Variation and correlation of clinical tests of accommodative function in a sample of school-age children.

Accommodative facility, lag of accommodation, accommodative response, and relative accommodation were measured in 244 school-age (7.9 to 15.9 years of age) children. The tests studied included monocular estimate method (MEM) dynamic retinoscopy, Nott dynamic retinoscopy, low neutral dynamic retinoscopy, the binocular cross cylinder test, lens accommodative rock (facility), distance (near-far) accommodative rock, negative relative accommodation (NRA), and positive relative accommodation (PRA). The mean, standard deviation, and range of test findings of each test are presented. Coefficients of correlation among the various tests are presented.     

Accommodation function comparison following use of contact lens for orthokeratology and spectacle use in myopic children: a prospective controlled trial

AIM: To study effects of orthokeratology (Ortho-k) on accommodation function in myopic children. METHODS: A prospective, non-randomized, case-control study was performed from September to October 2016. Eighty-three children with myopia were divided into two groups. One group was treated with the rigid contact lens for overnight Ortho-k, and the other was treated with single-vision spectacle lens (SVL). Accommodation function were assessed by accommodative amplitude (AA), accommodative sensitivity (AS), accommodative lag (Lag), negative relative accommodation (NRA), and positive relative accommodation (PRA) before and 1, 3, 6 and 12mo after treated. RESULTS: Totally 72 myopic children were finished the follow-up: 37 in Ortho-k group and 35 in SVL group. Wearing time had a significant effect on AA, AS, Lag, and NRA of myopic children in two groups (all P<0.05). Meanwhile, there was an interaction effect between wearing time and wearing types (FAA=5.3, FAS=45.5, FLag=7.0, FNRA=3.7, all P<0.05). However, the between-group difference of AA (F=0.1), AS (F=3.2), Lag (F=1.1), NRA (F=0.3), and PRA (F=0.1) showed no significance. AA, AS, NRA, Lag and PRA were improved significantly in Ortho-k group within 1 to 6mo after wearing. CONCLUSION: Wearing Ortho-k can improve the accommodation function of myopic children, which might be one of the mechanisms for myopia control.     

近视性屈光参差主导眼的屈光状态及其调节功能

目的 研究近视性屈光参差主导眼与近视程度的关系以及主导眼与非主导眼调节功能分析,探讨屈光参差的成因及其发展原因。设计 回顾性病例系列。研究对象 8～35岁近视性屈光参差患者59例,根据屈光参差程度,将其分为低度屈光参差（1.00 D≤双眼等效球镜度差≤2.50 D）和高度屈光参差（双眼等效球镜度差>2.50 D）两组。方法 对各组别患者应用简化双手卡洞法测定双眼中的主导眼眼别。使用综合验光仪测定患者单、双眼正/负相对调节及其比值（PRA/NRA）。采用改良移近法及正负球镜翻转法分别测量单、双眼的调节幅度和调节灵活度。主要指标 主导眼眼别与屈光度大的眼别的相关性。单、双眼正/负相对调节及其比值（PRA/NRA）,单、双眼的调节幅度和调节灵活度。结果 低度屈光参差患者26例,主导眼为右眼者22例（84.5%）;主导眼平均屈光度为（-4.01±1.96）D,非主导眼为（-3.19±1.80）D,平均参差程度（1.76±0.21）D。主导眼屈光度高于非主导眼（z=-2.37,P=0.02）。高度屈光参差患者33例,主导眼为右眼者21例（63.6%）;主导眼平均屈光度为（-3.90±2.84）D,非主导眼平均屈光度为（-3.47±2.20）D,平均参差程度（3.40±0.81）D。主导眼与非主导眼屈光度比较无统计学差异（z=-0.57,P=0.57）。低度屈光参差组主导眼平均正相对调节为（-2.68±1.44）D,非主导眼为（-3.29±1.31）D,差异有统计学意义（z=-2.27,P=0.02）;高度屈光参差组主导眼平均正相对调节为（-3.14±1.84）D,非主导眼为（-4.10±1.59） D,差异有统计学意义（z=-3.54,P=0.00）。低度屈光参差组主导眼平均PRA/NRA绝对值为（1.15±0.58）,非主导眼为（1.36±0.52）,差异无统计学意义（z=-1.89,P=0.06）;高度屈光参差组主导眼平均PRA/NRA绝对值为（1.34±1.57）,非主导眼为（1.74±0.62）,差异有统计学意义（z=-3.03,P=0.00）。结论 低度近视性屈光参差患者主导眼屈光度较非主导眼高;不同程度的屈光参差患者主导眼PRA及PRA/NRA低于非主导眼。（眼科,2016, 25： 102-105）     

Accommodative and vergence difficulties interfering with image clarity through a binocular indirect ophthalmoscope.

PURPOSE: This study sought to identify accommodative and vergence deficiencies that could explain why some students have difficulty seeing clearly when using a binocular indirect ophthalmoscope (BIO) containing its standard +2.00 D lenses. METHODS: A survey was distributed to Illinois College of Optometry 3rd- and 4th-year students. Based on the information supplied by the survey, students were divided into two groups: those who are unable ("BIO plano") and those who are able ("BIO plus") to obtain a clear image with the +2.00 D lenses in their BIO's. Forty-seven subjects participated: 22 in the BIO plano group and 25 in BIO plus group. Two of the authors, masked to subject group, measured all subjects' accommodative amplitudes and facilities, monocular estimation method (MEM) retinoscopy, negative relative accommodation and positive relative accommodation (NRA/PRA), distance and near vergence ranges, distance and near phorias, Worth 4-dot test, and near point of convergence (five times). RESULTS: The Mann-Whitney U analysis of numerical data for the two groups showed a statistically significant difference for accommodative facility in the right eye (p = 0.004). The difference between the two groups approached significance for accommodative facility with both eyes (p = 0.02), facility in the left eye (p = 0.03), distance base-out blur (p = 0.02), near base-out break (p = 0.02), and near base-out recovery (p = 0.04). For all findings in which the difference between the two groups was significant or approached significance, the BIO plus group had higher median values. When subjects were classified by difficulty with the plus side of the flippers during accommodative facility testing, there was a statistically significant difference with both eyes (Fisher exact test, p = 0.003) and with the right eye (p = 0.008) between the BIO plus and BIO plano groups. When subjects were classified by the presence or absence of an accommodative or binocular vision syndrome, categorical data analysis showed the difference between the two groups approached significance, with more BIO plano subjects having syndromes (p = 0.03). CONCLUSION: No one test absolutely defined who would have difficulty with the +2.00 D lenses in the BIO. There are several skills required; less developed plus acceptance and convergence may cause difficulties.     

9～10岁学生近视状态与调节因素的关系

目的分析9～10岁青少年近视状态与眼调节功能的相关性,试图探索预防、治疗、矫正青少年近视较佳方案。设计横断面研究。研究对象小学三四年级9～10岁、裸眼视力<0.9并近视屈光度≤-0.25 D的学生114例223眼。方法对以上小学生进行眼前段和眼底检查,调节幅度、调节灵活度及正、负相对调节检查,复方托吡卡胺滴眼液(美多丽)散瞳后行屈光度检查,根据近视屈光程度(散光以等效球镜度计算)将受试者分为A组-0.25～-1.25 D(115眼)、B组-1.50～-2.50 D(70眼)、C组-2.75～-4.50 D(38眼),分别进行调节相关参数与近视屈光状态间Pearson相关性检验以及单因素方差分析。主要指标近视屈光度,调节参数(调节幅度、调节灵活度、正相对调节、负相对调节)。结果 223眼近视屈光度为(-1.57±1.03)D(-0.25~-4.50 D)。调节幅度与近视屈光度呈正相关(r=0.22,P=0.001)。正相对调节与近视屈光度呈负相关(r=-0.25,P=0.000)。调节灵活度和负相对调节与近视屈光度不具有显著相关性(r=0.03、0.06,P=0.65、0.34)。对三组屈光度间学生的调节因素进行两两比较,显示调节幅度中A组与B组和C组相比较差异具有统计学意义(F=2.16、2.21,P=0.00、0.00);正相对调节中A组与B组和C组比较差异具有统计学意义(F=-0.45、-0.53,P=0.01、0.02);B组的调节幅度和正相对调节与C组相比差异无统计学意义(F=0.06、-0.09,P=0.95、0.72)。结论调节参数中调节幅度和正相对调节对近视的发展具有参考价值,通过视觉训练改善调节的异常,可能对部分调节滞后的儿童具有辅助治疗作用。     

角膜塑形镜联合视觉训练对无调节紊乱症状的近视儿童调节功能的影响

目的 观察角膜塑形镜联合视觉训练（orthokeratology combined with visual training, OCVT）对无调节紊乱症状的近视儿童调节功能的影响。设计 前瞻性病例系列。研究对象 120例无调节紊乱症状的近视儿童,平均年龄（11.18±1.89）岁,平均等效球镜度（-3.17±1.13）D。方法 120例儿童根据临床上选择的治疗方式不同被分为OCVT组（37例）、角膜塑形镜组（orthokeratology, Ortho-k,43例）和单光框架眼镜组（single vision spectacle lense, SVL,40例）。观察并比较三组儿童干预前和干预后1年的调节功能变化,并对OCVT组按照年龄中位数进行进一步的分层比较。主要指标 调节幅度（accommodative amplitude,AA）、调节灵敏度（accommodative sensitivity,AS）、调节滞后量（accommodative lag,Lag）、负相对调节（negative relative accommodation,NRA）和正相对调节（positive relative accommodation,PRA）。结果 共103例儿童完成试验（OCVT组31例,Ortho-k组37例,SVL组35例）。OCVT组干预前的AA、AS、Lag、NRA、PRA分别为（14.21±2.05）D,（8.87±1.80）cpm,（0.71±0.38）D,（1.80±0.38）D,（-1.85±0.42）D,干预后1年分别改善为（15.34±2.16）D、（11.16±2.18）cpm、（0.31±0.27）D、（2.15±0.35）D、（-2.08±0.45）D,其对调节功能的改善显著优于Ortho-k组和SVL组（P均＜0.05）。分层比较显示,OCVT组低于年龄中位数者的AA、AS、Lag、NRA、PRA改变量与高于年龄中位数者比较差异均无统计学意义（P均＞0.05）。结论  对于无调节紊乱症状的近视儿童,OCVT是一种较好的改善其调节功能的方法,但最佳的视觉训练类型和时间还需要进一步研究。     

Evaluating relative accommodations in general binocular dysfunctions.

PURPOSE: To examine the relationship between relative accommodation and general binocular disorders and to establish their importance in the diagnosis of these anomalies. METHODS: We analyzed data of negative relative accommodation (NRA) and positive relative accommodation (PRA) in 69 patients with nonstrabismic binocular anomalies. RESULTS: Statistical analysis showed that low values of NRA and PRA were not associated with any particular disorder. High values of PRA (> or = 3.50 D) were related to the disorders associated with accommodative excess, whereas high values of NRA (> or = 2.50 D) were not related to accommodative excess. Statistical differences suggested that a high value of PRA could distinguish between anomalies. Sensitivity analysis revealed that high PRA was the most sensitive sign in patients with convergence insufficiency combined with accommodative excess (0.89) and one of the most sensitive signs for subjects with accommodative excess (0.72) and for those with convergence excess combined with accommodative excess (0.70). CONCLUSIONS: Anomalous results of NRA were not clearly associated with any dysfunction. High values of PRA were related to disorders associated with accommodative excess, so the sign of a high value of PRA should be considered as one of the diagnostic signs of these anomalies.     

眼周穴位按摩联合中药敷贴法治疗近距离工作视疲劳的短期疗效

目的研究眼周穴位按摩联合中药敷贴法治疗近视中小学生持久近距离工作所致视疲劳的临床疗效及其对调节功能的影响。方法开放性随机对照研究。纳入2011年6-9月于温州医科大学附属眼视光医院就诊患者107例,按治疗方法及时长不同分为治疗2周组、治疗4周组和对照组,分别为39、38、30例。治疗组采用眼周穴位按摩联合中药敷贴法分别治疗2周和4周,对照组采用七叶洋地黄双苷滴眼液点眼4周,在治疗前、治疗后2周及治疗后4周分别评估患者主觉症状、UCVA及调节功能的变化。对所得数据采用重复测量方差分析进行比较。结果3组治疗后UCVA均有一定程度提高（F时间=39.66,P＜0.01）,但组间比较差异无统计学意义。3组患者治疗后视疲劳评分减小（F时间=175.91,P＜0.01）,组间比较差异无统计学意义。3组治疗后双眼调节幅度以及负相对调节（NRA）、正相对调节（PRA）均有改善（F时间=24.80、10.34、31.68,P＜0.01）,但组间比较差异无统计学意义。3组治疗后双眼调节灵敏度和调节滞后均有改善（F时间=101.22、11.73,P＜0.01）,且组间比较差异有统计学意义（F分组=3.66、4.73,P＜0.05）,以治疗4周组疗效最佳。结论眼周穴位按摩联合中药敷贴法与七叶洋地黄双苷滴眼液均可以改善近视青少年持久近距离工作所致视疲劳患者的自觉症状以及调节功能;但眼周穴位按摩联合中药敷贴法更有利于改善患者的调节灵敏度和调节滞后,推测眼周穴位按摩联合中药敷贴法对近视防控可能有一定作用。     

角膜塑形术对眼视觉质量、调节功能的动态影响

目的　探讨角膜塑形术对中低度近视眼的对比敏感度、调节近点、调节灵敏度、正负相对调节的影响及其动态变化过程。方法　连续收集２００９年８月至２０１３年８月就诊的青少年中、低度近视患者８３例１６６眼。按戴镜时间分为４组:１组（戴镜前５０例９９眼）,２组（戴镜后１～３个月３６例７２眼）,３组（戴镜后时间＞３～１２个月３８例７６眼）,４组（戴镜后时间＞１２～４０个月４２例８４眼）。检查对比敏感度,采用移近法测定调节近点,测定正、负相对调节,±２．００Ｄ翻转拍测定调节灵敏度。结果　（１）对比敏感度:与１组（３ｃ·ｄ－１:１．８０±０．１６;６ｃ·ｄ－１:２．０６±０．１５;１２ｃ·ｄ－１:１．８４±０．１５;１８ｃ·ｄ－１:１．４２±０．１５）比较,２、３、４组各空间频率均下降,差异均有统计学意义（均为Ｐ＝０．０００）。（２）调节近点变化:与１组（９．１０±１．８８）ｃｍ比较,２、３、４组调节近点分别为（７．７４±１．９０）ｃｍ、（７．４３±１．３５）ｃｍ、（７．０３±１．２６）ｃｍ,差异均有统计学意义（均为Ｐ＝０．０００）。（３）单眼调节灵敏度变化:与１组（８．７０±２．４６）周·ｍｉｎ－１比较,２组差异无统计学意义（Ｐ＝０．９０）;３组、４组调节灵敏度均增加,差异均有统计学意义（Ｐ＝０．０２、Ｐ＝０．００６）。（４）相对调节:正相对调节,与１组（－２．０７±０．８８）Ｄ比较,２组差异无统计学意义（Ｐ＝０．１１０）;３组、４组正相对调节均增加,差异均有统计学意义（Ｐ＝０．００１、０．００６）。负相对调节:与１组（＋２．５７±０．５８）Ｄ比较,２组、３组差异均无统计学意义（Ｐ＝０．２３、０．９８）,４组负相对调节减少（Ｐ＝０．００２）。结论　角膜塑形术引起各空间频率对比敏感度阈值均下降,调节能力增加。调节灵敏度、正相对调节能力保持稳定后呈增加趋势,负相对调节能力保持稳定后呈下降趋势。     

儿童非弱视性功能性视力低下的原因分析

分析儿童非弱视性功能性视力低下的形成原因。方法：系列病例研究。选取2015年6月至 2019年5月期间在濮阳市眼科医院就诊的非弱视性功能性视力低下儿童107例,年龄（8.3±1.9）岁。分别测量患者初始的最佳远近矫正视力（BCDVA、BCNVA）、单双眼调节灵敏度（MAF、BAF）、调节幅度（AMP）、调节反应（BCC）、正负相对调节（PRA、NRA）、远近水平隐斜（DLP、NLP）、调节性集合与调节比率（AC/A）、等效球镜度（SE）等数据。小数视力换算成5分记录法表达。用一元多重线性回归分析法研究训练前矫正视力与相关视功能参数自变量的关系。结果：双眼BCDVA均低于5.0者79例（73.8%）,单眼BCDVA低于5.0者28例（26.2%）;双眼BCNVA低于5.0者71例（66.4%）,单眼BCNVA低于5.0者22例（20.6%）。视功能检查显示所有视力低下眼的AMP均低于正常,诊断为集合不足和单纯性外隐斜者分别为59例和18例,分别占总例数的55.1%和16.8%,共占双眼BCDVA 均低于5.0例数的97.5%;单纯调节异常者27例,占总例数25.2%,占单眼BCDVA低于5.0例数的者 96.4%;BCDVA、BCNVA与AMP均呈正相关（r=0.563,P=0.035;r=0.587,P=0.029）,与NLP均呈负相关（r=-0.413,P=0.031;r=-0.409,P=0.030）,与BCC、PRA、NRA、DLP、AC/A、SE均无明显相关性（P均>0.05）。结论：①集合不足和单纯性外隐斜患者主要表现为双眼BCDVA均异常,单纯调节异常患者主要表现为单眼BCDVA异常。②儿童非弱视性功能性视力低下的形成和AMP、NLP异常有关,其中AMP异常是根本原因,NLP异常是继发原因。     

Factors affecting the clinical testing of accommodative facility

A number of variables in the accommodation flipper test are thought to contaminate the results: the time for naming symbols; the manual facility to actually operate the flippers; the minification or magnification of symbol target size by the lenses; saccadic eye movements; and the relationship between the accommodation stimulus and its response. With the exception of the last variable, all undesirable factors have been eliminated in a newly developed modified method of accommodation facility measurement. In this method, double measurement through plano and +/- 2.00 D lenses, is executed. The average time in seconds per one cycle, taking only the accommodation into account for a group of 43 children (age from 7 years 11 months to 9 years 11 months), is 3.7 monocularly and 8.5 binocularly and the average number of cycles per minute in this group is 32.1 and 33.8 monocularly (for the dominant and nondominant eye, respectively) and 22.6 binocularly. These results in sec/cycle do not differ considerably from results received by other authors, if one considers the time necessary for naming the digits, mechanically changing the lenses, saccadic eye movements etc., and even those results given in cycles/minute do not differ either taking the wide ranges of standard deviations into account. However, the method reported here reflects accommodation facility more precisely. Measurements were performed also with the hand held flipper. Comparison of results summarised above and those obtained with a hand held flipper demonstrates that the hand held flipper is not a good device to measure accommodative facility.     

不同程度近视性屈光参差患者双眼间调节参数的差异性分析

目的：探讨近视性屈光参差患者双眼间调节力差异与屈光参差程度间的关系。方法：横断面研究。收集2019年11月至2021年6月在山东第一医科大学附属青岛眼科医院就诊的近视患者123例（246眼），年龄8~21岁。根据双眼间等效球镜度（SE）差值分为屈光不正组（SE差值≤0.25D）29例、低度屈光参差组（1.00D≤SE差值<2.50D）62例及高度屈光参差组（SE差值≥2.50D）32例3组。所有患者符合双眼最佳矫正视力（BCVA）≥0.8且各项原始数据较为完善。使用综合验光仪测量3组患者的单眼调节幅度（AMP）、单、双眼负相对调节（NRA）、正相对调节（PRA）、调节反应（AR）及调节灵活度（AF）在睫状肌麻痹下验光后确定双眼间屈光度数，分析3组间双眼调节相关参数及单眼调节参数差差值（双眼间调节参数差值＝近视屈光度较高眼调节数值-近视屈光度较低眼调节数值）之间的差异。对3组间调节参数比较采用单因素方差分析；对屈光参差程度与双眼调节参数值及双眼间调节参数差值间的关系分析选择Spearman相关分析。结果：3组间双眼NRA、PRA、AR、AF值及单眼间NRA、AF差值比较差异均无统计学意义。3组AR差值分别为-0.03±0.25、0.20±0.30、0.26±0.36，差异有统计学意义（F=7.36，P<0.001）；3组PRA差值分别为0.04±0.27、0.34±0.72、0.66±0.63，差异有统计学意义（W=7.47，P<0.001）；3组AMP差值分别为0.41±0.86、-1.07±1.53、-1.02±2.18，差异有统计学意义（W=9.25，P<0.001）。事后多重比较显示，屈光不正组与低度屈光参差组和高度屈光参差的AR差值、PRA差值、AMP差值比较差异均有统计学意义（均P<0.05）。相关性分析显示，SE差值与AR差值、AMP差值存在低强度的正相关性（r=0.22，P=0.014；r=0.36，P<0.001）。结论：不同程度近视性屈光参差患者双眼间调节参数差值不同，且双眼间AR差值、AMP差值与双眼间屈光度差异程度存在一定相关性。     

青少年儿童近视性屈光参差双眼眼动参数的临床研究

目的：观察儿童和青少年近视性屈光参差患者双眼眼动参数,初步探讨儿童和青少年近视性屈光参差对眼动参数的影响。

方法：病例对照研究。选取2014-09/2016-05于重庆医科大学附属大学城医院就诊的7～14岁儿童及青少年82例,其中正视者(对照组)47例,近视性屈光参差者(试验组)35例,检测所有入选者的屈光度、5m和40cm隐斜、梯度性和计算性AC/A比值及调节功能\〖40cm的调节反应(FCC)、正负相对调节(NRA/PRA)、调节力(AMP)和调节灵敏度(AF)\〗。

结果：两组受检者5m和40cm隐斜度数、40cm FCC、PRA及AC/A比值差异均有统计学意义(P<0.05); AF、NRA、AMP与正常值最小值的差值差异均无统计学意义(P>0.05)。

结论：近视性屈光参差对儿童和青少年5m和40cm隐斜、40cm FCC、PRA及AC/A比值有显著影响。     

SMILE术后调节功能变化

目的 研究飞秒激光小切口角膜基质透镜取出术（SMILE）后双眼视及调节功能的变化特点。方法 回顾性研究。选取2015年3-12月在天津市眼科医院屈光手术中心接受SMILE的近视散光患者25例。分别在术前,术后1周、1个月、3个月测量调节功能参数,包括单眼调节幅度（MAA）、单眼调节灵敏度（MAF）、双眼交叉柱镜法（BCC）测量的调节反应、正相对调节（PRA）及负相对调节（NRA）。不同时间段之间参数的差异比较采用重复测量方差分析,两两比较采用LSD-t检验。结果 MAA在SMILE手术后1周下降,术后3个月时恢复到术前水平,差异有统计学意义（F=5.418,P=0.002）;MAF及PRA在SMILE术后1周轻微下降,术后3个月较术前显著增加（F=8.090,P<0.001;F=5.466,P=0.002）。BCC测量的调节反应及NRA在术后各个时期差异无统计学意义（F=2.445,P=0.071;F=0.536,P=0.659）。结论 SMILE可暂时性降低调节功能,但随着时间推移逐渐好转。     

老视前期近视患者LASIK术后相对性调节的变化

目的 探讨老视前期近视患者准分子激光原位角膜磨镶术(LASIK)檄后相对性调节的变化.方法 对接受LASIK手术治疗的老视前期近视患者58只眼,按平时戴镜情况分为两组:角膜接触镜组(13例26只眼)和框架眼镜组(16例32只眼),于术前、术后10d、1月和3月测定正负相对调节.结果 角膜接触镜组术后10 d和1月的负相对调节与术前相比差异无统计学意义(P＞0.05),而术后3月比术前有所增加(p=0.019),框架眼镜组术后各期与术前相比差异无统计学意义(P＞0.05).两组术后10d正相对调节与术前相比差异有统计学意义(P＞0.01),术后1月、3月与术前相比差异无统计学意义(P＞0.05),虽然术前角膜接触镜组明显高于框架眼镜组(P=0.028),但是术后10 d的下降值两组间差异无统计学意义(P=0.695).结论 老视前期近视患者LASIK术后出现的暂时性正相对调节量的下降是术后早期出现视疲劳的原因之一.     

高度近视有晶状体眼人工晶状体植入对调节功能影响

目的 分析有晶状体眼人工晶状体植入术对高度近视患者调节功能的影响.方法 收集2008年8月至2009年3月在行有晶状体眼人工晶状体植入的高度近视患者16例(32只眼),年龄(27.56±4.50)岁(19～35)岁,其中10例接受后房型有晶状体眼人工晶状体植入手术(Visian ICL),6例行虹膜夹型有晶体眼人工晶状体植入手术(Verisyse).分别于术前和术后1周及术后3个月测量屈光状态、最佳矫正远视力、调节近点、正负相对调节(PRA/NRA)、调节灵活度.数据采用SPSS15.0统计软件包行单因素方差分析.结果 术前、术后1周及术后3个月的最佳矫正远视力分别为4.84±0.12、4.91±0.11、4.92±0.11:调节近点分别为(10.02±1.92)cm、(14.38±3.59)cm、(13.19±2.91)cm.术后1周和3个月时较术前明显远移(F=19.45,P<0.05);PRA/NRA、单眼调节灵活度术前分别为(-2.29±0.48)D、(2.06±0.29)D、(9.50±2.00)cpm,术后1周分别为(-2.05±0.33)D、(2.09±0.27)D、(9.34±1.70)cpm,术后3个月分别为(-2.19±0.35)D、(2.14±0.27)D、(9.63±1.76)cpm,正负相对调节和调节灵活度手术前后差异均无统计学意义(P>0.05).结论 高度近视有晶状体眼人工晶状体植入术后调节近点明显远移,正负相对调节和单眼调节灵活度手术前后无明显变化.     

眼正负相对调节力比值变化与近视眼发病关系的研究

目的 选择同年龄段、同等学历的大学生测量不同屈光组眼正、负相对调节力及其比值等调节参数,分析其与近视眼的发病的关系.方法 同意被检查入校新生292人,平均年龄( 18.76±0.80)岁.正视组29人,低、中、高度近视组分别为118、82、37人;26人远视及屈光参差者被排除.被检者在电脑验光基础上,使用综合验光仪进行主觉验光,并测其调节幅度、正负相对调节力.结果 正视组正相对调节力(PRA)均值(-.4.87±1.47)D,低、中、高度近视组正相对调节力均值分别为(-2.36±1.21)D、(-2.92±1.40)D、(-2.86±1.81)D,不同近视组PRA比正视组均有显著降低(F=24.54,p=0.00);正视组负相对调节力(NRA)均值(+2.09±0.46)D,低、中、高度近视组负相对调节力均值分别为(+1.99±0.51)D、(+1.95±0.45)D、(+1.99±0.47)D,各组比较差异无统计学意义(F=0.58,P=0.63);正视组PRA/NRA的比值均值为2.35±0.51,低、中、高度近视组PRA/NRA的比值均值分别为1.21±0.66、1.53±0.76、1.49±0.95,不同近视组PRA/NRA的比值比正视组均有显著降低(F =19.06,P=0.00).结论 同年龄段、同等学历大学生近视组的正负相对调节力比值、正相对调节力明显低于正视组.近视眼的正负相对调节力比值及正相对调节力下降是近视眼发病的共同特征.     

对症视觉训练对双眼视功能参数的影响

目的 观察视觉训练对调节、集合等双眼视功能参数的影响,评估视觉训练对缓减视疲劳,改善异常双眼视功能的作用。方法 回顾性系列病例研究。收集在天津市眼科医院视光学中心视光门诊就诊的有视疲劳症状、双眼视功能异常患者121例,男62例,女59例,年龄8～27岁,平均（15.5±5.2）岁。排除眼部疾病后进行屈光和双眼视功能检查。按照诊断结果,进行9周的视觉功能训练,训练前后进行调节、集合等双眼视功能相关检查和评估。采用配对t检验。结果 通过视觉功能训练后,调节幅度（t=-9.015,P＜0.01）、正相对调节（t=9.569,P＜0.01）、负相对调节（t=-6.719,P＜0.01）、调节辐辏/调节（AC/A）（t=-3.244,P＜0.01）均显著改善。近外隐斜明显改善,差异有统计学意义（t=-3.716,P＜0.01）。调节滞后和远隐斜无明显变化,差异无统计学意义。结论 通过合理的视觉功能训练可以改善双眼视功能,其中调节幅度、正相对调节、负相对调节、近隐斜、AC/A都有明显的变化,患者的双眼视症状、视疲劳症状明显缓解,但调节滞后、远隐斜没有明显的改善。     

刺激小脑顶核对青少年近视眼调节影响的初步探讨

目的 评估刺激小脑顶核对青少年近视眼调节功能的影响。方法 收集我院门诊8名轻度近视儿童，用刺激小脑顶核的方法对受试者实施电刺激。检测刺激前后颈动脉及眼视盘血流参数，用综合验光仪检测刺激前后的单双眼相对性调节，调节幅度，调节灵敏度。结果 8名受试儿童刺激后1个月的调节功能各项指标均有显著性改善。结论 通过体外刺激小脑顶核可明显改善青少年近视的调节功能，但对于调节功能的改善与眼屈光发展的关系，以及是否能延缓近视形成，有待进一步研究。     

Accommodative function in school children with reading difficulties

Background  Prior findings suggest correlation between reading problems and accommodative function, but few studies have assessed accommodation in children with poor reading skills. Our aim was to characterize monocular accommodative amplitude, relative accommodation and binocular accommodative facility in a population of healthy, non-dyslexic primary school children with reading difficulties. Methods  We conducted a cross-sectional study on 87 poor readers and 32 control children (all between 8 and 13 years of age) in grades three to six recruited from 11 elementary schools in Madrid, Spain. In each subject with best spectacle correction, negative relative accommodation (NRA) and positive relative accommodation (PRA) were measured using a phoropter, monocular accommodative amplitude (MAA) was determined using the minus lenses method, and binocular accommodative facility (BAF) was measured using the Bernell Acuity Suppression Slide (VO/9) and a ± 2.00 D accommodative demand for a period of 1 minute. Results  Monocular accommodative amplitude was significantly lower (p < 0.001) in the group of poor readers (right eye 9.1 D ± 2.3, left eye 9.0 D ± 2.3) than in the control group (right eye 10.5 D ± 1.7, left eye 10.5 D ± 1.7). Binocular accommodative facility values were significantly lower (p < 0.05) in the poor readers (4.9 cpm ± 3.1) than controls (6.3 cpm ± 2.9). Negative and positive relative accommodation values were similar in both groups of children. Conclusions  This study provides data on the accommodative capacity of a population of children with reading difficulties. Our findings suggest a reduced monocular accommodative amplitude and binocular accommodative facility, such that this function should be assessed by an optometric clinician in children whose reading level is below average. Human subjects and informed consent  The authors confirm that this research was performed followed the tenets of the Declaration of Helsinki, and that informed consent was obtained from the subjects after having explained to them in detail the nature of the study. The study protocol was approved by the Clinical Research Ethics Committee of the School of Optometry.