（75％），9—12岁组基本治愈88眼（50％）；轻度弱视基本治愈245跟（90％），中度弱视基本治愈304眼（78％），重度弱视基本治愈77眼（65％）；单眼弱视基本治愈42眼（35％），双眼弱视基本治愈548眼（83％）。结论 弱视的治疗与年龄有密切关系，年龄越小疗效越高，弱视程度越轻，效果越好。且单眼弱视疗效低于双眼弱视。综合疗法治疗弱视行之有效。     

Detection of amblyopia and development of binocular vision in infants and children

Studies of visual development indicate that rapid changes occur in the first months of life and that it is during this period that the visual system is prone to aberrant development. The call for visual screening of children younger than 3 years of age is sensible in light of recent research findings. For children with visual problems, some recovery of visual function can occur if treatment is begun early. New tests of stereoacuity and vernier acuity may aid in the diagnosis of amblyopia, which is underestimated by grating acuity measures. Electrophysiologic testing, using visual evoked potentials and electroretinograms, is helpful in diagnosing visual problems at an early age.     

学龄前儿童视觉发育状况调查研究

目的 了解学龄前儿童视觉发育状况及斜弱视患病率.方法 对4610名城乡3～6岁学龄前儿童进行随机抽样调查,项目包括视力、屈光状态、眼位、斜视弱视等.用x2检验城乡及不同年龄视力分布差异.结果 3岁、4岁、5岁和6岁组儿童视力1.0以上检出率分别为28.4％、39.3％、46.2％、76.5％,各年龄组视力主要分布3岁(0.63±0.19)、4岁(0 69±0.16)、5岁(0.71±0.22)、6岁(0.79±0.29),乡镇较城市儿童视力好.屈光状态以远视为主;显性斜视检出率为2.21％,外斜视多见于内斜视;隐性斜视检出率为33.52％,主要是外隐斜;弱视患病率以现行诊断标准为6岁组2.93％,5岁组4.81％,4岁组16.21％,3岁组33.33％.结论 学龄前儿童视力随年龄增长而上升;国内弱视诊断中视力标准偏高,应尽快制定各年龄组弱视诊断视力标准.屈光不正、斜视和弱视是影响学龄前儿童正常视功能的主要因素,依然是儿童时期防盲治盲的重点.     

Anisometropic and strabismic amblyopia in the age group 2 years and above: a prospective study of the results of treatment.

Forty-four children aged 2-9 years with strabismic and anisometropic amblyopia were prospectively followed up during amblyopia treatment. The efficacy of optimised treatment in terms of number of cured children, time to achieve cure, and rate of initial improvement of visual acuity was evaluated in relation to age at start of treatment, type and initial degree of amblyopia, and adherence to treatment regimen. Compliance with treatment was the most critical factor predicting a successful outcome. Among the compliant children 35 out of 36 were cured (visual acuity difference between amblyopic and non-amblyopic eyes not more than one line) within five months regardless of age, treatment regimen, and type or initial degree of amblyopia as compared with none in the group with low compliance. Most of these compliant children were cured within three months, with shorter treatment times on average for the younger children. The initial improvement of visual acuity was also faster at 2 years than at 4 years of age. Anisometropes with moderate amblyopia at the start of treatment were over-represented in the group with low compliance. We conclude that early diagnosis of strabismus in combination with general population screening at the age of 4 to detect amblyopia caused by anisometropia or microstrabismus seems to be efficacious for the cure of most cases. The major factor in treatment failure was found to be inadequate adherence to the treatment regimen.     

Detection, prevention, and rehabilitation of amblyopia

The necessity of visual preschool screening for reducing the prevalence of amblyopia is widely accepted. The beneficial results of large-scale screening programs conducted in Scandinavia are reported. Screening monocular visual acuity at 3.5 to 4 years of age appears to be an excellent basis for detecting and treating amblyopia and an acceptable compromise between the pitfalls encountered in screening younger children and the cost-to-benefit ratio. In this respect, several preschoolers' visual acuity charts have been evaluated. New recently developed small-target random stereotests and binocular suppression tests have also been developed with the aim of correcting the many false negatives (anisometropic amblyopia or bilateral high ametropia) induced by the usual stereotests. Longitudinal studies demonstrate that correction of high refractive errors decreases the risk of amblyopia and does not impede emmetropization. The validity of various photoscreening and videoscreening procedures for detecting refractive errors in infants prior to the onset of strabismus or amblyopia, as well as alternatives to conventional occlusion therapy, is discussed.     

视力检查在眼病筛查中的作用

视力检查是许多致盲性眼病基层筛查工作的第一步。目前我国儿童人群视力损伤的初步筛查主要由教育机构中的保健老师完成,一直沿用的是以裸眼远视力检查结果为基础的视力不良标准。但该标准并不符合儿童视力发育规律,且可能导致大量已接受正确屈光矫正的患儿重复筛查、诊断和治疗,不符合筛查试验的基本原理。在成年人群基层眼病筛查工作中仍存在只检查裸眼视力的状况。建议对学龄前儿童的视力筛查界值参考我国新的弱视诊断标准而制订;综合裸眼、日常和矫正视力指标来全面了解儿童视力情况;加速儿童保健专业、小儿眼科和视光学专业在儿童视力检查工作上的并轨。在成年人群中,推行日常生活视力指标进行成年人群视力损伤的筛查,并根据所筛查的特定眼病来确定视力检查的具体方案。     

Random dot stereogram E in vision screening of children

The random dot stereogram E (RDE) has been shown to be a simple and effective test for the detection of binocular abnormalities and defective visual acuity in children. We determined the validity of the RDE as a screening test for reduced visual acuity, amblyopia and strabismus in two separate populations of children. A nonselective group of 100 school children (aged 5 to 15 years) who presented consecutively to the ophthalmology department at Auckland Public Hospital were tested with the RDE. All cases of amblyopia and strabismus were detected by the RDE. Similar screening with the RDE test of 168 preschool children (aged three to four years) in the community resulted in an unacceptably high over-referral rate. The test was unreliable in the preschool age group because of difficulty in distinguishing between test failure and non-cooperation with the test. The low positive predictive value of the test in the younger age group suggests the test to be unsuitable for preschool vision screening.     

Pediatric Amblyopia Risk Investigation Study (PARIS)

PURPOSE: To assess the learning curve, testability, and reliability of vision screening modalities administered by pediatric health extenders. DESIGN: Prospective masked clinical trial. METHODS: Two hundred subjects aged 3 to 6 underwent timed screening for amblyopia by physician extenders, including LEA visual acuity (LEA), stereopsis (RDE), and noncycloplegic autorefraction (NCAR). Patients returned for a comprehensive diagnostic eye examination performed by an ophthalmologist or optometrist. RESULTS: Average screening time was 5.4 +/- 1.6 minutes (LEA), 1.9 +/- 0.9 minutes (RDE), and 1.7 +/- 1.0 minutes (NCAR). Test time for NCAR and RDE fell by 40% during the study period. Overall testability was 92% (LEA), 96% (RDE), and 94% (NCAR). Testability among 3-year-olds was 73% (LEA), 96% (RDE), and 89% (NCAR). Reliability of LEA was moderate (r = .59). Reliability of NCAR was high for astigmatism (Cyl) (r = .89), moderate for spherical equivalent (SE) (r = .66), and low for anisometropia (ANISO) (r = .38). Correlation of cycloplegic autorefraction (CAR) with gold standard cycloplegic retinoscopic refraction (CRR) was very high for SE (.85), CYL (.77), and moderate for ANISO (.48). CONCLUSIONS: With NCAR, physician extenders can quickly and reliably detect astigmatism and spherical refractive error in one-third the time it takes to obtain visual acuity. LEA has a lower initial cost, but is time consuming, moderately reliable, and more difficult for 3-year-olds. Shorter examination time and higher reliability may make NCAR a more efficient screening tool for refractive amblyopia in younger children. Future study is needed to determine the sensitivity and specificity of NCAR and other screening methods in detecting amblyopia and amblyopia risk factors.     

Random dot stereogram E in vision screening of children

The random dot stereogram E (RDE) has been shown to be a simple and effective test for the detection of binocular abnormalities and defective visual acuity in children. We determined the validity of the RDE as a screening test for reduced visual acuity, amblyopia and strabismus in two separate populations of children.
A nonselective group of 100 school children (aged 5 to 15 years) who presented consecutively to the ophthalmology department at Auckland Public Hospital were tested with the RDE. All cases of amblyopia and strabismus were detected by the RDE. Similar screening with the RDE test of 168 preschool children (aged three to four years) in the community resulted in an unacceptably high over-referral rate. The test was unreliable in the preschool age group because of difficulty in distinguishing between test failure and non-cooperation with the test. The low positive predictive value of the test in the younger age group suggests the test to be unsuitable for preschool vision screening.     

深圳市宝安区学龄前儿童弱视发病率及其相关因素分析

目的：了解深圳市宝安区学龄前儿童弱视发病率及探讨其相关危险因素,为区域弱视预防工作提供可能依据。

方法：选取2017-06/2018-02在深圳市宝安中医院眼科门诊进行视力筛查的学龄前儿童818例为研究对象,依据弱视诊断标准统计弱视发病患儿,并将其视为观察组,其余作为对照组,且对两组进行单因素和多元Logistic回归分析。

结果：深圳市宝安区学龄前儿童弱视发病率5.7%(47/818)。其中,屈光不正性弱视最常见(63.8%),其次为屈光参差性弱视(21.3%),再者是斜视性弱视(12.8%),最后系形觉剥夺性弱视(2.1%)。两组在妊娠年龄、孕产次、孕周、近(弱)视家族遗传史相关因素中,差异有统计学意义(P<0.05)。妊娠年龄大、孕产次多、孕周短、有近(弱)视家族遗传史均是导致儿童弱视发病的高危因素(P<0.05)。

结论：深圳市宝安区学龄前儿童弱视发病率较高,应予以重视,同时影响因素颇多,而全面开展学龄前视力筛查是实现早发现、早诊断及早治疗的有效方法。