Commentary

Leadership in education is needed to ensure that the American Occupational Therapy Association's 2017 vision is achieved. Education prepares tomorrow's leaders. Ultimately, the profession needs to commit to developing leaders in practice, research and education to move our profession forward.     

Œil et sport. Physiologie et moyens d’exploration. Mise au point CAT devant les lésions oculaires dues aux sports

For practising sports, vision is a major sensorial element whatsoever sport level is concerned. The vision is based on a sensorial system and the eye picks up the information. This information conveys through retina, visual ways and brain. Throughout this process, filtration or amplification mechanisms, plurimodal and multisensorial mechanisms, cognitive mechanisms, paying attention and memorizing mechanisms are playing an essential role. This so perfect and rather complex construction can be easily damaged when the eye is wounded. Practising a sport may expose the eyes to damageable traumatisms. The subsequent secondary effects would be a decline of the visual capacity and consequently a decline of the athletic performance. Finally, “sport doctors” and coaches focus on the physical preparation, heart ventilation, cardiovascular monitoring, but they should not forgot the visual system which has an essential role as the brain is in an hermetically closed box and can only react when receiving relevant information of which 80% come from vision. Most injuries involve the cornea due to penetration of small foreign bodies. Direct or indirect shock can have secondary consequences such as glaucoma, cataract or retinal injury. The secondary effects can be measured in terms of visual acuity.     

早产儿健康眼出生时视网膜电图特点

目的 了解早产儿出生时视网膜功能发育程度，比较早产儿和足月 产婴儿出生时视 网膜功能发育的异同。 方法 健康无眼病的早产儿10例10只眼和足月产 婴儿20例20只眼，随 机选取1只眼在出生后1周内进行闪光视网膜电图（FERG）检测，记录视杆细胞反应、视锥细 胞反应、最大混合反应，振荡电位（OPs）及30 Hz闪烁光反应。 结果 与足月产 婴儿比较，早产儿出生时视杆细胞反应潜伏期明显延长 (t=3.216，P=0.003)，振幅明显降低(t=6.050，P=0.000），差异有统计学意义；最大反应a、b波潜伏期差异无 统计学意义(t=0.465，P=0.650；t=1.068，P=0.295)，而振幅降低(t=6.584，P=0.000；t=6.649，P=0.000)差异有统计学意义。两组婴儿视锥细胞反应a、b波潜伏期 差异无统计学意义(t=0.077，P=0.939；t=0.935，P=0.358)，早产儿组振幅明显降 低(t=3.417，P=0.002；t=6.310，P=0.000)， 差异有统计学意义；两组间30 Hz闪烁光峰值潜伏期差异无统计学意义(t=0.968，P=0.341），早产儿组振幅明显降低（t=3.745，P=0.001），其差异有统计学意义。 两组间最大混合反应的b／a波振幅比值差异无统计学意义(t=0.215，P=0.831)。 结论 出生时早产儿视网膜的发育程度低于足月产婴儿。     

准分子激光原位角膜磨镶术治疗远视眼老视的临床观察

目的 探讨准分子激光原位角膜磨镶术(LASIK)治疗远视眼老视的临床效果.方法 回顾性病例分析研究.收集32例(64只眼)因远视眼老视行LASIK患者的资料.术前屈光度数:球镜为+0.75～+3.00 D,柱镜为0.00～+1.75 D.术后预期目标屈光度数:主视眼为0.00～-0.50 D视远,非主视眼为-1.50～-2.50 D视近,目标近视力等于或高于J3.术后随访时间12个月,观察术后双眼裸眼远近视力、角膜形态、屈光度数及对比敏感度等.本研究采用t检验、X2检验、SNK-q检验方法对数据进行统计学分析.结果 LASIK术后12个月双眼裸眼远视力≥0.8且近视力等于或高于J3及等于或高于J4的患者分别为53.1%(17/32)及87.5%(28/32).术后不同时间角膜屈光力较术前[角膜直径3 mm区域为(44.12±1.38)D、5 mm区域为(43.42±1.53)D]均有明显增加,且对应的角膜非球面参数Q值,如主视眼术后1、3、 6、 12个月分别为-0.514±0.053、-0.416±0.065、-0.389±0.076、-0.368±0.087,亦呈负值增加(t=19.25,12.14,9.82,8.11;P<0.01).术后12个月等效球镜屈光度数与预期目标差值在±0.50 D和±1.00 D以内者主视眼分别为87.5%(28/32)、100.0%(32/32),非主视眼分别为56.2%(18/32)、90.6%(29/32).术后6个月双眼各空间频率对比敏感度与术前比较,差异均无统计学意义(t:0.63,0.45,0.37,1.06,0.64;P0.05);术后12个月主诉有干眼症状的患者占15.6%(10/23),满意度调查84.4%(27/32)患者对疗效满意.结论 根据单眼视原理采用LASIK治疗远视眼老视可获得较好的临床效果,但其远期疗效和稳定性有待进一步观察.     

高中学生视力检查中存在的问题

目的了解现行标准对数视力表用于高中学生视力检查时所存在的问题,并提出改进意见。方法原测(5.0m)对双眼视力均≤4.3的高中学生97人194只眼,采取变距测量(2.5m),比较原测与复测值。差值≤-0.2的有背诵可能;差值≥ 0.2的可能是逆反心理。结果有背诵可能的占42.3%(82/194),背诵者中,背诵2行的较多,占53.7%(44/82)。原测4.0组的检测结果可靠性较高,有背诵可能的为22.0%(20/91);4.1组有背诵可能的增高至57.63%(34/59);4.2组和4.3组的更高。另有4.1%(8只眼)可能存在逆反心理,故意称看不清楚。检查结果比较准确的占53.6%(104/194)。未变距测量,而视力≤4.3的高中学生每只眼平均偏高0.1206(1.2行)。结论检测高中学生视力,现行仪器设施及其使用方法需要改进。     

高度近视合并原发性开角型青光眼的临床分析

目的 探讨高度近视合并原发性开角型青光眼（primary open-angle glaucoma,POAG)的早期诊断依据。方法 （1）将存档的21例（40只眼）高度近视合并POAG患者资料（A组）与随机抽取的21例（40只眼）中度近视合并POAG患者的资料（B组）及21例（42只眼）低度近视合并POAG患者的资料（C组）进行对照,比较初次就诊时3组患者间视野缺损,视网膜神经纤维层缺损（retinal nerve fibre layer defect,RNFLD),最高眼压值及最佳矫正视力等指标的差异;（2）观察A组患者的三维眼底照片,分析其临床特点。结果 （1）初诊时,A组患者中,重度视野缺损和RNFLD的比例明显高于B,C组,矫正视力低于B,C组;（2）高度近视患者视乳头,视网膜的特异性变化及视乳头周围病变等,直接干扰对青光眼的早期诊断;（3）散瞳检查或立体眼底拍片是提高青光眼检出率的重要手段。结论 认识高度近视本身及合并POAG时的临床特点,有利于提高临床医师对该病的警觉性及早期诊断水平。     

间歇性外斜视患者交叉视差和非交叉视差的临床观察

目的　了解间歇性外斜视患者交叉视差和非交叉视差的临床变化。方法　对 5 5例间歇性外斜视患者 ,术前应用颜少明的《立体视觉检查图》检测其近零视差、交叉视差及非交叉视差 ,并根据检测情况分为 3组进行分析。结果　第 1组 2 5例 ,近零视差立体视锐度正常者占 4 8 0 % ,其交叉视差和非交叉视差立体感知度检测值均不在正常范围 ,交叉视差者的立体感知度检测值比非交叉视差者大 ,差异有显著意义 (t =84 3 5 ,P <0 0 0 0 1)。第 2组 2 6例 ,近零视差立体视锐度正常者占30 8% ,其交叉视差立体感知度检测值不在正常范围 ,未见有非交叉视差者。第 3组 4例 ,为仅查到不正常的近零视差立体视锐度者。 5 5例中 ,无近零视差仅和非交叉视差共存者 ,也无交叉视差和非交叉视差各自独立存在者 ,亦无交叉视差和非交叉视差两者共存者。结论　 (1)本组间歇性外斜视患者近零视差立体视锐度及交叉视差和非交叉视差立体感知度不健全 ;(2 )间歇性外斜视患者视差的损害顺序依次为非交叉视差、交叉视差、近零视差。 (3)双眼黄斑颞侧视网膜对应的是交叉视差 ,双眼黄斑鼻侧视网膜对应的是非交叉视差     

广东省斗门县白内障手术的生存质量评价

目的：评价广东省斗门县年龄≥50岁人群中白内障术后患者的主观视功能（visual function,VF）和生存质量（quality of life,QOL）。方法：整群抽样法确定样本人群,其中白内障术后患者组成手术组,视功能损害者（1只眼视力＜0．1者）和部分正常对照者（双眼视力均＜＞0．3者）组成非手术组,由4位工作人员按照标准化方式完成VF和QOL问卷调查工作。结果：在5342例受检查中,手术组109例白内障术后患者中99例,非手术组626例视功能损害者中535例、3227例正常对照者中119例完成问卷调查工作。随着视力自正常下降至严重盲,非手术组VF和QOL分数的中位数分别自92下降至2和自100下降至19;手术组VF和QOL分数的中位数分别自80下降至8和自90下降至31。手术组视力与VF和QOL分数的关系与非手术组相似。VF和QOL的总分数手术组分别为40和56,非手术组分别为56和72。通过多因素回归分析校正视力、年龄、性别和教育程度后,非手术组和手术组的QOL分数差异有显著意义（P＝0．015）,VF分数差异无显著意义（P＝0．199）。结论：VF和QOL与视力显著相关。在本研究人群中,白内障术后患者的主观VF和QOL无明显提高,临床应进一步重视白内障术后患者的随访工作和社会心理康复。     

Cerebellar fastigial neurons send bifurcating axons to both the left and right superior colliculus in cats

Anesthetized cats were injected with 2% Fast Blue and 0.5% Nuclear Yellow into the intermediate and deep layers of the left and right superior colliculus, respectively. In the right caudal part of the cerebellar fastigial nucleus (cFN), double-labeling was found in 38.5% of the neurons labeled with Fast Blue, and in 11.5% of the neurons labeled with Nuclear Yellow. In the left cFN, 52.2% of the neurons labeled with Fast Blue and 11.0% of the neurons labeled with Nuclear Yellow were double-labeled. The results suggest a role of bifurcating fastigial fibers in cerebellar visual control.     

Vision for spatial perception and vision for action: a dissociation between the left-right and near-far dimensions

Neuropsychological and psychophysical studies have suggested that two distinct visual sub-systems are responsible for perception and action. One of the main psychophysical arguments for this is based on visual illusion such as the Induced Roelofs Effect (IRE), where the location of a visual target presented with an off-centre frame is misperceived when evaluated verbally, but not with a reaching response. This dissociated effect suggests the existence of two independent representations of visual space devoted, respectively, to categorisation and to egocentric localisation of reachable objects. These "cognitive" and "sensorimotor" representations have been assumed to be produced through specific anatomical pathways stemming from the primary visual cortex (respectively, the ventral and dorsal streams). To account for the dissociation found with the IRE, it has been suggested that only the cognitive system is sensitive to contextual information. However this view has been challenged by recent psychophysical studies demonstrating the influence of environmental cues on distance perception and the guiding of movement. In the present study, the IRE is re-evaluated but the near-far and right-left dimensions were dissociated. In agreement with previous findings, our results showed that the IRE in the right-left dimension gives rise to a perceptual misperception of target position with no effect on motor performance. Conversely, when the IRE was induced in the near-far dimension a misperception of the target position affected both perceptual and motor responses. This dissociation indicates that the spatial constraints of the task, and not only the nature of the response, interfere with sensitivity to contextual information leading to visual illusions. It is thus likely that the action system (imputed to the dorsal stream) can be sensitive to contextual information, at least when depth processing is emphasised.