调节聚散系统交互作用的相关性

目的：探讨正视眼和早发性近视眼刺激性调节性集合/调节比值（AC/A值）、刺激性集合性调节/集合比值（CA/C值）、反应性AC/A以及反应性CA/C之间的差异及相互关系。方法：病例对照研究。选取 2016年10月至2017年1月在温州医科大学附属眼视光医院视光门诊就诊的9～14岁早发性近视患者 27例为早发性近视组,另选取20例正视者作为正视组,在双眼视状态使用精工自动红外验光仪和改良式Thorington法分别测量25 cm处5个调节刺激水平和6个聚散刺激水平下的调节反应和隐斜量,计算2组的刺激性AC/A、刺激性CA/C、反应性AC/A以及反应性CA/C值。数据采用t检验和Pearson 相关性分析进行统计分析。结果：正视组、早发性近视组的反应性AC/A分别为（4.07±1.47）Δ /D、（5.13±1.95）Δ /D,差异有统计学意义（t=2.12,P=0.04）。正视组、早发性近视组的刺激性AC/A和反应性AC/A值之间均呈正相关（正视组：r=0.903,P<0.001;早发性近视组：r=0.880,P<0.001）。正视组的反应性AC/A和反应性CA/C呈负相关（r=-0.450,P=0.04）,早发性近视组这2个参数间无相关性（r=-0.367,P=0.06）。结论：早发性近视眼的反应性AC/A高于正视眼。AC/A和CA/C之间的负相关性只见于正视眼的反应性比率之间,提示单AC/A值不能全面评估调节系统和聚散系统之间的交互作用。     

儿童青少年配戴多焦软性角膜接触镜对调节聚散功能的影响

目的：:比较儿童青少年近视患者配戴单光框架眼镜和多焦软性角膜接触镜（简称多焦软镜）对调节和聚散功能的影响。方法：:系列病例研究。选取2017年7─10月在温州医科大学附属眼视光医院视光门诊就诊的46例近视患者参加本研究,分别在配戴单光框架眼镜和多焦软镜时测量其调节参数和聚散参数,包括调节幅度、调节反应、调节微波动、相对...     

聚散参数对集合不足患者视疲劳症状的影响

探讨视功能参数对集合不足患者视疲劳症状的影响,以期找到能反映集合不足患者视疲劳程度的相关指标。方法：回顾性研究。从2013 年7 月至2017 年7 月温州医科大学附属眼视光医院就诊的集合不足患者中,随机抽取58 例,年龄为（22.7±9.3）岁,排除斜视、眼部疾病、外伤史、屈光参差以及调节功能障碍。根据视疲劳症状问卷（CISS）总分按疲劳程度由重到轻分为重度组、中度组、轻度或无症状组3 组,其中重度组20 例,中度组19 例,轻度或无症状组19 例,分析其远/近隐斜量（PD/PN）、近距BO侧模糊点（PB）、恢复点（PR）与视疲劳程度的关系。使用Sheard法则PSheard=2/3PN-1/3PB以及隐斜与恢复点差值PR-N=PR-PN（PD/PN为外隐斜,计算用正数）进行计算。PSheard大于0 说明不满足Sheard法则,PR-N小于0 说明恢复点小于隐斜。使用方差分析进行数据比较。结果：视疲劳重度组（-9.5△±4.1△）,中度组（-5.0△±3.1△）,轻度或无症状组（-13.6△±5.4△）的PN比较差异有统计学意义（F=19.458,P<0.001）。3 组间PB、PR差异均无统计学意义。3 组PSheard值（重度组为1.9△±3.0△,中度组为-2.1△±3.0△,轻度或无症状组为3.4△±3.1△）差异有统计学意（F=16.670,P<0.001）,中度组与轻度或无症状组、重度组之间差异均有统计学意义（均P<0.05）。中度组PSheard小于0,说明满足Sheard法则。轻度或无症状组和重度组PSheard大于0,不满足Sheard法则。重度组PR-N值为-5.6△±3.2△（95%CI：-7.4△,-4.3△）,中度组为0.6△±4.6△（95%CI：-1.6△,2.9△）,轻度或无症状组为-11.6△±6.5△（95%CI：-14.8△,-8.5△）,3 组间差异有统计学意义（F=29.127,P<0.001）,组间两两比较差异均有统计学意义（均P<0.05）。结论：隐斜和恢复点的关系对集合不足患者的视疲劳症状有影响,当恢复点小于或略大于隐斜量,即PR-N<2.86△（中度组95%CI）,容易出现视疲劳。当PR-N<-8.49△（轻度或无症状组95%CI）,可能发生近距的间歇性抑制,症状反而减轻。     

Vergence Profile and Prevalance of Non-Strabismic Vergence Anomalies Among School Children in Abia State,Nigeria

Purpose: To determine the prevalence of non-strabismic vergence anomalies and their relationship with age, gender, and school level in children aged 10–16 years

Method: A cross-sectional study was conducted among 537 children (255 male, 282 females; mean age 13.0 ± 2.0, years) selected from nine schools using stratified, cluster, and random sampling. The participants completed a Convergence Insufficiency Symptom Survey (CISS) and eye examinations, including the measurement of visual acuity, non-cycloplegic refraction, cover test, near point of convergence, fusional vergences, accommodative functions, and ocular health evaluation. All binocular tests were performed following the subjective refraction with the corrective lenses in place, if prescribed.

Results: The prevalence of low suspect, high suspect, and definite convergence insufficiency was 9.6%, 5.8%, and 4.1%, respectively. Other prevalence estimates included convergence excess (2.9%), fusional vergence dysfunction (2.6%), basic exophoria (1.7%), basic esophoria (2.8%), divergence insufficiency (0.8%), and divergence excess (0.6%). The prevalence of high suspect (p < 0.01) and definite (p < 0.01) convergence insufficiency was significantly higher in older than younger children, and as expected, in secondary more so than primary school children (p = 0.01). There was no statically significant association between gender and various vergence anomalies.

Conclusion: The study showed that vergence anomalies are common vision conditions among Abia State school children. Given the importance of visual skills in learning and academic achievements, there is a need to develop screening and management strategies that will target those visual conditions to prevent educational and social progress being affected.     

阅读障碍儿童双眼调节及集合功能的研究

目的：:研究阅读障碍儿童双眼调节、集合功能的特点,为阅读障碍的预防和临床治疗提供依据。方法：:病例对照研究。采用整群随机抽样法抽取天津市东丽区2所小学2 301名3~5年级学生进行问卷调查。根据阅读障碍诊断标准及纳入标准筛选出102例阅读障碍儿童作为阅读障碍组,并在非阅读障碍儿童中选出年龄、性别、班级相匹配的102例正...     

单眼水平直肌后徙联合缩短术与内直肌斜向缩短术治疗集合不足型外斜视的疗效对比

目的：比较单眼水平直肌后徙联合缩短手术与内直肌斜向缩短术对集合不足型外斜视的治疗效果。方法：前瞻性研究。对2016年9月到2017年2月在郑州大学第一附属医院就诊的36例集合不足型外斜视患者行手术治疗,随访时间≥6个月。根据手术方式不同分为3组：单眼水平直肌后徙联合缩短手术组（A组,16例）、单眼内直肌斜向缩短术组（B组,9例）和双眼内直肌斜向缩短术组（C组,11例）。A组中外直肌按照看远斜视度数后徙,内直肌按照看近斜视度数缩短。B组和C组中内直肌肌止端上端按照看远斜视度数缩短,肌止端下端按照看近斜视度数缩短。术后正位的评价标准为看远斜视度在±10 △ 以内。采用Fisher精确概率检验、重复测量方差分析进行数据分析。结果：随访期末,A组正位占比为14/16例,显著高于B组（2/9例）和C组（4/11例）,差异具有统计学意义（均P < 0.05）。A组看近和看远斜视度均小于其他2组,差异具有统计学意义（均P < 0.05）。3组间手术后看近和看远斜视度的差异无统计学意义。结论：单眼水平直肌后徙联合缩短手术中外直肌按照看远斜视度数后徙,内直肌按照看近斜视度数缩短设计术式,可以有效治疗集合不足型外斜视,优于内直肌斜向缩短手术。     

Influence of Accommodative Lag upon the Far-Gradient Measurement of Accommodative Convergence to Accommodation Ratio in Strabismic Patients

Purpose

To determine the influence of the lag of accommodation (LOA) on the accommodative convergence to accommodation (AC/A) ratio measured by the far-gradient method in strabismic patients.

Methods

The AC/A ratio was measured with a distance target viewed with and without ?3.00 diopter (D) addition lenses in 63 patients with different types of strabismus (age range, 7–34 years; range of strabismic angle, ?60 to +40 prism diopters; refractive error range, ?7.33 to +6.63?D). The LOA for the same lens was measured with an open-view-type autorefractometer. The stimulus AC/A ratio and the AC/A ratio adjusted by the individually measured LOA (adjusted AC/A ratio) were compared.

Results

The mean ± SD of the LOA to the ?3.00?D lenses was 1.06 ± 0.43?D. The mean adjusted AC/A ratio was 41% greater than the stimulus AC/A ratio. The LOA differed widely among patients (0.13 to 2.14?D), and a large LOA tended to appear in myopic or young patients.

Conclusions

The AC/A ratio obtained using the conventional far-gradient method is significantly biased by the LOA, and thus does not always represent the actual relationship between accommodation and vergence control systems.?Jpn J Ophthalmol 2006;50:438–442 © Japanese Ophthalmological Society 2006     

Diagnostic values of questionnaires of Convergence Insufficiency Symptom Survey and College of Optometrists Vision Development Quality of Life in the screening of convergence insufficiency

AIM: To compare and analyse the diagnostic efficacy of the College of Optometrists Vision Development Quality of Life Questionnaire (COVD-QOL) and the Convergence Insufficiency Symptom Survey (CISS) in detecting convergence insufficiency and to compare their diagnostic value in clinical applications. METHODS: Using the diagnostic test method, 62 adult patients with convergence insufficiency (age: 24.74±3.75y) and 62 normal participants (age: 23.61±3.13y) who visited the Optometry Clinic of West China Hospital of Sichuan University from April 2021 to January 2023 were included. All subjects completed the CISS and COVD-QOL. Statistical analysis of the sensitivity and specificity of the CISS and COVD-QOL and comparison and joint experimental analysis of their diagnostic efficacy were performed. RESULTS: The sensitivity of the CISS and COVD-QOL for convergence insufficiency was 64.5% and 71.0%, respectively, while the specificity was 96.8% and 67.7%, respectively. Compared to the CISS alone, the combination of the CISS and COVD-QOL demonstrated lower sensitivity and specificity. The areas under the receiver operating characteristic curve of CISS, COVD-QOL and CISS combined with COVD-QOL were 0.806, 0.694 and 0.782, respectively. CONCLUSION: Considering the low sensitivity of the CISS and the low specificity of the COVD-QOL, it is recommended to supplement these questionnaires with other screening tests for the detection of convergence insufficiency.     

双眼外直肌倾斜后徙术治疗儿童集合不足型外斜视

目的：:评价双眼外直肌倾斜后徙术（S-BLRc）治疗儿童集合不足型间歇性外斜视（CI-IXT）的有效性和安全性。方法：:回顾性病例对照研究。收集2019年8月至2020年7月于天津市眼科医院收治的集合不足型外斜视儿童患者58例,年龄4~10岁。根据S-BLRc外直肌上、下缘止点后徙量的差异分为3组：A组（1 mm,22...     

Portsea Modified Clinical Technique: Evaluation of an Expanded Optometric Vision Screening Protocol for Children

ABSTRACT A new screening protocol, the Portsea Modified Clinical Technique, is evaluated in terms of the results acquired from screening 5,597 Australian children. The nature of the vision defects detected is examined. The significance of these defects to children and their amenability to optometric treatment is discussed. The expanded screening battery provides a broad clinical profile including information about the accommodative and vergence system. A detailed referral schedule has been devised which should facilitate the application of this protocol.