年龄相关性白内障术后视力再下降患者的临床特征分析

目的　分析年龄相关性白内障术后视力再下降患者的临床特征,为该病诊断和治疗提供依据。方法　收集2017年1月至2020年6月在北京朝阳医院眼科就诊的年龄相关性白内障术后视力再下降患者,回顾性分析其疾病构成比、裸眼视力、最佳矫正视力（BCVA）、等效球镜度、前房深度及眼底病变等。结果　本研究共收集283例（397眼）白内障术后视力再下降患者,导致白内障术后视力再下降的主要原因有屈光不正（30.0%）、后发性白内障 (PCO,23.2%)、人工晶状体位置改变（3.8%）、眼底病变（25.7%）、视神经疾病（4.5%）、眼表疾病（3.3%）、多因素复杂眼病（7.1%）及原因不明（2.5%）,共8类;但主要由其中5种眼病引起,即屈光不正、PCO、糖尿病视网膜病变、高度近视性眼底病变、年龄相关性黄斑变性,此5种眼病占术后视力再下降患者的72.5%（288眼）。屈光不正及PCO患者BCVA通过治疗均可明显提高。结论　年龄相关性白内障患者术后视力再下降原因复杂,其中半数患者通过治疗可再次显著提高视力。     

糖尿病患者盲与低视力的流行病学调查

目的通过对上海市北新泾社区糖尿病患者眼部病变的流行病学调查,了解糖尿病患者盲与低视力的情况。方法对上海市长宁区北新泾社区糖尿病患者进行视力损伤眼病的流行病学调查,内容包括:问卷调查询问一般状况和生活习惯;全身情况的检查:血压、血糖;眼部检查:日常生活视力、小孔镜视力、裂隙灯检查、眼底镜检查、自动验光仪验光、免散瞳眼底照相机眼底照相。结果应有590人进行调查,实际调查共535人,其中盲的患病率为1．12％,低视力的患病率为9．91％。导致盲的首要病因是糖尿病视网膜病变,其次是白内障和其他视网膜病变,导致低视力首要病因是白内障,其次是屈光不正和糖尿病视网膜病变。结论北新泾地区糖尿病患者防盲工作重点是糖尿病视网膜病变、白内障以及屈光不正的防治。     

早期老年性白内障患者视力和屈光变化观察

目的 探讨早期老年性白内障患者的视力和屈光状态。方法 47例确诊为早期老年性白内障视力下降患者，作仔细眼部和屈光状态检查，并矫正其视力。结果 裸眼视力随年龄的增长下降愈明显，通过扩瞳验光，矫正视力≥0.6者77只眼(81．9％)与裸眼视力≥0．6者27只眼(28．7％)相比，本组病例的矫正视力有显著提高。结论 早期老年性白内障患者，可通过矫正屈光不正提高视力。     

老年性白内障屈光状态临床分析

目的探讨老年性白内障类型与其屈光状态关系.方法对102例(204眼)老年性白内障以裂隙灯检查散瞳后晶状体混浊状况,应用自动验光仪对小瞳孔及散瞳眼行电脑验光,并对矫正前后视力及屈光状态进行比较.结果老年性白内障类型与屈光不正种类有着显著的关系(P＜0.001),皮质性和混合性多为远视及远视散光,核性以近视及近视散光为主,初中期白内障矫正视力有明显提高.结论老年性白内障其晶状体混浊引起的屈光状态改变是导致初中期自内障患者视力下降的主要原因,早期患者矫正视力可明显提高.     

白内障术前OCT检查的临床意义

目的 探讨光学相干断层扫描(optical coherence tomography,OCT)在白内障术前检查中的临床意义.方法 选择OCT检查可见眼底的白内障患者193例217只眼,包括糖尿病史患者40例,高度近视患者10例,术前进行全面详细的眼科常规检查和眼底OCT检查.对比计算裂隙灯用前置镜与OCT检查两种检查方法对眼底病的检出率,了解OCT对白内障术前眼底情况的评估意义.结果 术前OCT检出眼底病31例(39只眼),前置镜检出眼底病15例(18只眼).用配对卡方检验OCT计算出眼底病阳性率与前置镜阳性率在α =0.05水平均具有显著性差异.结论 两种检查方法相比较,OCT检查可以明确白内障患者术前眼底情况,预测白内障术后视力,可作为术前常规检查.     

早期老年性白内障与屈光不正

老年人远视力减退,除与老年性白内障、黄斑变性和其他眼底等疾病有关外,也与眼的屈光不正密切相关。为探讨老年性自内障的屈光不正的关系,作者于1987年2月至8月间,随机对我科门诊的病人;凡因视力减退巳在我院或他院眼科检查确诊患有早期老年性白内障病,并在门诊长期接受药物     

视网膜视力测定在眼科的应用

视网膜视力测定是随着激光技术和人眼空间调制传递函数的深入研究而产生的新方法,它能反映屈光间质混浊情况下的视网膜功能.本文对视网膜视力仪进行了分类并阐述了其工作原理及使用方法,介绍了视网膜视力测定在白内障术前、视网膜病变、玻璃体疾病、角膜病变、弱视及屈光不正等病例中的应用,比较了不同视网膜视力仪在各类病变中的应用价值及其优缺点.     

农村白内障患者人工晶状体植入术后低视力病因分析

目的分析农村白内障患者小切口非超声乳化人工晶状体植入术后低视力发生的原因及防治方法。方法对556例(589眼)农村白内障患者行小切口非超声乳化人工晶状体植入术,于术后1d、1周、1月、3月分别测定手术眼的裸眼视力,<0.5归为低视力者,对低视力患者进行病因分析。结果术后1d低视力者235眼(39.9%),其主要原因为手术并发症共112眼(47.6%);随着术后时间的延长,低视力人数逐渐减少,至术后3月低视力者120眼(20.3%),而其原因为屈光不正45眼(37.5%)和眼底病37眼(30.8%)。结论人工晶状体计算误差造成的屈光不正、手术源性散光及眼底病变是造成小切口非超声乳化人工晶状体植入术后低视力的主要原因,低视力的发生与病例的选择及技术操作有关。     

白内障术后生存质量分析及其影响因素的研究进展

随着医学模式的发展,白内障患者术后生存质量的评价比单纯术后视力测量更能全面体现手术对患者造成的生理及心理的改变.近年来学者们对不同的白内障手术方式、不同的人工晶状体(IOL)类型及术前术后等因素对白内障患者生存质量的影响进行了研究.此外,眼底病、术后残余屈光不正、眼表疾病及性别、年龄、社会心理学等因素也对患者术后生存质量产生一定的影响.眼科工作者不仅要关心白内障手术质量,还要了解患者对手术的期望值及具体要求,最大程度地提高白内障患者的生存质量.     

职业性视疲劳与屈光不正的关系

目的：观察机关干部有视疲劳症状而视力正常的屈光不正特点，探讨患病原因与治疗原则。方法：调查分析了52例视力在正常范围内患者的病史、屈光状态、矫正效果、眼压、眼位和用眼状况等因素及随诊情况。结果：52例患者视力虽在正常范围，而经屈光检查均有轻度的屈光不正，并以轻度散光居多。视疲劳以轻度和中度为主，但有一定的特点。其中查找有无屈光不正的因素不可忽略，还有眼外肌平衡，双眼单视功能，电脑前工作强度、年龄和全身情况等多方面原因，但首先排除屈光不正，这是缓解疲劳的手段之一。     

Detection of early visual impairment in patients with epiretinal membrane

Purpose: Patients with epiretinal membrane sometimes complain of impaired central visual function, despite good best corrected visual acuity (BCVA), as measured by visual acuity (VA) charts. Here, we evaluate early epiretinal membrane–induced changes in central VA. Methods: Subjects were 72 eyes of 36 patients with epiretinal membrane in only one eye and a BCVA in each eye better than 1.0, as measured by conventional Landolt C chart, at the Retina Division Clinic of the Department of Ophthalmology, Keio University Hospital, between December 2010 and November 2011. The conventional Landolt VA, functional VA (FVA) and contrast VA measurements were taken after a general eye examination. For the FVA, Landolt optotypes were sequentially displayed every 2 seconds, which size was changed according to the correctness of the answer. To exclude the influence of other diseases, a standard Schirmer test was performed to diagnose dry eye, and corneal and lens densities were evaluated. Results: Average BCVA measured by Landolt C chart was not changed between affected and unaffected fellow eyes. However, the affected eyes showed a poorer FVA score (0.21 ± 0.12, affected; 0.09 ± 0.12, fellow) and visual maintenance ratio (VMR) (0.90 ± 0.04, affected; 0.94 ± 0.04, fellow), measured by the FVA system, and contrast VA score (0.35 ± 0.11, affected; 0.25 ± 0.14, fellow) than fellow eyes. The FVA and contrast VA values were correlated with the presence of epiretinal membrane, but not with the presence of dry eye, cataract and corneal densities. Conclusion: FVA and contrast VA results reflected early changes in central visual function caused by epiretinal membrane, which were not detected by conventional Landolt BCVA.     

Optical aberrations and visual disturbances associated with dry eye

Optical aberrations and visual disturbances are associated with dry eye, although visual impairment is often not detected by conventional visual acuity testing. The newly developed functional visual acuity (FVA) device allows continuous dynamic evaluation of distance visual acuity and assessment of the effect of natural tear film status on dynamic visual function. Similarly, to detect corneal surface irregularities during sustained eye opening in dry eye subjects, a new tear stability analysis system (TSAS) has been developed. Both FVA and TSAS measurement systems seem to be effective tools in the assessment of dynamic visual acuity changes in dry eye and normal subjects. Both methods were also found to be helpful in the evaluation of the outcome of management of dry eye disease. FVA testing has been suggested to be an important indication of an individual's performance in relation to certain daily activities, such as driving, reading and working at a video display terminal. This review provides illustrations of results obtained from FVA and TSAS systems.     

Effect of preoperative tear function on early functional visual acuity after laser in situ keratomileusis

PURPOSE: To assess the effect of preoperative tear function on early changes in functional visual acuity (FVA) after laser in situ keratomileusis (LASIK). SETTING: Minamiaoyama Eye Clinic, Tokyo, Japan. METHODS: This prospective single-center study assessed the effect of preoperative and postoperative tear functions on FVA in 30 eyes of 15 patients who had LASIK. Functional visual acuity was defined as the binocular recognition acuity measured by the FVA tester (Wellsystem) during a 10-second, blink-free period. All patients had a Schirmer test with anesthesia and tear-film breakup time (BUT) measurements preoperatively and 1 day and 1 week after LASIK. Corneal topography and Landolt visual acuity and FVA measurements were performed before surgery and 1 day and 1 week after LASIK. Eyes with a Schirmer test reading less than 5.0 mm and a BUT less than 5 seconds were grouped as definite dry eye (DDE). Eyes with a normal Schirmer test score but a shortened BUT were grouped as probable dry eye (PDE). RESULTS: In all patients, the best uncorrected Landolt visual acuity was 20/20 or better at the postoperative examination times. In the DDE group, the mean preoperative FVA declined from 1.2 to 0.75 +/- 0.16 (SD) at 1 day and increased to 1.2 at 1 week. No change in FVA was observed postoperatively in the PDE group. CONCLUSION: Laser in situ keratomileusis patients with low basal tearing and full uncorrected distance Landolt acuity may experience a transient decrease in FVA that returns to baseline within 1 week.     

负球差人工晶状体在屈光手术后白内障患者手术中的应用

高度近视眼患者行角膜屈光矫正术后其角膜形态改变,曲率和像差均较正常角膜发生了变化.该类患者按照传统方法计算人工晶状体(intraocular lens,IOL)度数易产生屈光预测误差.屈光术后角膜正球差增加,亦明显影响患者的视觉质量.针对上述问题,目前已有一系列以降低预测偏差为目的的IOL度数计算方法,以期获得更为准确的IOL度数预测值.此外,白内障术前根据角膜球差选择个体化的负球差IOL,能够降低全眼球差,减少患者夜间视力下降、眩光等视觉不适症状,进一步提高患者的视觉和生活质量.     

Efficacy of punctum plug treatment in short break-up time dry eye

PURPOSE: To evaluate the efficacy of punctum plug insertion on tear and dynamic visual function in dry eye patients with short break-up time (s-BUT) of the tears. METHODS: A prospective comparative case series design was used. Twenty-seven eyes of 27 dry eye patients with a s-BUT seen at Keio University School of Medicine, Department of Ophthalmology, were studied. Functional visual acuity (FVA) measurements, tear function examinations and ocular surface evaluations including Schirmer test, tear break-up time, fluorescein and Rose Bengal vital staining scores were performed before and 1 month after insertion of punctum plugs (PP) in dry eye patients with s-BUT. Degree of satisfaction with the PP treatment was also graded. RESULTS: Nineteen out of 27 eyes (70.4%) showed a satisfactory outcome with the PP treatment because of decreased subjective dry eye symptoms. On the other hand, six out of eight eyes with an unsatisfactory outcome had epiphora. The visual maintenance ratio value was observed to significantly increase from 0.87 +/- 0.09 to 0.91 +/- 0.07 in eyes with no epiphora, whereas the visual maintenance ratio value significantly decreased from 0.98 +/- 0.10 to 0.86 +/- 0.13 in the group of eyes with epiphora after PP treatment. (p < 0.05) Likewise, FVA significantly improved after PP insertion in the group with no epiphora and decreased in eyes with epiphora. Visual acuity in the conventional Landolt visual testing remained significantly unchanged in both group of eyes with or without epiphora. CONCLUSIONS: FVA was useful in assessing and quantifying vision related symptomatology in s-BUT type of dry eye treated with PP occlusion.     

The application of a new continuous functional visual acuity measurement system in dry eye syndromes

PURPOSE: To evaluate the efficacy of a new continuous functional visual acuity measurement (FVAM) system for the assessment of dry eye patients. DESIGN: Prospective comparative study. METHODS: Monocular recognition acuity measured continuously by the FVAM system during a 30-second blink-free period was defined as functional visual acuity (FVA). Examinations using the FVAM system were conducted in 35 eyes of 20 healthy controls and 19 eyes of 13 dry eye patients. Tear function examinations including the Schirmer test, tear film break-up time, and fluorescein and Rose Bengal staining were performed in all subjects. Functional visual acuity and tear functions were also examined before and after insertion of punctum plugs in dry eye patients. Functional visual acuity results at 10, 20, and 30 seconds were compared. RESULTS: Functional visual acuity in dry eyes were significantly lower than control subjects at all time points (P < .05). Functional visual acuity after punctum plugs insertion improved significantly at all time points (P < .05). CONCLUSIONS: FVAM system seemed not only to be an effective tool in the assessment of dynamic visual acuity changes in dry eye and normal subjects but in evaluating the outcome of management of dry eye disease by punctum plugs.     

Relative afferent pupillary defect in the "better" eye

A relative afferent pupillary defect usually occurs in an eye with unilateral or asymmetric optic nerve or extensive retinal disease. In general, the eye with poorer visual acuity has the afferent pupillary defect. Twenty-five patients are reported, however, in whom an afferent pupillary defect occurred in the eye with better visual acuity. These eyes had optic nerve or retinal dysfunction. The eyes with worse visual acuity but no afferent pupillary defect had an abnormality of the ocular media (corneal opacity, hyphema, anterior segment membrane, cataract, or vitreous opacity), amblyopia, refractive error, age-related macular degeneration, or cystoid macular edema. An afferent pupillary defect does not necessarily occur in the eye with poorer visual acuity.     

LASIK术后泪液稳定性及功能性视力的研究

目的:研究LASIK手术后泪液稳定性及功能性视力的变化。方法:我们对2008-04/06在我院接受LASIK治疗近视的48例患者(96眼)进行前瞻性病例对照研究,分别在术前、术后1d;1wk;1,3,6mo进行干眼症状问卷调查,检测泪膜破裂时间(tear break-up time,BUT)、泪液分泌试验(schimer test values,STV)、角结膜荧光素钠染色(sodium fluorescein,FL)、比较功能性视力(functional visual acuity,FVA)与基础视力(baseline VA)的差值(FVA)。结果:术前有15眼(16%)有干眼症状,术后分别有91眼(95%),82眼(85%),57眼(59%),43眼(45%),32眼(33%)在术后1d;1wk;1,3,6mo表现有干眼症状;术后第1dBUT由术前7.06±2.04s缩短至4.4±1.8s(t=2.65,P=0.00),STⅠ由术前12.7±6.6mm增加到14.5±6.6mm(t=1.76,P=0.036),STⅡ由术前7.2±2.4mm减少到5.47±2.02mm(t=1.68,P=0.00),术前FL评分1.0±0.8,术后1d增多到1.4±1.0(t=0.375,P=0.002)。术后6mo除STⅠ10.6±7.0mm,仍低于术前(t=1.83,P=0.03),其余参数均恢复至术前水平。FVA术后1d由术前0.50±0.37增加至0.62±0.35(t=1.146,P=0.025),1wk后恢复至术前水平。结论:本研究证实术后干眼是LASIK矫正近视的常见并发症,主要影响BUT,STⅠ,STⅡ。LASIK术后早期功能性视力有所下降,1wk后逐渐好转。     

Visual acuity and quality of life in dry eye disease: Proceedings of the OCEAN group meeting

Dry eye disease (DED) results in tear film instability and hyperosmolarity, inflammation of the ocular surface and, ultimately, visual disturbance that can significantly impact a patient's quality of life. The effects on visual acuity result in difficulties with driving, reading and computer use and negatively impact psychological health. These effects also extend to the workplace, with a loss of productivity and quality of work causing substantial economic losses. The effects of DED and the impact on vision experienced by patients may not be given sufficient importance by ophthalmologists. Functional visual acuity (FVA) is a measure of visual acuity after sustained eye opening without blinking for at least 10 s and mimics the sustained visual acuity of daily life. Measuring dynamic FVA allows the detection of impaired visual function in patients with DED who may display normal conventional visual acuity. There are currently several tests and methods that can be used to measure dynamic visual function: the SSC-350 FVA measurement system, assessment of best-corrected visual acuity decay using the interblink visual acuity decay test, serial measurements of ocular and corneal higher order aberrations, and measurement of dynamic vision quality using the Optical Quality Analysis System. Although the equipment for these methods may be too large or unaffordable for use in clinical practice, FVA testing is an important assessment for DED.