双眼多焦点人工晶状体眼的远期立体视觉研究

目的比较双眼植入多焦点人工晶状体(MIOL)和单焦点人工晶状体(SIOL)植入术后远期的立体视觉,评价MIOL植入眼远期的立体视觉,进一步完善MIOL植入眼远期视功能的研究。方法观察2000年至2004年在我院接受白内障超声乳化吸除联合人工晶状体植入的患者共29例,其中双眼MIOL16例,双眼SIOL13例,术后随访时间>7m,分别检查术后非矫正近、远视力,矫正近、远视力,屈光,非矫正视力下远、近立体视锐度,矫正视力下远、近立体视锐度,问卷调查术后满意度、视觉症状。结果81.25%的MIOL眼非矫正近视力≥0.5,优于SIOL眼的15.38%(χ2=25.16,P<0.001,差异具有极显著性);非矫正远视力、矫正远视力及矫正近视力MIOL眼与SIOL眼差异无显著性(P>0.05);非矫正近视力下近立体视锐度,68.75%双眼植入MIOL者≤60s,而双眼植入SIOL者则无≤60s,两组间差异极具显著性(χ2=25.294,P<0.001);矫正近视力下近立体视锐度,93.75%的双眼植入MIOI者≤60s,相比双眼植入SIOL者的46.15%差异极具显著性(χ2=9.650,P=0.008,P<0.01);非矫正远视力下及矫正远视力下远立体视锐度,双眼植入MIOL组与双眼植入SIOL组间差异均无显著性;植入MIOL者术后满意度高于植入SIOL者(t=3.512,P=0.001,P<0.01)。结论术后远期,双眼MIOL植入者近立体视觉优于双眼SIOL植入者,植入MIOL患者满意度高于植入SIOL患者。     

儿童眼外伤治疗前后双眼视觉功能观察

目的 观察儿童眼外伤76例治疗后的双眼视功能,并对其相关因素进行分析.方法 3～14岁儿童眼外伤76例（76眼）,于眼外伤一期修复后检查视力,分≤0.3,0.4～0.6和≥0.6 3组.使用AIT-1000型同视机及Titmus检查治疗后患儿的融合和立体视功能,对具有融合或立体视功能的患儿按年龄分成3～5岁、6～7岁和8～14岁3组.统计治疗前后不同视力差异,以及不同年龄和不同视力间双眼视功能的差异.结果 76例治疗后视力较治疗前有明显提高（P＜0.01）.视力≤0.3者,无1例具有融合或立体视功能.视力在0.4以上具有融合功能者39例,具有远立体视者25例,具有近立体视者33例.39例具有融合功能的患儿,0.4～0.6和≥0.6两组间不管是融合还是远、近立体视,≥0.6者例数均较多,差异有统计学意义（P＜0.05）.6～7岁与3～5岁和8～14岁间不管融合、远立体视还是近立体视比较,6～7岁组例数均较少,差异有统计学差异（P＜0.05）.而3～5岁与8～14岁患儿间的融合、远、近立体视差别均无统计学意义（P＞0.05）.结论 儿童眼外伤双眼视功能的恢复与视力恢复成正相关.6～7岁间患儿双眼视功能恢复情况较3～5岁与8～14岁患儿的差.     

儿童先天性白内障摘除人工晶状体植入术后视功能观察

目的观察儿童先天性白内障摘除联合后房人工晶状体植入术后视功能的变化。方法对27例(46只眼)先天性白内障儿童患者行白内障摘除联合后房人工晶状体植入术,分为双眼组(19例)和单眼组(8例),术后3月观察眼屈光状态、眼轴、最佳矫正远视力(best-corrected distance vision acuity,BCDVA)和最佳矫正近视力(best-corrected near vision acuity,BCNVA)以及远、近立体视锐度。结果27例(46只眼)患者手术年龄(5.8±3.8)岁,眼轴(22.92±2.05)mm,术后等效屈光度(-0.40±1.13)D。两组术后35只眼(76%)BCDVA≥0.3,31只眼(67%)BCNVA≥0.3。27例患者中分别有2例(11%)和12例(44%)患者获得良好远、近立体视功能。结论先天性白内障摘除联合后房人工晶状体植入术后可恢复一定程度的视功能。     

多焦点人工晶体眼视功能的研究

目的　比较多焦点人工晶体 (MIOL)眼与单焦点人工晶体 (SIOL)眼的视功能状况 ,评价多焦点人工晶体植入的有效性及安全性。方法　从我院住院的老年性白内障患者中选择合适的病例 4 4例 (6 0只眼 ) ,随机分为两组 ,每组 30眼 ,行超声乳化白内障吸出术 ,MIOL组植入AMOArraySA4 0N ,SIOL组植入AllerganSI4 0NB。术后 1d查远、近视力 ,3m对患者进行远、近视力、对比敏感度 (CS)、色觉、立体视锐度、视野等视功能的检查 ,问卷调查视物情况及视觉症状。结果　MIOL眼具有与SIOL眼一样良好的非矫正远视力 (分别为 1 0 0± 0 2 7、 0 89± 0 2 3,P >0 0 5 ) ,非矫正近视力明显优于SIOL眼 (分别为 0 86± 0 2 7、 0 4 5± 0 14 ,P <0 0 5 ) ;两组病人CS在低、中空间频段均位于正常范围内 ,高空间频段则有部分病例稍下降 ,异常率差异无显著性 (P >0 0 5 ) ;双眼植入MIOL近立体视觉优于双眼植入SIOL ;两组病人色觉无异常 ;视野检查均正常 ;多数患者对手术效果满意 ,MIOL组近距离作业满意度高于SIOL组 (85 71%、 34 78% ,P <0 0 5 ) ;脱镜率MIOL组 5 7 14 % ,SIOL组无人能脱镜 ;两组病人视觉症状均较少 (10 0 0 %、 3 33% ,P >0 0 5 )。结论　MIOL植入安全而有效 ,可以提供与SIOL一样良好的远视力 ,但近     

成人斜视术后双眼单视功能的临床观察

目的观察成人斜视术后双眼单视功能情况。方法对35例18岁以上的共同性斜视患者手术矫正眼位后的双眼单视功能进行检测。用同视机测定视远双眼单视功能,用Titmus立体视图谱测定近立体视锐度。结果30例共同性外斜视患者,28例有不同程度的近立体视,范围50″～400″；仅1例通过同视机Ⅲ级功能检查,2例术后仍无双眼单视。5例共同性内斜视患者,2例获得同视机Ⅰ～Ⅲ级功能及400″近立体视。结论一部分成人斜视患者手术矫正眼位后可以获得一定程度的双眼视觉。共同性外斜视术后获得视近双眼单视的可能较性大。     

中心性浆液性脉络膜视网膜病变患者远近立体视功能

目的 :比较“中浆”患者远近立体视功能损害的临床特点。方法 :对 48例 (5 1眼 )中浆患者按常规方法检查视力、屈光、Amsler方格卡、双眼影像、眼底FFA或OCT ;用同视机检查患者双眼同时知觉、融合范围及定性立体视 ;采用同视机随机点画片及《立体视觉检查图》检测患者的远近立体视功能及抑制性暗点。结果 :48例患者除中心视力下降、视物变形和有中心暗点等单眼视功能受损外 ,还有双眼影像不等及双眼视功能不同程度的损害。双眼视功能受损中 ,双眼同时视障碍为 2 .1% ,双眼融合视缺失为 4.3% ,而双眼定性立体视丢失为 16 .7%。采用随机点画片定量检测发现 ,远距离交叉视差锐度和非交叉视差锐度及近距离立体视锐度达到正常者分别为 2 8例 (占 5 8.3% )、2 4例 (占 5 0 .0 % )和 14例(占 2 9.2 % )。显示近立体视损害较远立体视更明显 ,差异有显著性 (P <0 .0 5 )。病愈后三项功能恢复中心立体视者分别为 47例 (占 97.9% )、46例 (占 95 .8% )和 45例 (占 93.8% )。病愈前后远近距离三项立体视锐度达到正常者的比例以及平均视锐度值 ,差异有显著性 (P <0 .0 1)。影响立体视功能的主要原因是两眼视力相差大 ,双眼同时视像差大及有抑制性中心暗点。结论 :中浆患者视功能受损表现是多方面的。双眼视功能受损特     

儿童眼外伤76例双眼视功能的观察

目的:测定76例经治疗后的眼外伤儿童立体视训练前后双眼视功能,评价双眼视功能训练对眼外伤儿童立体视的影响。方法:收集2006-01/2009-12期间在我院诊治的儿童眼外伤76例76眼,进行一期修复后,即进行双眼视功能训练。使用AIT-1000同视机检查眼外伤儿童训练前后融合和远立体视功能,使用Titmus立体图检查近立体视功能。结果:训练前无双眼视功能者26眼(34%),训练后无双眼视功能者16眼(21%);训练前有融合功能者27眼(35%),训练后有融合功能者48眼(63%);训练前有远立体视功能者23眼(30%),训练后有远立体视功能者29眼(38%),训练前有近立体视功能者14眼(18%),训练后有33眼(43%)。经统计分析,双眼视功能在训练前后的差异具有统计学意义。结论:对眼外伤儿童及时行双眼视功能训练,有助于重建患儿的双眼视功能。     

间歇性外斜视手术时机探讨

目的 通过观察不同年龄、双眼视功能状态手术前后变化,探讨间歇性外斜视的手术时机.方法 将56例间歇性外斜视患者根据手术时年龄≤5岁、5～9岁和≥9岁分为A、B、C三组,再根据术前有无融合功能及远或近立体视分组,统计分析不同年龄组手术前后眼位、双眼视功能变化,以及手术前后融合功能变化、远或近立体视功能变化.结果 术后眼位正位率A组77.8%、B组91.7%、C组85.7%,差异无统计学意义.双眼视觉功能的恢复率A组88.9%、B组87.5%、C组50.0%,差异显著有统计学意义.结论 B组术后正位率优于A组,但双眼视觉功能的恢复却A组优于B组.术前具有融合点及融合范围者,术后双眼视功能恢复率高.近立体视丧失、远立体视保存者术后远立体视锐度恢复好,术后立体视的恢复由远立体视开始.间歇性外斜视的手术时机应根据病人眼位、年龄、融合状态及立体视功能多方面综合考虑.     

儿童先天性上斜肌麻痹术后双眼视功能的变化

目的:通过对儿童先天性上斜肌麻痹手术前后双眼视功能的观察,探讨其术后成功重建双眼视觉的影响因素。方法:对30例34眼接受手术治疗的儿童先天性上斜肌麻痹患者进行回顾性分析,所有患者手术前后均用同视机检查双眼视功能,Titmus(立体视检查图)检查近立体视觉。结果:手术后同时知觉、融合功能、远立体视、近立体视较术前均有明显改善,有统计学差异(P<0.05);比较不同视力手术后立体视的变化情况,发现好视力组术后立体视恢复较差视力组好,两者比较有统计学差异(P<0.05);不同斜视度数术后立体视改善情况不同,大度数组术后立体视恢复较小度数组差,两者比较有统计学差异(P<0.05)。比较有无代偿头位,发现有代偿头位组术后立体视好于无代偿头位组,两者有统计学差异(P<0.05)。结论:儿童先天性上斜肌麻痹术后双眼视功能明显改善,视力、斜视度、代偿头位对术后双眼视觉重建均有影响。     

老年性白内障摘除术后早期双眼视觉的恢复

目的　观察老年性白内障摘除术后早期患者双眼视觉的恢复情况 ,并探讨影响其恢复的原因。方法　对 5 5例 (6 6只眼 )老年性白内障患者行囊外白内障摘除人工晶状体植入术 (ECCE组 )或超声乳化白内障吸除人工晶状体植入术 (PHACO组 ) ,术后检查矫正视力、屈光度数 ,以及双眼同视、融合及远、近距离立体视功能。结果　术前术眼视力ECCE组低于PHACO组 ,差异有显著意义 (P <0 0 5 ) ;术后术眼和非术眼视力两组比较 ,差异均无显著意义 (P >0 0 5 )。术后ECCE组双眼柱镜屈光度数差值较大 ,与PHACO组比较差异有非常显著意义 (P <0 0 1)。两组患者术后均具有较好的双眼同视和融合功能。ECCE组和PHACO组分别有 83 3%和 94 7%的患者获得不同程度的远距离立体视 ,差异无显著意义 (P >0 0 5 ) ;分别有 2 8%和 2 1 1%的患者获得黄斑中心近距离立体视 ,差异有显著意义(P <0 0 5 )。结论　老年性白内障摘除术后早期患者的双眼视觉未完全恢复 ;术前长期的视觉抑制 ,尤其是单眼抑制和术后的屈光参差可能是影响双眼视觉恢复的原因。     

Assessment of visual acuity by evoked potential recording: Ambiguity caused by temporal dependence of spatial frequency selectivity

The spatial-frequency selectivity of pattern evoked potentials depends on the stimulus repetition rate: responses to low spatial frequencies are emphasized by stimulating at 16–20 Hz, while responses to high spatial frequencies are emphasized at 5–8 Hz. These findings are consistent with the suggestion that pattern EP's are a mixture of pattern responses and responses to local flicker. To a first approximation the “local flicker” responses resemble EP's produced by flickering a light similar to the patterned stimulis in all respects except for absence of pattern. Any developmental changes in the temporal tuning of pattern responses and/or local flicker responses might distort the results of studies in which pattern EP's have been used as an index of either (a) the development of visual acuity or (b) acuity changes due to visual deprivation. Methods of minimizing this problem are suggested.     

Habitual vs optimal distance visual acuity

PURPOSE: The maintenance of a good level of vision is desirable for developmental and social reasons; it is also a requirement that should not be overlooked in the clinical research environment. This study set out to quantify and analyse any difference between 'habitual' (pre-sight test) and 'optimal' (post-refraction) distance visual acuity in an optometric population. It is intended that the outcome of this work will inform not only clinicians but also those undertaking vision research. METHODS: Binocular logMAR visual acuity was determined at 6 m before and after optometric intervention in patients attending optometric practice for a routine sight test. Cases were recorded seriatim but restricted to the 'core' refraction range representative of typical optometric practice; three further exemption criteria included subject illiteracy, the necessity for a non-standard test distance and contact lens wear. Over a 12-month period, two-thirds of patients examined satisfied the study inclusion criteria; it is the clinical data of these 1288 individuals that are described and analysed here. RESULTS: These data provide a quantitative demonstration that an optometric intervention will most likely improve the habitual distance visual acuity of subjects, irrespective of gender, age group, time interval since last test, refractive status and whether or not the subject is a habitual spectacle wearer. The improvement found was typically within one logMAR chart line (<5 letters), being greatest in spectacle-wearing teenagers and in individuals beyond retirement age (increasing to eight letters in elderly habitual non-spectacle wearers); also in non-wearers who left an interval of 2 years or more between sight tests. CONCLUSIONS: Clinical and laboratory-based investigators are advised that a current and optimal refractive correction should be worn by subjects of all ages enrolled in vision-related studies. Refractive defocus may introduce or exaggerate test outcome variability.     

原发性青光眼早期诊断方法的对比研究

目的　比较图形视网膜电图(P-ERG),图形视觉诱发电位(P-VEP),中央视野视网膜光敏感度和眼部动脉血流速度在早期原发性青光眼诊断中诊断价值的大小。方法　对128例230只眼早期原发性开角型和慢性闭角型青光眼以及48例96只眼正常对照组进行上述4种诊断。方法　的检测,计算各方法的敏感度特异度和诊断指数,并对其进行相应的统计学检验.结果　各方法诊断指数间差异均有显著性(P<0.01),并得出这4种检测方法在原发性青光眼早期诊断中的价值为P-ERG>P-VEP>中央视野视网膜光敏感度>眼部动脉血流速度测量。结论　P-ERG,P-VEP和中央视野视网膜光敏感度较眼部动脉血流速度检测在早期原发性青光眼诊断上更有价值     

扫描翻转图像视觉诱发电位视力与对数视力表视力的比较

目的 对扫描图像视觉诱发电位视力(SPVER视力)与对数视力表视力进行比较。方法比较50例受试者的视力表和SPVER视力。在SPVER视力的测定中用了8个不同空间频率的光栅条纹连续扫描,所得数据经离散傅立叶分析后,获得振幅一空间频率曲线,并由外推法估计其视力。结果SPVER视力与视力表视力的总体相关系数r=0．699,在视力表视力大于0．5时,SPVER视力有低估现象,而在视力表视力小于0．5时SPVER视力有高估现象。结论SPVER视力与视力表视力有良好的相关性。由于视力表视力和SPVER视力所用于评估视力的指标不同,使两者结果不完全相同。     

A Review of Strategies for Screening of the Visual Fields

: Some strategies for rapid investigation of the visual fields are reviewed. Those aspects considered are the testing of central and peripheral fields, the pattern and density of sampling the visual field with static stimuli and the most suitable stimulus intensity at which to begin the screening of each subject. Some of the design features of 10 visual field screeners and 3 automated perimeters are tabulated to indicate the importance of control of perimetric variables and how strategies for screening have developed from earlier to later designs.     

弱视眼的激光干涉条纹视力测定与研究

测定了４２名（６１眼）斜视性／屈光参差性／屈光不正性弱视少儿的激光干涉条纹视力（Ｌａｓｅｒｉｎｔｅｒ－ｆｅｒｅｎｃｅｆｒｉｎｇｓｖｉｓｕａｌａｃｕｉｔｙＩＶＡ）并与其Ｅ字母视力表视力（ＥＶＡ）作了比较和分析，弱视眼的ＩＶＡ多数高于ＥＶＡ（５９．２６～８６．３６％），相当一部分弱视眼（１３．６４～２２．２２％）的ＩＶＡ低于ＥＶＡ，０．００～１８．５２％的弱视眼ＩＶＡ等于ＥＶＡ。作者从视觉通道的角度讨     

Visual function and visual perception in cerebral palsied children

PURPOSE: To investigate visual function and perception in cerebral palsied (CP) children. METHODS: A total of 105 congenitally CP children (aged 6-15 years), without severe mental retardation, were classified into three groups: those with spastic quadriplegia, spastic diplegia and spastic hemiplegia. Data collected included patient history, IQ, refraction, far and near visual acuity, position of the eyes and eye movements, visual fields, colour perception, stereoacuity, slit lamp and fundoscopic examinations, and evaluation of visual perception. The results were compared with a control group from the general paediatric population. RESULTS: The IQ of the CP children ranged between 70 and 100. A total of 59% of them had best corrected distance visual acuity <6/6, with 25.5% <6/9. Near visual acuity was also reduced (70.1% scored <6/6 and 38.4% scored <6/9). Incidence of refractive errors was higher than in the control group (hypermetropia in 43.8% of the eyes, myopia 16.19% and astigmatism 40.9%) as was the incidence of strabismus (26.7% esotropic and 27.6% exotropic). In visual field testing, 80.95% of CP children were normal. A total of 94.28% had normal colour perception and 89.52% were free of ocular pathology. Stereopsis was abnormal or absent in 85.71% of the cases. Visual perception was markedly reduced: in 57.14% of the cases it was less than or equal to that of 6-year-old children; in 26.66% equal to that of 6- to 7.5-year-old children, and in 16.2% of the cases greater than or equal to that of 7.5-year-old children. CONCLUSIONS: In the absence of severe mental retardation, CP children have deficient visual skills. It is suggested that the poor visual skills of CP children are a separate, identifiable factor compounding the adverse effects of mental retardation.     

Visual behaviours of neurologically impaired children with cerebral visual impairment: an ethological study

BACKGROUND/AIMS—Visual functions of neurologically impaired children with permanent cerebral visual impairment (CVI) can be difficult to determine. This study investigated the behavioural profile of CVI children by means of ethological observations in order to gain a better understanding of their visual functions.
METHODS—Video registrations of nine subjects who were unable to undergo more orthodox methods of visual function testing were observed and analysed by an ethologist.
RESULTS—A series of behaviours (direct signs) and supportive or confirming behavioural elements (indirect signs) indicating some visual perception in the children were found.
CONCLUSION—Detailed ethological observations of visual behaviour were shown to be useful for analysing visual functions of children with permanent CVI.

Keywords: cerebral visual impairment; visual function; visual behaviour; ethological analysis     

Perceptual visual dysfunction in children - An Indian perspective

Perceptual visual dysfunction (PVD) comprises a group of vision disorders resulting from dysfunction of the posterior parietal and/or temporal lobes. Often, affected children have normal/near normal visual acuities and/or visual fields, but have difficulties in activities of daily living involving the use of vision. PVDs are known to be common among children with risk factors such as a history of prematurity and/or neurodevelopmental disorders. The inferior temporal lobes and ventral stream transform visual signals into perception, while the posterior parietal lobes and dorsal stream transform visual signals to non-consciously map the scene to guide action and facilitate attention. Dysfunction of these can lead to specific visual impairments that need to be identified during history taking, triggering ascertainment of further details by a structured inventory approach. Clinical tests to elicit dorsal and ventral stream visual dysfunctions have good specificity but low sensitivity. Neuropsychologists are rarely available in the developing world to perform detailed assessments, but there are a few tests that can be used by eye care professionals with some training. Optical coherence tomography (OCT) showing thinning of the ganglion cell layer and retinal nerve fiber layer is being explored as a potential tool for rapid assessment in the clinic. The behavioral outcomes of PVD can mimic psychological conditions including autism spectrum disorder, attention deficit hyperactivity disorder, specific learning disability, and intellectual impairment, and one needs to be aware of overlap among these differential diagnoses. A practical functional approach providing working solutions for each child''s set of difficulties in day-to-day activities is needed.