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。     

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。     

三种不同方法检查主导眼的对比观察

目的:了解三种不同方法手指法、卡洞法、Worth四点仪法检查主导眼的优缺点,为临床应用提供参考。方法:选择来我院近视眼中心拟行LASIK手术的近视眼患者118例(236眼),年龄18～42(平均25.3±6.2)岁,LASIK手术前用三种不同方法手指法、卡洞法、Worth四点仪法检查主导眼并记录每位患者主导眼的眼别。结果:经统计学一致性检验表明,手指法与卡洞法检查主导眼时两种方法一致性好,符合率高;Worth四点仪法与手指法和卡洞法两两比较一致性差,符合率也较低。结论:本研究结果提示,手指法、卡洞法、Worth四点仪法检查主导眼各有优缺点,因手指法与卡洞法两种方法一致性好、符合率高,检查简便易行可以联合起来作为临床上确定主导眼的检查方法;Worth四点仪法因本身作为融像的检查方法且受影响的因素较多,不适合作为主导眼的检查方法。     

压眼闪光眼压计在准分子激光角膜屈光手术中的应用

目的评价压眼闪光眼压计(pressure phosphene onometer,PPT)在准分子激光原位角膜磨镶术(laser in situ keratomileusis,LASIK)手术前后测量结果的准确性,并与非接触式眼压计(noncontact tonometer,NCT)相比较,探讨其临床应用价值。方法对行LASIK手术的近视眼患者25例50眼分别于手术前及手术后第1个月、第3个月用两种眼压计分别进行眼压测量,并对眼压结果进行对比。结果手术前NCT和PPT两种眼压计眼压测量眼压分别为(17.6±4.3)mmHg和(18.4±3.2)mmHg,两者差异经统计学处理无显著性(P>0.05),手术后第1个月、第3个月NCT测量结果分别为(10.4±2.8)mmHg和(11.2±3.6)mmHg,与手术前相比差异具有显著性(P<0.01);PPT眼压计测量结果分别为(18.6±3.5)mmHg和(17.8±3.7)mmHg,与手术前测量结果相比差异无显著性(P>0.05)。NCT手术前后眼压差与角膜厚度及角膜屈光度改变成正相关(r=0.480,P<0.05,r=0.380,P<0.05),而PPT手术前后眼压差与角膜厚度及屈光度无相关性(r=0.021,P=0.52,r=0.018,P=0.45)。结论在LASIK手术前,PPT与NCT测量结果有很高的一致性,其测量结果不受角膜厚度和曲率的影响,在屈光性角膜手术中有较高的使用价值。     

正视眼和近视眼在明暗环境中不同对比度的视力比较

目的正视眼和近视眼人群在明暗环境中不同对比度时的视力的对比研究。方法134例受试者,按屈光不正度数分成正视组、低度近视组、中度近视组和高度近视组。先主觉验光,再用卡洞法找出优势眼,屈光矫正后应用多功能视力测量仪检测优势眼在明和暗环境中不同对比度视力。结果高度近视组在明和暗环境中不同对比度时视力均较其它3组差,与正视组比较有显著性差异(P<0.05)。随着近视屈光度的增加,在明和暗环境中不同对比度时视力呈现下降趋势。在相同对比度下,明环境中的视力好于暗环境中的视力。在相同环境下,随着对比度的下降,视力随之下降。结论框架眼镜矫正时高度近视眼视觉质量明显差于正视眼及低中度近视眼。其视力受环境照明及对比度差异的影响。     

暗环境下低中度近视优势眼与非优势眼及双眼对比度视力的对照研究

目的比较暗环境下低中度近视优势眼与非优势眼、双眼对比度视力的差异。方法随机选择拟行准分子激光手术的低中度近视患者47例(94只眼),综合验光仪主觉验光,卡洞法确定优势眼,应用多功能视力检查仪分别测量优势眼、非优势眼和双眼在暗环境暗背景条件下,对比度分别为100%、25%、10%和5%的最佳对比度视力。对所有受试者以及区分低中度近视的优势眼、非优势眼及双眼各对比度视力的差异进行统计学分析。结果所有受试者以及区分低中度近视的双眼对比度视力在对比度为25%、10%、5%均优于优势眼和非优势眼(P<0.05),在对比度为100%时,双眼对比度视力与优势眼差异无统计学意义(P>0.05),但优于非优势眼(P<0.05)。随着对比度的下降,单、双眼的对比度视力亦随之下降。结论在暗环境屈光矫正条件下,高对比度时优势眼的对比度视力优于非优势眼,但低对比度时双眼优于优势眼和非优势眼。     

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。     

视网膜调制传递函数测量与屈光不正矫正的关系

目的探讨屈光不正矫正与视网膜调制传递函数测量结果的关系。设计前瞻性非随机自身对照研究。研究对象无其他眼病的单纯性屈光不正者25例50眼。方法受试者首先测量裸眼视力,再分别测量在屈光未矫正、用框架眼镜矫正和用隐形眼镜矫正三种状态下不同干涉条纹视力(0.06、0.1、0.2、0.4、0.6、0.8)的视网膜调制传递函数值(用RM-800视网膜调制传递函数仪)。主要指标视网膜调制传递函数值。结果对于未矫正的屈光不正患者,视力表视力与干涉条纹视力有显著性差异(Z=9.009,P=0.000);对于矫正后的单纯性屈光不正患者,视力表视力与干涉条纹视力无显著性差异(Z=1.009,P=0.317);在屈光未矫正、用框架眼镜矫正和用隐形眼镜矫正三种状态下测得的视网膜调制传递函数值的差异有统计学意义(P﹤0.05),且戴隐形眼镜矫正所测得值略高于戴框架眼镜所测得值。结论干涉条纹视力比视力表视力更能准确反映视网膜-大脑的视觉功能;屈光未矫正进行视网膜调制传递函数的测量将可能出现假阳性,建议测量视网膜调制传递函数时要矫正屈光不正。     

正视和近视儿童调节幅度的三种测定方法比较

目的分析正视和近视儿童用不同测量方法测量的眼调节幅度的差异(amplitude of accommodation,AMP)并初步探讨不同方法测量对眼AMP测量的影响。方法随机选取9岁~13岁的40例受试者,分为正视组(17例)和近视组(23例)。应用移近法、负镜片法和红外电脑验光仪法分别测定受试者的单眼AMP。结果①正视和近视儿童三种方法测量AMP值分别为:(14.13±2.16)D,(9.15±1.99)D,(7.36±1.23)D和(14.39±2.94)D,(9.79±1.65)D,(8.32±0.66)D。②在正视组移近法、负镜片法和红外视力计法测量的AMP值三者之间差异有显著性(P值分别为0.000,0.000,0.003),近视组三种测量方法之间的AMP差异也具有显著性(P值分别为0.002,0.002,0.036)。③正视组和近视组之间仅红外视力计法测量时两者AMP差异有显著性(P=0.006)。结论不同测量方法会影响AMP,使用移近法测量AMP倾向于高估AMP值,使用负镜片法及红外电脑验光测量的方法则倾向于低估AMP值。近视儿童的AMP与正视儿童的有一定的差异性。     

青少年单眼轻度近视程度与主导眼间的相关性研究

目的：研究青少年单眼轻度近视主导眼与近视程度间的关系。
　　方法：回顾分析我院2012-12/2013-12于我科门诊检查的158例青少年单眼轻度近视患者资料,以柱镜散光值作等效球镜转换,依据近视程度将其分为三组, A 组30例(-0.25~-0.75D),B组92例(-1.0~-2.0D),C组36例(-2.25~-3.0D)。选择卡洞法对受检者注视近33cm处、远5m处主导眼进行测量,对屈光不正予以配镜矫正后,再对远、近处主导眼别进行重新测量。
　　结果：单眼轻度近视主导眼、非主导眼的调节功能相较,差异无统计学意义(P>0.05)。三组主导眼、非主导眼平均屈光度与眼别的相关性相较,差异无统计学意义(P>0.05)。三组5 m处主导眼眼别相较,差异有统计学意义(P<0.05)。三组33cm处主导眼眼别相较,差异有统计学意义(P<0.05)。不同视物距离下主导眼眼别相较,差异有统计学意义(P<0.05)。单眼轻度近视裸眼与配镜后主导眼眼别相较,差异有统计学意义(P<0.05)。
　　结论：近视性屈光参差的形成,与视物的清晰程度有关,予以配镜矫治虽然可改善视物的清晰程度,同时也会影响主导眼的选择,由于近视性屈光参差最早出现于主导眼,因此配镜矫治阶段需将其考虑在内,避免青少年近视程度加重。     

间歇性外斜视青少年不同类型优势眼与注视眼的关系

探讨间歇性外斜视（IXT）青少年不同类型优势眼与注视眼（非偏斜眼）的关系。方法：系列病例研究。选取2018年7-12月于湖南爱尔眼视光研究所就诊的IXT青少年患者43例，屈光全矫后分别使用卡洞法测量注视性优势眼，使用集合近点法测量运动性优势眼，使用基于Gabor信号识别的连续闪烁抑制法测量知觉性优势眼，并采用眼位控制力评分观察受检者的远距离客观控制力来判定注视眼。采用Kappa一致性检验比较优势眼与注视眼的一致性，采用单因素Logistic回归分析双眼知觉性优势差异和优势眼与注视眼一致性程度的关系。结果：43例IXT患者中，注视性优势眼、运动性优势眼及知觉性优势眼均与注视眼呈现出中度一致性（Kappa值分别为0.46、0.43、0.68，均 P<0.001）。30例有明确双眼知觉优势差异的患者，其知觉性优势眼与注视眼高度一致（Kappa值= 0.86，P<0.001），而注视性优势眼、运动性优势眼与注视眼的一致性仍为中度一致性（Kappa值= 0.57，P=0.002；Kappa值=0.44，P=0.006）。单因素Logistic回归分析显示IXT患者的双眼知觉性优势差异是知觉性优势眼与注视眼一致性程度的影响因素（B=0.53，OR=1.70，P<0.001），即双眼优势差异越大，知觉性优势眼与注视眼一致性的概率越高。结论：青少年IXT患者的注视性优势眼、运动性优势眼、知觉性优势眼均与注视眼有一致性，但知觉性优势眼与注视眼的一致性更为紧密，尤其当患者有明确知觉优势差异时，知觉性优势眼检查比注视性优势眼和运动性优势眼检查来确定注视眼更为可靠。     

Association of ocular dominance and anisometropic myopia

PURPOSE: To determine the association between ocular dominance and degree of myopia in patients with anisometropia. METHODS: Fifty-five subjects with anisometropic myopia were recruited. None of them had amblyopia. Refractive error and axial length were measured in each subject. Ocular dominance was determined using the hole-in-the-card test and convergence near-point test. RESULTS: There was a threshold level of anisometropia (1.75 D) beyond which the dominant eye was always more myopic than the nondominant eye. Of the 33 subjects with anisometropia of < or =1.75 D, the dominant eye was more myopic in 17 (51.5%) subjects. Dominant eyes, determined by the hole-in-the-card test, had a significantly greater myopic spherical equivalent (-5.27 +/- 2.45 D) than nondominant eyes (-3.94 +/- 3.10 D; P < 0.001). Dominant eyes also had a longer axial length than nondominant eyes (25.15 +/- 0.96 mm vs. 24.69 +/- 1.17 mm, respectively; P < 0.001). The difference was more evident in those subjects with higher anisometropia (>1.75 D), but was not significant in those with lower anisometropia (< or =1.75 D). Similar results were obtained using the convergence near-point test. CONCLUSIONS: The present study shows that the dominant eye has a greater degree of myopia than the nondominant eye in subjects with anisometropic myopia. Taking ocular dominance into account in the design of randomized clinical trails to assess the efficacy of myopia interventions may provide useful information.     

Association between ocular dominance and refraction

PURPOSE: To investigate the association between ocular dominance and refraction. METHODS: A retrospective study of the cycloplegic refraction of 2453 consecutive patients with a mean age of 46 +/- 12 years (range: 18 to 79 years) was performed. One thousand one hundred fifty-seven (47%) patients were men and 1296 (53%) were women. Patients who had previous eye surgery, ocular disease, or > 2 lines of best spectacle-corrected visual acuity (BSCVA) difference between eyes were excluded. Motor ocular dominance was determined using the hole-in-the-card test. RESULTS: The right and left eyes were dominant in 67% (1650) and 33% (803) of patients, respectively. Males had a higher right eye dominance (70%) than females (65%) (P = .0168) with a mean cycloplegic spherical equivalent refracton (SE) of -2.12 diopters (D) and -2.38 D, respectively. This higher rate of right eye dominance in males was seen at all levels of SE refractive error. Mean BSCVA was 20/19 in both right and left eyes (P>.05) with a mean SE of -2.25 +/- 3.63 D and -2.26 +/- 3.66 D in the right and left eyes, respectively. Neither mean SE difference nor BSCVA difference between eyes was found to correlate with motor eye dominance. CONCLUSIONS: Gender appears to be a factor when testing ocular dominance but not SE refractive error. The hole-in-the-card dominance test is a method that is easy to perform for both patients and clinicians.     

Comparison of anisometropes with and without amblyopia

Background:

To compare binocular functions in amblyopic and non-amblyopic anisometropes and to investigate the possible associated factors for amblyopia development such as type of refractive error and initial age of refractive error correction.

Materials and Methods:

Prospectively anisometropic subjects with (n=42) and without amblyopia (n=33) were included in the study. Full ophthalmological examination including binocularity and motility was performed.

Results:

There was no statistically significant difference between the ages at the time of initial refractive error correction ( P =0.946). All of the anisometropes (100%) had fusion with Worth 4-dot test and Bagolini glasses. However 81% of amblyopic subjects had fusion with Worth 4 dot test and 88.1% had normal response with Bagolini glasses. Median stereopsis was 60 sec of arc in anisometropic subjects and 400 sec of arc in amblyopes.

Conclusion:

Our data support that, binocular functions are well developed in anisometropes without amblyopia and initial age at correction of refractive error has no primary effect on development of amblyopia.     

准分子激光角膜原位磨镶术后主导眼改变及其影响的研究

目的 观察准分子激光原位角膜磨镶术（LASIK）后主导眼分布特点及其影响.方法 前瞻性病例对照研究.选取行LASIK的近视患者190例（380眼）,按屈光参差度数及主导眼眼别分为3组：A组,两眼等效球镜度差异＜1.75 D,共154例;B组,两眼等效球镜差异≥1.75 D,且主导眼为近视度数较高眼,共19例;C组,两眼等效球镜差异≥1.75 D,且主导眼为近视度数较低眼,共17例.术前和术后1个月分别检查裸眼视力、屈光度及确定主导眼（卡洞法）,术后1个月接受远、近视觉满意度问卷调查.组间率的比较采用卡方检验,计量资料采用独立样本t检验.结果 LASIK术前右眼为主导眼125例（65.8%）,左眼65例（34.2%）;术后右眼为主导眼92例（48.4%）,左眼98例（51.6%）.59例（31.1%）患者在术后发生主导眼转变.B组患者中主导眼转变率（47%）高于A组（29%）和C组（29%）（x2=5.38,P＜0.05）.屈光参差患者术前主导眼与非主导眼等效球镜度差异无统计学意义.术后主导眼的等效球镜度为（-0.29±0.89）D,较非主导眼[（-0.42±0.91）D]低,差异存在统计学意义（t=2.448,P=0.015）.主导眼改变和未改变患者的远、近视觉满意度分别为2.33、2.40和3.62、3.95,差异均无统计学意义.结论 LASIK术后存在主导眼的改变,即关键期后,眼优势具有可塑性,尤其在术前有屈光参差且主导眼为近视度数较高眼的患者中发生率更高.术后非主导眼较主导眼更偏近视.但主导眼改变与否对术后视觉满意度无显著影响.     

Factors affecting sensory functions after successful postoperative ocular alignment of acquired esotropia.

PURPOSE: We sought to evaluate the sensory status of patients with acquired esotropia who were able to re-establish stable alignment by optical correction and surgery and to determine the possible predictors of the different sensory outcomes. METHODS: Thirty-four successfully aligned esotropic patients were included in the study. Preoperative evaluation comprised history taking, measurement of visual acuity, evaluation of the sensory status (using the Worth 4-Dot test, and the Titmus Stereo test), measurement of ocular deviation, cycloplegic refraction, and fundus examination. All patients underwent successful surgical alignment to within 10 prism diopters (Delta) of orthotropia. At each postoperative follow-up visit, the sensory functions and ocular alignment were assessed. Statistical analysis of the results was performed. RESULTS: Among the 34 patients included in the study, 62% achieved fusion, 17% had diplopia, 15% had suppression, and 6% had a variable response to the Worth 4-Dot test at 6 months after surgery. Stereopsis was achieved in 32% as determined by the Titmus Stereo test. Statistical analysis revealed a significant relationship between the sensory status and the duration of strabismus (P=.00002), the age at surgery (P=.00289), and postoperative ocular alignment (P=.02211). CONCLUSION: Early surgical and optical ocular alignment of strabismic patients is advisable to achieve fusion and stereopsis.     

Ocular dominance, laterality, and refraction in Singaporean children

PURPOSE: To explore the effect of dominance and laterality on refractive error and axial length. METHODS: Ocular dominance was assessed with the hole-in-the-card test in 543 children during their 2006 follow-up visits for the Singapore Cohort study Of the Risk factors for Myopia (SCORM). Data were compared to cycloplegic refractions and axial lengths measured by ultrasound. RESULTS: The spherical equivalent refraction was essentially the same between the right and left eyes, although there was a small but statistically significant longer axial length in the right eyes. Right and left ocular dominance was noted in 58% and 30% of the subjects, respectively, with 12% having no eye preference. There was no significant difference in spherical equivalent refraction (2.56 +/- 2.46 D [mean +/- SD] vs. -2.45 +/- 2.52 D, P = 0.22) or axial length (24.36 +/- 1.19 mm vs. 24.32 +/- 1.18 mm, P = 0.05) between dominant and nondominant eyes. In subjects with anisometropia >or=0.5 D, dominant eyes were more myopic in 52%. Dominant eyes, however, had less astigmatic power (-0.88 +/- 0.80 D versus -1.00 +/- 0.92 D; P < 0.001). CONCLUSIONS: Ocular laterality and dominance have no significant effect on spherical equivalent. All axial length and astigmatic differences were small and clinically insignificant. The study findings suggest that in Singaporean children, bias is not present in those investigations that restrict analyses to right or left eyes. Although there is no apparent association between refraction and ocular dominance in young Singaporean children, more research is needed to resolve the disparate results in existing reports.     

Association between Ocular Dominance and Spherical/Astigmatic Anisometropia, Age, and Sex: Analysis of 1274 Hyperopic Individuals

Purpose. To determine the association between ocular dominance and spherical/astigmatic anisometropia, age, and sex in hyperopic subjects. Methods. The medical records of 1274 hyperopic refractive surgery candidates were filtered. Ocular dominance was assessed with the hole-in-the-card test. Refractive error (manifest and cycloplegic) was measured in each subject and correlated to ocular dominance. Only subjects with corrected distance visual acuity of >20/22 in each eye were enrolled, to exclude amblyopia. Associations between ocular dominance and refractive state were analyzed by means of t-test, χ(2) test, Spearman correlation, and multivariate logistic regression analysis. Results. Right and left eye ocular dominance was noted in 57.4 and 40.5% of the individuals. Nondominant eyes were more hyperopic (2.6 ± 1.27 diopters [D] vs. 2.35 ± 1.16 D; P < 0.001) and more astigmatic (-1.3 ± 1.3 D vs. -1.2 ± 1.2 D; P = 0.003) compared to dominant eyes. For spherical equivalent (SE) anisometropia of >2.5 D (n = 21), the nondominant eye was more hyperopic in 95.2% (SE 4.7 ± 1.4 D) compared to 4.8% (1.8 ± 0.94 D; P < 0.001) for the dominant eye being more hyperopic. For astigmatic anisometropia of >2.5 D (n = 27), the nondominant eye was more astigmatic in 89% (mean astigmatism -3.8 ± 1.1 D) compared to 11.1% (-1.4 ± 1.4 D; P < 0.001) for the dominant eye being more astigmatic. Conclusions. The present study is the first to show that the nondominant eye has a greater degree of hyperopia and astigmatism than the dominant eye in hyperopic subjects. The prevalence of the nondominant eye being more hyperopic and more astigmatic increases with increasing anisometropia.