视疲劳患者症状调查及证型分布分析

目的：通过对视疲劳患者的调查,探讨视疲劳患者的症状发生频率及证型分布。方法设计视疲劳调查表,采集视疲劳患者一般资料及中医四诊信息,进行视力、验光、隐斜、眼压、角膜上皮荧光素染色等检查,将患者各症状、体征、舌脉录入计算机,建立数据库。运用SPSS17.0软件计算症状发生频率和证候分布。结果①症状发生频率从高到低依次为院眼干涩、眼疲倦、眼胀痛、视物模糊、眼酸、颈肩酸痛、疲倦(发生频率>50%);②肝肾阴虚、肝肾阴虚夹气滞、肝肾阴虚夹湿的累计频率达81.08%,其中肝肾阴虚的出现频率达43.24%。结论①视疲劳以眼局部症状为主,伴随全身不适,且与精神因素相关;②视疲劳临床证型可分为肝肾阴虚、肝肾阴虚夹气滞、肝肾阴虚夹湿三型,以肝肾阴虚最为多见,部分证型为复合证型。     

越橘叶黄素酯软胶囊缓解视疲劳的保健作用

目的：观察越橘叶黄素酯软胶囊对缓解视疲劳功能的效果.方法：选择长期用眼,视力易疲劳的成人104例,随机分成试食组和对照组,每组各52例.试食组食用越橘素酯软胶囊,对照组食用安慰剂,食用方法均为每天1次,每次1粒.结果：经过45 d试食后,试食组对眼痛、眼胀、畏光、视物模糊、眼干涩等临床症状有所改善,试食组临床观察总有效率为80.77％,与对照组（23.88％）比较差异有显著性（P＜0.05）.试验组明视持久度较试验前提高0.11,与自身试食前及对照组试验后比较,差异皆有显著性（P＜0.05）.结论：越橘叶黄素酯软胶囊具有缓解视疲劳功能的作用.     

客观评价近视眼配镜过矫对人眼调节功能影响的临床研究

目的探讨客观评价近视眼配镜过矫对人眼调节功能影响的价值。 方法收集2010年1月至2014年6月就诊于首都医科大学附属北京同仁医院北京同仁眼科中心视光学门诊的近视眼配镜过矫伴视疲劳患者16例(30只眼)。其中,男性10例(19只眼),女性6例(11只眼),年龄14~38岁,平均年龄(23.7±7.2)岁。所有患者均进行视力检查、显然验光、复方托吡卡胺散瞳验光、原框架眼镜屈光度检查、主观调节幅度检查及客观调节功能检查。根据近视眼配镜过矫状态下患者主观调节幅度下降、客观调节不足、客观调节异常及客观调节微波动高频成分增加进行分组。使用均数±标准差描述年龄的分布情况;采用眼数和百分比描述各组的病例数量与病例分布情况。使用McNemar配对资料卡方检验和用Kappa一致性检验比较近视眼配镜过矫状态下主观调节幅度下降组与客观调节不足组、客观调节异常组及客观调节微波动高频成分增加组的差异。 结果近视眼配镜过矫伴视疲劳患者16例(30只眼)中,主观调节幅度正常者有8例(11只眼),占36.7%(11/30);主观调节幅度下降者有11例(19只眼),占63.3%(19/30);客观调节检查结果正常者有6例(7只眼),占23.3%(7/30);客观调节异常者有13例(23只眼),占76.7%(23/30);单纯客观调节不足者有3例(3只眼),占10.0%(3/30);单纯客观调节过度者有1例(2只眼),占6.7%(2/30);单纯客观调节紧张者有4例(7只眼),占23.3%(7/30);单纯客观调节痉挛者有1例(2只眼),占6.7%(2/30);客观调节不足伴调节紧张者有4例(7只眼),占23.3%(7/30);客观调节不足伴调节痉挛者有1例(2只眼),占6.7%(2/30)。客观调节紧张者有7例(14只眼),占46.7%(14/30);客观调节不足者有8例(12只眼),占40.0%(12/30);客观调节微波动高频成分增加者有10例(18只眼),占60.0%(18/30)。自身配对资料McNemar精确概率法卡方检验提示主观调节幅度下降组与客观调节不足组的差异有统计学意义(χ²＝5.143,P<0.05)。对比主观调节幅度下降组与客观调节异常组以及客观调节微波动的高频成分增加组的差异均无统计学意义(χ²＝2.250,0.000;P>0.05)。进一步经过Kappa一致性检验,主观调节幅度下降组与客观调节异常组有高度一致性(κ＝0.689,P<0.05),而主观调节幅度下降组与客观调节微波动高频成分增加组一致性弱(κ＝0.366,P<0.05)。 结论近视眼配镜过矫常伴随调节功能异常的类型以调节不足和调节紧张为主。人眼调节功能客观检查可对近视眼配镜过矫视疲劳状态进行客观量化的评估。鉴于本研究中主观调节幅度下降组与客观调节异常组的高度一致性,推荐近视眼配镜过矫伴视疲劳患者中使用主观调节幅度检查作为客观调节功能详细检查的筛查指标。     

480例军校学员视疲劳的临床研究

目的观察军校学员视疲劳的临床特点，探讨处理原则。方法分析480例视疲劳军校学员的病史、眼科检查及治疗情况。结果视疲劳的症状复杂多样，无特异性，为多因素所致，其中以屈光不正、配戴不合适眼镜、操作电脑终端等为主要因素。隐斜视和调节、集合功能异常也为常见因素。结论视疲劳防治困难，必须全面分析病史，详细检查，针对病因采取综合治疗。     

Evaluation of Accommodative Insufficiency with the Visual Analogue Scale (VAS)

Purpose: The purpose of this study was to evaluate whether asthenopic symptoms in schoolchildren diagnosed with accommodative insufficiency (AI) and graded with the Visual Analogue Scale (VAS) could be correlated with the degree of accommodative deficiency in these children, and to investigate if VAS grading of the asthenopic symptoms could be used as an instrument to indicate the level of improvement of AI. Methods: Forty-nine children (mean age 10.2 years ± 2.7) diagnosed with AI graded their degree of asthenopia on the VAS before and after a 12-week treatment period wearing individually dispensed reading glasses. Results: The improvement in accommodation after treatment was statistically significant (p < 0.001) and 83.7% of the children obtained normal accommodative amplitude in relation to age. The reduction in asthenopic symptoms as graded with the VAS was also statistically significant (p < 0.001) after treatment and 89.9% of the children obtained a normal VAS score. However, no correlation between the degree of accommodative deficiency and the VAS grading could be found, neither before nor after treatment. Discussion: Based on these results we conclude that the visual analogue scale (VAS) cannot be used as an instrument to indicate the degree of accommodative deficiency nor can it be used to indicate the level of improvement during the course of treatment. However, the VAS can be used as an instrument to verify and document whether or not asthenopic symptoms are present, and therefore also to indicate when symptoms have been relieved.     

准分子激光角膜切削术后肌性视疲劳与切削偏心的关系

目的：探讨准分子激光角膜切削术（ｐｈｏｔｏｒｅｆｒａｃｔｉｖｅｋｅｒａｔｅｃｔｏｍｙ，ＰＲＫ）后肌性视疲劳与切削偏心的关系。方法，对８例１６只眼近视性屈光不正行ＰＲＫ后随访６～１４个月，视力均在０．８以上且主观接受棱镜矫正的肌性视疲劳者，根据术后与术前的角膜地形图及其相减图的数据，按Ｈｏｌｌａｄａｙ法计算角膜实矫屈光度Ｄ，检测偏离瞳孔中心的切削偏心量ｈ（以ｍｍ为单位）及方向，用公式（棱镜度）δ≈Ｄ     

103例视疲劳患者的病因及治疗

目的 调查视疲劳的病因,探讨其治疗方法.方法 前瞻性系列病例研究.103例视疲劳患者,检查其眼前后节、远近隐斜、水平聚散力、集合近点、调节性辐辏/调节值、调节幅度、调节灵敏度、相对调节、调节反应,对视疲劳症状进行评分,分析视疲劳的原因.针对病因给予矫正屈光不正、调节辐辏训练、配戴三棱镜、药物治疗.评价这些治疗对视疲劳的治疗效果.采用独立样本t检验.结果 103例视疲劳患者性别比为男∶女=1∶1.5.其病因分别是:屈光不正38例(36.9％),干眼症26例(25.2％),肌性视疲劳29例(28.2％),调节性视疲劳10例(9.7％).治疗前视疲劳评分为(4.8±0.7)分,治疗后症状缓解,评分为(2.0±0.6)分,差异有统计学意义(t=16.0.P＜0.01).结论 视疲劳常见病因是屈光不正、辐辏异常、干眼症、调节异常,治疗方法主要有矫正屈光不正、视觉训练、配戴三棱镜、药物对症治疗等.     

Asthenopia in Schoolchildren,Orthoptic and Ophthalmological Findings and Treatment

The aim of this study was to describe the orthoptic and ophthalmological findings in schoolchildren with asthenopia, to correlate them with asthenopic symptoms and to evaluate the effect of treatment. One hundred and twenty schoolchildren, aged 6–16 years, were included in the study. They were all referred by school nurses, for asthenopic symptoms. An orthoptic and ophthalmological assessment was performed. The main diagnoses were accommodative insufficiency, convergence insufficiency, refractive errors, and latent strabismus. Reading glasses could help 98% of the schoolchildren with reduced accommodation, and 94% of the children with refractive errors and heterophorias were helped with appropriate spherical, cylindrical and prism correction. Convergence exercise reduced the symptoms in all patients with convergence insufficiency. Ninety-three percent of all 120 schoolchildren were symptom free 3–6 month after treatment had started. By an orthoptic and ophthalmological examination abnormalities in schoolchildren with asthenopia related to visual problems can be identified. Most of the children were relieved from their symptoms by giving adequate glasses, convergence exercises and surgery.     

109例视频终端用户视觉障碍的原因对比分析

目的对比调查视频终端用户视疲劳产生原因的特点,探讨如何注意劳动保护。方法收集我院门诊就诊、有眼疲劳主观感受的患者185例,其中视频终端用户109例,其他行业工作者76例,详细询问病史和眼部检查,进行病因分析。定量资料组问比较采用t检验,定性资料组间比较采用检验,等级资料采用秩和检验。结果年龄、性别、主观症状、眼位功能、配镜情况两组差别无统计学意义,日作业时间、屈光检查、泪液分泌功能两组间差别有统计学意义。结论视频终端用户组日视作业时间高于其他行业组;屈光检查结果显示,视频终端用户组屈光不正高于其他行业组;视频终端用户组泪液分泌功能障碍更严重。     

清热解毒眼贴的毒理药理实验研究

目的 探讨治疗视疲劳的清热解毒眼贴的毒理和药理作用.方法 借助兔、小鼠、豚鼠动物模型,以清热解毒眼贴中剂量和大剂量组为观察组,并设立正常对照组,采用国际经合组织化学品检测指南和美国环境保护署预防、农药及有毒物质办公室统一检测指南评估眼贴对眼部的刺激反应;采用透皮吸收试验评估眼贴药液的皮肤通透性;应用局部施压法制作肌紧张模型,利用肌电描记仪分析眼贴对豚鼠肌电信号的平均幅值与平均频率的影响.结果 应用清热解毒眼贴14 d后,眼贴对眼部刺激为轻微刺激,评估评分低于2A级.眼贴中、大剂量组的透皮吸收速率分别是正常对照组的1.78和2.32倍,与模型组比较,能够显著缓解局部施压法制作的豚鼠肌紧张模型的肌电时限[(5.36±0.25)ms(模型组)比(4.74±0.33)ms(中剂量组),(4.12±0.28)ms(大剂量组),P＜0.05]和波幅[(498±78) μV(模型组)比(422±72) μV(中剂量组),(388±68) μV(大剂量组),P＜0.05],使局部肌肉松弛,震颤减少.结论 清热解毒眼贴的眼部刺激症状轻微,能够有效地通过皮肤吸收,并且具有缓解肌肉紧张效果,提示对视疲劳有治疗作用.