优先注视法评估婴幼儿视力研究进展

早期评估婴幼儿视力的重要性已被临床眼科医师所接受。优先注视法是测定婴幼儿客观视力的一种重要方法，利用优先注视法测定的婴儿务栅视力让视觉研究者了解了视觉发育的有关信息。本研究就优先注视法原理及其对条栅视力的评估、务栅视力与认知视力之间的关系作一综述。     

建立闭路式强化优先注视法检测系统的初探

目的建立由电脑控制的闭路式强化优先注视法视力检测系统(Closed-circuitOperantPreferentialLookingSystem,COPL),并探讨其临床的实用性。方法装置:本系统由刺激显示部分和眼动监视部分组成。刺激显示部分含动画图像强化幼儿注视条栅的行为,眼动监视部分可观察到幼儿的注视行为。测试过程由电脑控制。对象:随机选择符合录入标准的幼儿79人(男42人,女37人)作为研究对象,年龄12～40月,平均23.81±8.38月,按年龄分为7组。结果可测性:完成视力检查的幼儿66人,男35人,女31人,总可测性为83.54%,男可测性为83.33%,女可测性为83.78%。测试时间:统计完成视力检查的幼儿的平均测试时间329.70±86.60秒。视力情况(以折合5分记录表示):(1)视力与性别的关系:采用独立样本t检验比较男女视力,差异无显著性(=0.41)。(2)各年龄组的平均视力:12～16月组4.47±0.12,17～20月组4.58±0.17,P21～24月组4.60±0.21,25～28月组4.79±0.19,29～32月组4.81±0.16,33～36月组4.88±0.18,37～40月组5.0±0.00。(3)视力与年龄的关系:12～40月幼儿的视力发育与年龄呈高度正相关(相关系数r=0.76,P=0.00),进一步推出视力(Y)与月龄(X)之间的回归直线为:Y=0.0208X+4.1872。(4)重复性:20名幼儿完成两次视力检查,且两次皆由一位检查者操作     

闭路式强化优先注视法用于早产儿早期视力发育的观察

目的用闭路式强化优先注视（COPL）法检测早产儿6月龄前的条栅视力,探讨其发育情况。方法前瞻性病例对照研究。符合筛选标准且能完成条栅视力检查,随访1〉6个月的早产儿48名,用COPL法检测条栅视力,年龄7d～8个月,体重（2233．4±448．0）g,分组段定期测试每一名早产儿单、双眼视力。另外筛选正常足月儿34名作为对照组,体重（3443．3_＋553．0）g,定期作检测。视力结果以5分法记录。数据采用独立样本t检验、配对t检验、单因素方差分析、Pearson相关、直线回归及Mann—Whitney检测进行分析。结果早产儿出生2周内、校正孕周满38周、出生后14周、校正孕周满52周、出生后6个月、校正孕周满63周的右眼和左眼条栅视力分别为2．48±0．02和2．49±0．02,2．70±0．01和2．70±0．01,3．54±0．03和3．51±0．03。3．70±0．03和3．69±0．03,3．98±0．03和3．95±0．03,4．10±0．02和4．09±0．02,同一个体左右眼视力差异无统计学意义;各组段双眼条栅视力分别为2．51±0．02、2．70±0．01、3．55±0．03、3．69±0．03、3．96±0．03、4．18±0．02。早产儿的视力与月龄之间存在高度正相关关系（r=0．928,P〈0．01）,视力（V）与月龄（X）之间的直线回归方程为Y=0．248X＋2．457（R。=0．861,F=1769．743,P〈0．01）;视力与孕周呈高度正相关（r=0．725,P〈0．01）,视力（Y）与孕周（X）之间的直线回归方程为Y=0．017X＋1．457（R。=O．261,F=11．743,P〈0．01）。与出生体重、性别的相关性无统计学意义。足月儿出生后2周、出生后3个月、出生后6个月右眼和左眼视力分别为2．60±0．02和2．63±0．02,3．71±0．02和3．72±0．02,4．06±0．02和4．05±0．02,同一个体左右眼间视力差异无统计学意义;足月儿各组段双眼视力分别为2．60±0．02、3．72±0．02、4．14±0．02。比较同组段平均单双眼条栅视力,各月龄早产儿平均单双眼条栅视力与同组段正常足月儿相比,均较低,差异均有统计学意义（t=0．81、0．79、0．87,P〈0．05）。结论无眼底病变早产儿的单眼条栅视力与眼别无关,单、双眼条栅视力均低于同龄正常足月儿,条栅视力发育与月龄、孕周呈高度正相关,与性别、体重和屈光状态无相关性。电脑控制强化优先注视检测系统是检测0～6月龄早产儿视力的有效手段。     

闭路式强化优先注视法在婴幼儿视力检查中的应用

目的检测和评估闭路式强化优先注视法对婴幼儿视力检查的有效性和可靠性。方法利用电脑控制的闭路式强化优先注视法(COPL)视力检测系统对不会主观视力检查的598例婴幼儿进行常规视力检查。最后确定样本量为468例,分四组:正常足月儿360例、有全身疾病组25例、早产儿组69例、有眼部疾病组14例。结果不同组别视力检测成功率和不同组检测所需时间均无统计学差异。足月产儿的平均视力为4.64,而早产儿的平均视力为4.54,早产儿的视力低于足月产儿。正常婴幼儿的条栅视力随年龄增长而上升,2m、4m、6m、8m、10m、12m、16m、20m、24m、28m、32m、36m的平均视力分别为3.6、3.9、4.2、4.3、4.3、4.4、4.5、4.6、4.7、4.8、4.9、4.9,但不同时期呈现不同的增长速率。结论COPL视力检测系统可以用于无法进行主观视力检查者的临床视力常规检查,并且有效、可靠和快速。     

婴幼儿主观认知视力可测性年龄发生与视力发育的探讨

目的探讨婴幼儿主观认知视力可测性年龄的发生以及视力随月龄增长的变化规律。方法采用横断研究设计。以随机顺序对264名正常婴幼儿用带围栏的HOTV视频和由电脑控制的闭路式强化优先注视法（COPL）进行单眼视力检测及影响因素调查。采用配对t检验、独立样本t检验、Pearson相关、直线回归及Logistic回归对数据进行分析。结果26％的婴幼儿自24月龄开始接受主观认知视力检测,至46月龄时,已达到100％;24月龄右眼和左眼的平均主观视力分别为4．86＋0．05和4．881-0．08,至46月龄时均达5．0。左右眼间主观视力值比较,差异无统计学意义,男女间的主观视力值差异无统计学意义。主观视力与月龄呈正相关关系（r=O．526,P〈0．01）,主观视力（Y）与月龄（X）之间的直线回归方程为Y_4．699＋0．006X。应用Logistic回归分析,发现母亲教育背景（B=0．460,P=0．05）、A＇JL受教育程度（B=0．386,P〈0．01）对主观视力检测配合度的影响具有显著性。结论电脑控制的带围栏的HOTV认知视标检测系统为观察婴幼儿主观视力可测性的发生及其演绎提供了一种方法,婴幼儿主观视力检测应根据婴幼儿的年龄、认知水平选择不同的方式进行。     

3～6岁学龄前儿童的视力发育曲线比较性研究

目的用不同的方法检查正常3～6岁学龄前儿童的视力,比较研究学龄前儿童正常视力发育的曲线表现,并探讨不同年龄段儿童可行的视力检查方法。方法对幼儿园身体健康状况良好、无眼部器质性病变、屈光度在正常生理值范围的3～6岁的学龄前儿童检查条栅视力、E字视力、图形视力。结果(1)对不同的视力检查方法,幼儿的视力发育趋势表现有所不同,视力发育成熟的年龄亦有差异。其中,条栅视力发育较快,在3岁左右达到5.0;图形视力和E字视力发育接近,6岁以后达到5.0。(2)就3～6岁之间幼儿的视力发育呈阶段性,大致可分为2岁10个月～3岁3个月、3岁4个月～4岁3个月、4岁4个月～4岁9个月和5岁4个月～6岁3个月四个阶段,P<0.01,差异有显著性;其中,2岁10个月～3岁3个月和4岁4个月～4岁9个月两阶段视力发育更敏感,持续时间相对较短,为半年;继这两个阶段之后分别是两个视力发育相对缓慢期,为3岁4个月～4岁3个月和5岁4个月～6岁3个月两个年龄段,持续时间较长,约为一年。结论视力发育过程不仅与视神经传导功能的发育有关,还与幼儿的心理发育及认知能力有关;针对3～6岁的学龄前儿童,其视力检查以E字视力最敏感;其视力发育曲线可为视力普查时判断幼儿视力是否正常提供参考值。     

8351人次0~3岁眼科住院婴幼儿的临床特征分析

目的探讨首都医科大学附属北京同仁医院近5年眼科住院婴幼儿的临床特征,为婴幼儿眼病的筛查和治疗提供临床依据。 方法收集2014年1月1日至2018年12月31日眼科住院婴幼儿的信息,包括病案号、性别、年龄、入院日期、出院日期、住院天数、主要诊断编码及主要诊断名称,回顾性分析患儿住院病历的年龄、性别及眼病的分布情况。用均数±标准差描述年龄的分布情况;采用频数和百分比描述疾病的分布情况;性别的组间比较,采用χ²检验。 结果在全部8351人次的住院病历中,纳入本研究的病历为5902人次,年龄为3个月~3岁,平均年龄(1.9±0.9)岁。其中,男性3448人次(占58.4%),女性2454人次(占41.6%)。将纳入本研究的5902人次病历分为1岁组、2岁组及3岁组。1岁组,共计2577人次(占43.7%),男性1514人次(占58.8%),女性1063人次(占41.2%);2岁组,共计1559人次(占26.4%),男性890人次(占57.1%),女性669人次(占42.9%);3岁组,共计1766人次(占1766%),男性1044人次(占59.1%),女性722人次(占40.9%)。三组性别构成的比较,差异无统计学意义( χ²＝1.608,P>0.05)。在全部纳入本研究的5902例病历中,患前五位眼病的婴幼儿共计3020例,占总数的51.2%。排名第一位的眼病为视网膜恶性肿瘤,频数1224(占20.7%);第二位的眼病为先天性白内障,频数989(占16.8%);第三位的眼病为先天性青光眼,频数494(占8.4%);第四位的眼病为家族性渗出性玻璃体视网膜病变,频数178(占3.0%);第五位的眼病为先天性内斜视,频数135(占2.3%)。在排名前五位眼病的病例中,1岁组,依次为先天性白内障657例(占25.5%)、视网膜恶性肿瘤468例(占18.2%)、先天性青光眼349例(占13.5%)、永存原始玻璃体增生症87例(占3.4%)及家族性渗出性玻璃体视网膜病变81例(占3.1%);2岁组,依次为视网膜恶性肿瘤500例(占32.1%)、先天性白内障149例(占9.6%)、先天性青光眼76例(占4.9%)、先天性内斜视69例(占4.4%)及家族性渗出性玻璃体视网膜病变48例(占3.1%);3岁组,依次为视网膜恶性肿瘤256例(占14.5%)、先天性白内障183例(占10.4%)、间歇性外斜视89例(占5.0%)、先天性上睑下垂71例(占4.0%)及先天性青光眼69例(占3.9%)。 结论0~3岁住院婴幼儿常见眼病发生发展具有一定规律性,建议在今后的临床工作中重视儿童眼底和斜视专科相关筛查和早筛查。     

应用Suresight对1-3岁婴幼儿屈光状态的筛查与分析研究

目的　应用Ｓｕｒｅｓｉｇｈｔ手持式自动视力筛查仪对１～３岁婴幼儿的屈光状态进行检测,了解婴幼儿视觉系统屈光状态及分布规律。方法　选取２０１３年８月至２０１４年２月于郑州市儿童医院眼科门诊进行视力体检的１～３岁婴幼儿２３９名,按年龄分成４组:１２～１７个月龄组、１８～２３个月龄组、２４～２９个月龄组、３０～３６个月龄组,利用Ｓｕｒｅｓｉｇｈｔ手持式自动视力筛查仪进行屈光检测,并对结果进行统计分析。结果　在２３９名被检测幼儿中,有１８名幼儿未检测出其屈光状态,其总检测率为９２.５％,其中近视状态２例。１２～１７个月龄组、１８～２３个月龄组、２４～２９个月龄组、３０～３６个月龄组屈光球镜值分别为（＋１.９３±０．６３）Ｄ、（＋１．７９±０．５５）Ｄ、（＋１．５０±０．６５）Ｄ、（＋１．５４±０．７１）Ｄ,各组间差异有显著统计学意义（Ｆ＝７．０６２,Ｐ＝０.０００）,屈光柱镜值分别为（０．８２±０．４０）Ｄ、（０．７８±０．４６）Ｄ、（０．６９±０．４９）Ｄ、（０．７２±０．４３）Ｄ,各组间差异无统计学意义（Ｆ＝１．１２５,Ｐ＝０．３３９）。相关及回归分析显示,１～３岁婴幼儿月龄与其屈光球镜值之间存在负相关关系（ｒ＝－０.４１１,Ｐ＝０．０００）,即１～３岁婴幼儿屈光球镜值随年龄增长而降低;１～３岁婴幼儿月龄与其屈光柱镜值之间存在负相关关系（ｒ＝－０．１０５,Ｐ＝０.０３５）,即１～３岁婴幼儿屈光柱镜值随年龄增长而降低,但其相关性较低。结论　建议婴幼儿应从出生后６个月起至少每半年进行一次视力及屈光检查,密切观察屈光及视力的发育状态,保证视力健康发育。     

Lea图形与HOTV字母视力表对3～4.5岁儿童视力检查的比较

目的:比较分析Lea图形与HOTV字母视力表在3~4.5岁学龄前儿童视力检查中的适用情况及视力发育情况。方法:采用调查研究,以随机顺序先后应用两种视力表对广州地区两所幼儿园共133例266眼进行视力检查,视力值及其差异均用logM AR记录方法表示。结果:Lea视力较HOTV视力总体可测率高(96.24%vs92.48%),但差异无统计学意义(P>0.05)。儿童单眼两种视力差异均无统计学意义(右眼t=0.517,P=0.606;左眼t=-0.618,P=0.538)。儿童左右眼之间的视力差异均无统计学意义(Lea视力表:t=0.638,P=0.525;HOTV视力表:t=-0.897,P=0.372)。男性儿童的两种视力均优于女性儿童,但差异无统计学意义(均P>0.05)。3岁、3.5岁、4岁、4.5岁四个年龄组单眼的两种视力检查结果显示,儿童的视力随年龄增长逐渐提高,但四个年龄组间Lea视力差异无统计学意义(右眼:F=2.662,P=0.052;左眼:F=1.850,P=0.143),HOTV视力差异具有统计学意义(右眼:F=4.518,P=0.005;左眼:F=3.893,P=0.011)。结论:两种视力表都适合于3~4.5岁学龄前儿童的视力筛查;3~4.5岁儿童单眼的两种视力结果相似;视力发育与眼别、性别均无关;年龄大于3岁的儿童基本都可以接受主观视力检查,且在学龄前早期主观视力发育较快。     

Development of acuity and stereopsis in infants with esotropia

Visual acuity and stereopsis of 19 esotropic infants and toddlers, 36 normal infants and 7 children with refractive anomalies were measured during the first three years of life using newly developed preferential looking procedures. Children with infantile esotropia corrected with prisms equal in size to the deviation show some degree of binocularity up to at least 21/2 years, as measured by a polaroid bar stereogram procedure with a 1800 seconds of arc disparity. A few children, who did not receive any therapeutic intervention, failed this test during the first and second year. However, all older subjects (over 6 years of age) with a history of infantile esotropia failed the test.     

选择观看法对正常婴儿双眼视力的初步评价

目的　应用选择观看法 (Preferentiallooking ,PL)初步研究国人正常婴儿视力发育状况。方法　使用自行研制的婴幼儿PL视力检测仪对 64例正常婴儿双眼视力进行测定。结果　正常婴儿的双眼视力发育与年龄增加呈高度正相关 ,视力随着婴儿年龄增长而上升 ,2月、 4月、 6月、 8月、 1 0月及 1 2月的平均视力值分别为 0 0 6、 0 1 0、 0 1 5、 0 1 6、 0 2 0及 0 2 5。结论　正常婴儿视力随着年龄增长而不断提高 ,婴儿视力的测定不仅掌握其视力发育过程 ,而且有助于早期发现婴儿视力发育迟缓。     

Infant visual acuity and its meridional variation

One hundred and four infants were tested using a preferential looking procedure. Results for subsets of these infants tested in three experiments were as follows: Median preference at the 75% level for vertical gratings over a homogeneous field increased monotonically from 3.0 c/deg at 17 weeks of age to 8.0 c/deg at 45 weeks of age; at the 58% level it increased from 3.7 c/deg to 11.8 c/deg. In the second experiment main axes gratings were directly paired with oblique gratings of the same spatial frequency. Results showed that the median spatial frequency at which main axes gratings were preferred over obliques (oblique effect) increased with age at a rate similar to the preference for vertical gratings. In the third experiment, vertical gratings were paired with the homogeneous field, and in separate sessions on the same infants, oblique gratings were paired with the homogeneous field. Preference thresholds for vertical gratings were similar to those for oblique gratings in very-young infants, but the preference threshold for vertical gratings increased more rapidly with age, becoming almost 1 octave greater by 11 months.     

Visual acuity in human infants: a review and comparison of behavioral and electrophysiological studies.

Three techniques—optokinetic nystagmus (OKN), preferential looking (PL), and the visually evoked potential (VEP)—have been used to assess visual acuity in infants between birth and 6 months of age. All three techniques indicate that the visual acuity of infants increases during the first 6 months postnatal. The accumulating evidence strongly suggests that all three techniques give meaningful and reliable—if somewhat different—estimates of visual acuity in infants, and that variants of these techniques will eventually be useful for the assessment of infant vision in clinical settings.     

Visual acuity assessment in infants and young children

The accurate and reliable assessment of visual function in infants and young children is important for ensuring optimal management of those at risk of abnormal visual development. Visual acuity is the aspect of visual function most commonly assessed by optometrists and can be measured in infants and children using appropriate techniques. Acuity measurements obtained using different techniques may show considerable disagreement and may mislead the optometrist when monitoring acuity development. It is important for the practitioner to appreciate these differences so that reasonable comparisons may be made between acuity estimates made using different techniques. With this in mind, we discuss methodological differences between some of the techniques used in visual assessment of very young patients and the effects those differences may have on acuity estimates.     

Measuring visual acuity in infants

This paper reviews the course of development of visual acuity in human infants and young children. Researchers have devised methods based on optokinetic nystagmus, visually evoked cortical potentials and preferential looking to assess visual acuity in infants and preverbal youngsters. During the first postnatal year and early childhood, acuity, measured by any of these methods, improves with increasing age. Each of these methods, has now been applied to the evaluation of clinical cases. Also presented are the results of a quick and simple test based on preferential looking, which has been incorporated into our clinical evaluation of infants. The data so far indicate that infants with normal eyes pass the test while infants with ocular problems which would interfere with vision fail. For evaluation of large numbers of infants this test appears to have the potential to assist nonspecialized personnel in the early identification of ophthalmic abnormalities.     

Visual acuity development: A study of preterm and full-term infants

Visual acuity was measured in both preterm and full-term infants by means of forced-choice preferential looking. The ages of infants tested ranged from one month to 12 months. The results of both groups were considered and compared in terms of natal and conceptional age. The data suggested that preterm infants show visual responses equivalent to their full-term counterparts by nine months of age. Trends indicate that visual acuity development in healthy preterm infants appears to be accelerated when compared with full-term infants of the same post-conceptional age.     

Development of vernier acuity in infants

The development of vernier acuity in human infants aged 2-9 months was assessed by a preferential looking procedure using a vernier-motion display. The displacement of vernier offsets gives the impression of motion only when the vernier offsets are detected. Grating acuity of the same group of infants was also measured by a preferential looking procedure. Vernier acuity was found to be superior to grating acuity only after 3 months of age. This superiority of vernier acuity was compared with the superiority of stereoscopic acuity to grating acuity. The two classes of hyperacuity proved to be almost equivalent in terms of their developmental time-courses. A common physiological basis for the development of hyperacuities is suggested.