Pre-school visual acuity tests

A number of visual acuity tests are available for both the literate and the preliterate child. This paper compares the results obtained with five different visual acuity tests; Illiterate E, Landolt C, Bailey-Hall Cereal test, Lighthouse Flash Cards and Stycar Five Letter test, for 43 children between the ages of three and five years. The linear Illiterate E test appears to be the test of choice; it will detect amblyopia, and the results are not significantly different from those obtained for the single optotype tests. No significant differences were found between the results for the different single optotype tests used in this study. The Landolt C test results are significantly different from those for the other tests and we do not recommend this test for young children.     

一种新的计算机适应色觉试验

目的:提出一种新的计算机适应色觉试验(NCACVT)并且解释它在实际应用中的可靠性和重要性.方法:法一孟二式100色度试验(FM100HT)和Holmgren试验已经被改良并且适应计算机应用.经典的Ishihara假同色法试验方法(IPPT)已被假定是色盲的一个简便的筛选检查工具;因此依照Ishihara试验结果,受试者被分为色觉有缺陷组(第1组)和对照组(第2组).第1组为色觉有缺陷者13例(男12例,女1例),年龄在19～29(平均21)岁,而第2组为对照组,13个受试者色觉无缺陷(男8例,女5例),年龄在19～28(平均22)岁.为了研究两组人的色觉敏感性,所有的受试者都要进行FM100HT和NCACVT试验.将经典的IPPT,FM100HT和NCACVT的试验结果用统计学方法进行比较.在这两组中NCACVT和FM100HT的误差计分用秩和检验来分析.结果:在误差计分中的差别分别在统计学上是有显著意义的(U=169,P＜0.05;U=153 P＜0.05).根据NCACVT来诊断色觉缺陷的临界点是通过使用接受机器作特征曲线(ROC)而被发现是23.根据23这个临界点的误差计分,在筛选检查色觉缺陷方面,发现NCACVT具有100%的敏感性和100%的特异性.结论:根据Harper和Reeves,这些特点使得这个试验成为一个可靠的、有创意的眼科实践筛选试验.     

A computer-generated test of acuity for multi-handicapped children

Assessment of visual function in severely intellectually handicapped children is difficult but necessary for educational purposes. The difficulties encountered include: lack of literacy skills; lack of verbal and fine motor skills; and low interest level of the optotypes. A computer-generated test has been developed that helps overcome these difficulties. This test presents pictures equivalent in line width to Snellen, which are manipulated on screen to provide movement and change of size to facilitate non-verbal responses and to increase interest level. Evaluation trials were conducted with 96 cognitively normal children and 37 multi-handicapped children. The computer test facilitated testing of significantly more of the multi-handicapped children. Data from both trial groups indicated a good positive correlation between the computer test and a standard optotype test. Further refinement and evaluation of this computer test is continuing.     

Clinically relevant colour album test for the colour defective medical student

Purpose:To evaluate the impact of color vision deficiency (CVD) in medical undergraduates by a more clinically applicable test.Methods:Cross-sectional study of 31 students with CVD (Ishihara diagnosed) asked to identify subject-specific signs/tests requiring color identification on a customized medical multispecialty designed color album test (CAT). They were further subjected to Farnsworth D-15 testing.Results:The error score of CVD students (4 ± 3.2) on 39 plates of color album test was highly significant as compared to the error score of color normal (0.3 ± 0.6). The CAT depicted linear correlation with Farnsworth D-15 and emerged as a valid tool of assessment. Ishihara interpretation did not correlate with the clinical impact of CVD. Nature of error suggests that CVD students can anticipate problems in dermatology, pathology, hematology, microbiology, and biochemistry.Conclusion:Color album test is a more clinically relevant test for CVD doctors to identify specialties where they can anticipate difficulties     

随机点立体图与图形立体图检测立体视的一致性分析

目的:研究随机点立体图与图形立体图检测立体视锐度的一致性,评估偏差仅限于周边立体视或无立体视范围,还是包括黄斑中心凹立体视的整个立体视谱。方法:对4~25岁双眼视正常组76例及共同性斜视组89例,采用TNO及Randot立体图于40cm处检查近距离立体视,比较两种方法测得的立体视锐度的一致性。结果:双眼视正常组两种方法测得的立体视锐度分布无统计学差异;斜视组两种方法检测的立体视锐度分布有显著统计学差异(χ2=19.27,P<0.01),且差异存在于整个立体视谱。结论:随机点及图形立体图检查结果的不一致反应了两类方法的机制不同,图形立体图检查混杂了单眼信息导致的假阳性结果,随机点立体图检查无立体视可能并非大脑皮质立体视觉真正丧失。     

共同性斜视立体视觉的临床检测与分析

目的:研究不同检查方法检测斜视患者立体视锐度的一致性,以及不同类犁斜视立体视损害的差异.方法:对4-25岁双眼视正常组76例及共同性斜视组89例(间歇性外斜39例,恒定性外斜22例,非调节性内斜28例),采用TNO及Randot立体图于40 cm处检查近距离立体视,采用Optec3500视觉检查仪检查远距离立体视,比较3种方法测定的立体视锐度的一致性及不同类型斜视的立体视差异.结果:随机点立体图(TNO)的立体视锐度高于非随机点立体图(Randot与Optec3500)的立体视锐度(P＜0.01);恒定性外斜及内斜TNO近立体视丧失达90%以上,3种方法检查的立体视分布无显著性差异;间歇性外斜的远、近立体视均存在,但其分布有显著性差异(P＜0.05),远立体视的中心凹立体视比例明显降低.结论:立体视损害与斜视偏斜性质无关;随机点及图形立体图对斜视者的检查结果在中心凹立体视一致性好,在黄斑及周边立体视差异较大,故不能仅凭一种检查方法来判断斜视者是否存在立体视.     

Assessment of stereopsis in pediatric and adolescent spectacle-corrected refractive error – A cross-sectional study

Purpose:To assess the level of stereopsis in school children with spectacle-corrected refractive errors using Titmus fly and Randot stereo tests, evaluate the factors associated with the level of stereopsis, and determine the level of agreement between the two tests.Methods:A cross-sectional study was done on 5- to 18-year-old school-children wearing spectacles for at least 1-month duration. Visual acuity was assessed using Snellen’s visual acuity chart, and their spectacle correction being used currently was measured using an auto lensmeter. The level of stereopsis was assessed using Randot and Titmus fly stereo tests. Data were entered using Microsoft Excel and analyzed using IBM-SPSS version 20, Chicago, IL. The associations between stereopsis and type of refractive error, visual acuity, age, and gender were analyzed. An agreement between Randot and Titmus fly test was done using Kappa statistics.Results:A total of 222 children (101 boys and 121 girls; mean age 13 years) were assessed. Astigmatism was the most prevalent refractive error (60.4%), followed by myopia (24.8%) and hypermetropia (1.4%). Thirty children (13.5%) had anisometropia. All hyperopes had normal stereopsis. Children with spherical myopia had better stereopsis, followed by astigmatism and anisometropia in the same order (P = 0.036). Children with anisometropia ≤1.5 D had better stereopsis than anisometropia more than 1.5 D. Stereopsis was also found to have no correlation with the age and visual acuity at the time of testing or the age at which the child first started wearing spectacles. Stereopsis values obtained from Randot and Titmus fly stereo tests showed moderate agreement with Kappa value 0.581.Conclusion:Anisometropia and astigmatism are the most critical factors determining the level of stereopsis in refractive errors.     

酚红棉线试验与Schirmer试验在干眼诊断中的比较研究

目的 比较酚红棉线试验和Schirmer试验的重复性、在干眼诊断上的灵敏度和特异度、两者的一致性等。方法 分别收集48例干眼患者和12例正常人,依次进行干眼问卷调查、裂隙灯体征检查、酚红棉线试验、Schirmer试验及2种试验的刺激性调查,并选择其中12例干眼患者进行2种泪液分泌试验的一致性检验。对数据进行统计学分析检验。结果 酚红棉线试验和Schirmer试验均有一定的可重复性;对干眼诊断的敏感度分别为44.2%和53.5%,特异度分别为81.8%和54.5%;2种试验的一致性kappa值为0.229,而酚红棉线试验的刺激性显著低于Schirmer试验(P<0.05)。结论 酚红棉线试验和Schirmer试验均有一定的可重复性,但两者对于干眼诊断的灵敏度均不高,且一致性较差,因此均只能作为诊断干眼的辅助手段,而酚红棉线试验相较Schirmer试验具有较高的特异度和舒适程度,可以帮助医师更好地做出排除诊断。     

全过程滤过试验在小梁切除术中应用

目的：探讨全过程滤过试验在小梁切除术中的应用及效果。方法：即小梁切除、巩膜瓣缝合、结膜瓣缝合后经前房穿刺口各进行一次前房注水,检验小梁切除的内口、巩膜隧道及外口的滤过情况,并予以调整。将施行该试验的１５９眼确定为Ⅰ组,。未行试验的１０７眼定为Ⅱ组。比较两组术后眼压、前房、视力的变化情况。结果：Ⅰ、Ⅱ组术后高眼压发生率分别为３．１４％、８．４１％,浅前房发生率分别为４．４％、２０．５６％。Ⅰ组视力均保持术前水平,提高者５５．３５％。Ⅱ组视力下降者占８．４１％,提高者占３６．４５％。结论：全过程滤过试验的应用厅明显提高小梁切除术的质量。     

单纯疱疹性角膜炎几种常用辅助诊断方法的比较

目的 比较常用的3种检测单纯疱疹性角膜炎(HSK)辅助诊断方法的敏感性和临床实用性。方法6只新西兰白兔双眼接种1×105PFU单纯疱疹病毒I型(HSV-I)McKrea株。病毒接种后第8天应用无环鸟苷眼膏每2 h 1次,共4次。另外2只兔中1只兔双眼在角膜上划痕但不接种病毒,另1只兔双眼角膜接种曲霉菌作为阴性对照。在病毒接种后的3、9、21天,利用病毒分离、多聚酶链反应(PCR)和蛋白吸附膜快速单纯疱疹病毒I型抗原检测方法进行检测。结果 接种后第2天全部角膜出现典型的HSK点状或树枝状浸润,第5天出现地图状溃疡,第21天仍有2只角膜有持续性感染。抗病毒治疗1天后无明显好转。2只兔于接种后14和16天死亡。病毒分离方法只有接种后3天的泪液培养阳性,第9、21天的标本检测均为阴性。有11/12、11/12和6/8只角膜在接种后的第3、9、21天用PCR方法检测到了HSV-I DNA。蛋白吸附膜抗原检测在接种后的第3、9、21天的阳性率分别为12/12、12/12和3/8。结论 蛋白吸附膜快速HSV—I检测是一种快速、简便、经济的方法。其阳性结果与临床表现相吻合。     

A Novel Computerized Visual Acuity Test for Children

Purpose

To investigate the efficacy of a computerized visual acuity test, the SNU visual acuity test for children.

Methods

Fifty-six children, ranging from 1 to 5 years of age, were included. In a dark room, children gazed at and followed a circular dot with 50% contrast moving at a fixed velocity of 10 pixels/sec on a computer monitor. Eye movement was captured using a charge coupled device camera and was expressed as coordinates on a graph. Movements of the eye and dot were superimposed on a graph and analyzed. Minimum visualized dot diameters were compared to the Teller visual acuity.

Results

Ten eyes (8.9%) of six children failed to perform the Teller visual acuity test, and two eyes (1.8%) of one patient failed to perform the SNU visual acuity test. The observed Teller visual acuity and SNU visual acuity were significantly correlated (p < 0.001). Visual angle degrees converted from the Teller visual acuity and SNU visual acuity were also significantly correlated (p < 0.001).

Conclusion

The SNU visual acuity using moving targets correlated well with Teller visual acuity and was more applicable than the Teller acuity test. Therefore, the SNU visual acuity test has potential clinical applications for children.     

聚散灵敏度与融像性聚散的相关性研究

目的 探讨聚散灵敏度与融像性聚散的相关性,为临床聚散系统异常的诊断提供更直接、更有意义的指标.方法 临床病例自身对照研究.对2012年10～12月在天津医科大学眼科中心志愿随机抽取50名20～28周岁在校近视大学生,应用电脑验光仪和综合验光仪行规范验光后,在屈光不正全矫的基础上分别进行聚散灵敏度检测和融像性聚散检测,并利用Flashed Von Graefe法测量视近隐斜,利用SPSS 13.0统计软件对相关数据进行分析,确定聚散灵敏度与融像性聚散的相关性.结果 (1)视近隐斜偏高组(＞6EXO)和视近隐斜正常组(0-6EXO)的聚散灵敏度差异显著有统计学意义(P＜0.05),而融合性聚散(BI)恢复点数值差异无统计学意义(P＞0.05).(2) BI模糊点和破裂点与聚散灵敏度无相关性,而其恢复点与聚散灵敏度有相关性.结论 可以通过被检者的恢复点数值推测患者的聚散灵敏度是否异常,可使聚散检测中恢复点数据得到充分的使用,从而减少了专项的聚散灵敏度检查,使双眼视异常的诊断更为简便.     

角膜映光检查法理论与临床

正确理解角膜映光检查法光学原理,对于正确理解与正确使用角膜映光检查法及以角膜映光检查法为基础的他觉斜角检查方法具有重要意义。我们从几何光学与心理物理学角度论述角膜映光检查法光学原理,总结与角膜映光检查法有关的斜角检查方法,介绍3种特大斜角临床检测方法。论证巩膜映光点来源,求得巩膜映光点每毫米位移约对应4.8°斜角,理论Hirschbergratio约为7.349°/mm;近来美欧等发达国家采用照相或摄像检查方法所得照相或摄像Hirschbergconversionratio约为12～13°/mm(21～22PD/mm)的原因,是因为其所依据的检测参照点—“瞳孔入口中心”在角膜表面的投影位置是随“角膜映光检测点”的移动而移动的,及将其三维空间距离二维平面化测量之故。     

Horizontal lang two-pencil test as a screening test for stereopsis and binocularity

Purpose:

To assess the horizontal Lang two-pencil test as a bedside test to detect gross stereopsis.

Materials and Methods:

Eighty-four strabismic subjects divided into two groups based on the amount of deviation, and 40 normal subjects were studied. Sensory status examination including binocularity and stereopsis were evaluated with Bagolini, Titmus test and the Netherlands organisation for applied scientific research (TNO), Randot, synoptophore and horizontal Lang two-pencil test.

Results:

The subjects in the group with smaller deviation showed better performance on all the four stereo tests and over 90% demonstrated presence of fusion. When compared to TNO and Randot for determining presence of stereopsis, the horizontal Lang two-pencil test demonstrated sensitivity of 100% and 83.9%, specificity of 77.8% and 73.7%, and negative predictive value of 100% and 100% respectively. It also showed 100% specificity as a test for binocularity when compared with the Bagolini striated glass test.

Conclusion:

Horizontal Lang two-pencil test, an easily performed test with a high sensitivity and negative predictive value can be used as a screening test to detect gross stereopsis and binocularity.     

用卡洞法和Worth四点法检测优势眼与屈光参差的相关性

目的：研究优势眼眼别与其两眼中近视性屈光程度较大眼的眼别关系,并分别研究Worth四点法测量优势眼与卡洞法测量优势眼的相关性。方法：选取125例受试者,按照双眼屈光参差的程度分为生理性屈光参差组与病理性屈光参差组。在医学验光基础上分别运用Worth四点法及卡洞法判别双眼中优势眼的眼别。结果：（1）生理性屈光参差组（卡洞法）优势眼眼别与双眼中近视性屈光程度较大眼眼别显著相关（Z=-4.057,P〈0.01）;Worth四点法优势眼眼别与双眼中近视性屈光程度较大眼眼别显著相关（Z=-3.558,P〈0.01）;而病理性屈光参差组,两种方法所测均无显著相关（P〉0.05）。（2）Worth四点法和卡洞法测得的优势眼眼别差异无显著性（n=125,P〉0.05）。结论：优势眼由基因决定或幼年时期形成并持续维持,而近视性屈光参差可能影响优势眼的选择。优势眼的测量中Worth四点法具有一定的参考意义。     

Laboratory support in the diagnosis of uveitis

Intraocular inflammations are still a diagnostic challenge for ophthalmologists. It is often difficult to make a precise etiological diagnosis in certain situations. Recently, there have been several advances in the investigations of uveitis, which has helped the ophthalmologists a lot in the management of such clinical conditions. A tailored approach to laboratory diagnosis of uveitic cases should be directed by the history, patient''s symptoms and signs, and clinical examination. This review summarizes various modalities of laboratory investigations and their role in the diagnosis of uveitis.     

用卡洞法和Worth 四点法检测优势眼与屈光参差的相关性

目的：研究优势眼眼别与其两眼中近视性屈光程度较大眼的眼别关系,并分别研究Worth四点法测量优势眼与卡洞法测量优势眼的相关性。

方法：选取125例受试者,按照双眼屈光参差的程度分为生理性屈光参差组与病理性屈光参差组。在医学验光基础上分别运用Worth四点法及卡洞法判别双眼中优势眼的眼别。

结果：(1)生理性屈光参差组(卡洞法)优势眼眼别与双眼中近视性屈光程度较大眼眼别显著相关(Z=-4.057,P<0.01); Worth四点法优势眼眼别与双眼中近视性屈光程度较大眼眼别显著相关(Z=-3.558, P<0.01); 而病理性屈光参差组,两种方法所测均无显著相关(P>0.05)。(2)Worth四点法和卡洞法测得的优势眼眼别差异无显著性(n=125, P>0.05)。

结论： 优势眼由基因决定或幼年时期形成并持续维持,而近视性屈光参差可能影响优势眼的选择。优势眼的测量中Worth四点法具有一定的参考意义。     

Identification of red–green colour deficiency: sensitivity of the Ishihara and American Optical Company (Hard,Rand and Rittler) pseudo‐isochromatic plates to identify slight anomalous trichromatism

Screening sensitivity, based on a specific number of errors, of the Ishihara plates and of the American Optical Company (Hardy, Rand and Rittler) plates (HRR plates) was determined by reviewing data obtained for 486 male anomalous trichromats identified and classified with the Nagel anomaloscope. Data were obtained for the 16 screening plates, with Transformation and Vanishing numeral designs, of the 38 plate Ishihara test, and for the four red–green screening plates (with six Vanishing designs) of the HRR test. Sensitivity of the Ishihara plates was found to be 97.7% on 4 errors and 98.4% on 3 errors. Only anomalous trichromats with slight deficiency, according to the anomaloscope matching range, made 8 errors or fewer. One screening error, a single missed figure, is normally allowed as a pass on the HRR test and 3 errors is often recommended as the fail criterion to eliminate false positive results. Twenty‐three subjects made no error on the HRR screening plates and 12 subjects made a single error (35 anomalous trichromats). Screening sensitivity was therefore 92.8% using 2 errors as the fail criterion. Screening sensitivity was reduced to 87% when 3 errors was the fail criterion, and some deuteranomalous trichromats with moderate deficiency, according to the anomaloscope matching range, were not identified. Individuals who make a maximum of 2 errors on the HRR test, or on the Richmond HRR 4th Edition, should be re‐examined with the Ishihara plates to determine their colour vision status. The present review confirms that the Ishihara test is a very sensitive screening test and identifies people with slight anomalous trichromatism. The HRR test is unsatisfactory for screening and should not be chosen solely for this purpose.     

中远距离立体视觉检查仪的研制和初步试用报告

目的：设计一种行之有效用于中远距离的立体视检查方法。方法：以新立体视觉检查（ＮＳＴ） 为样本研制计算机中远距离立体视觉检查仪（ＣＳＴ）,分别在１ 、１．５、２、３、４ 、５ 米距离检查正常人７２ 例的交叉及非交叉立体视差。结果：各距离交叉视差的集中趋势分别为１．５、１ ．６、１．８、２．３ 、２．９、３ ．７“象素点”（ 下同） ,８０％ 范围值为１１．９、１１．９、１２．３、１３．２、１３．０、１４．７。非交叉视差的集中趋势分别为：１．６ 、１．７、１ ．９、２．６、３．５ 、４．７。８０％ 范围值为１１．９、１２．０、１２．５、１３．４、１５．４、１６．３。结论：ＣＳＴ可以检查中远距离立体视功能。     

Adverse effects of topical antiglaucoma drugs on the ocular surface

Purpose : This study was designed to determine the effect of long‐term antiglaucoma topical medication on the ocular surface; measuring basal Schirmer’s and tear break‐up time tests using conjunctival impression cytology. Methods : The ocular surfaces of 30 control subjects (group 1), 24 primary open‐angle glaucoma patients treated with 0.5% betaxolol hydrochloride (group 2), 27 primary open‐angle glaucoma patients treated with 0.5% timolol maleate (group 3) and 26 primary open‐angle glaucoma patients treated with 0.5% betaxolol and 1% dipivefrin hydrochloride (group 4) were evaluated. Basal Schirmer’s and tear break‐up time tests were measured and ocular surface changes were determined by impression cytology. Impression cytology specimens of each group were graded and scored in the range 0–3 according to Nelson’s method. Results : Patients in groups 2, 3 and 4 showed statistically significant fewer normal basal Schirmer’s tests (wettability) and tear break‐up time tests (P < 0.01). Also, the conjunctival impression cytology scores were significantly higher in groups 2, 3 and 4 than in group 1 (P < 0.01). Conclusions : The conclusion was that it is possible that conjunctival surface and tear film function change after the long‐term use of antiglaucoma medication.