儿童视力自动检测系统在婴幼儿视力评价中的初步应用

目的: 采用北京大学第一医院与北京大学信息科学技术学院、心理与认知科学学院共同研制开发的儿童条栅视力自动检测系统(AACP)对婴幼儿视力进行测量, 探讨该系统的应用价值。方法: 前瞻性临床研究。于2018年2月至2021年10月利用北京大学多个院系联合研制开发的AACP, 对5个月～6岁儿童进行视力自动检测, 并同时使用条栅视力检测卡(TAC-II)进行人工检测, 将2种检测所得结果做对比研究。采用Wilcoxon检验进行2种视力间的差异比较, Spearman相关进行相关性分析, Bland-Altman图进行一致性分析。结果: 33例(66眼)3～6岁儿童全部完成AACP与TAC-II的双眼视力检测, 其中30例(54眼)儿童完成AACP与TAC-II的单眼视力检测, 双眼视力检查完成率100%, 单眼检查完成率90.0%。194例(388眼)5～30个月龄婴幼儿中, 141例(282眼)完成2种检测方法的双眼视力检测并得到有效数据, 完成率为72.7%。33例3～6岁儿童的AACP与TAC-II双眼视力及单眼视力均呈正相关(r=0.40, P=0.021;r=0.55, P<...     

5至24个月婴幼儿条栅视力发育规律的初步研究

目的 对5至24个月龄正常婴幼儿条栅视力发育规律进行初步研究.方法 使用以优先注视原理设计的Teller acuity cardsⅡ检测5至24个月龄正常婴幼儿的双眼及单眼视力.应用方差分析进行差异性比较,月龄组间两两比较使用Dunnett's方法,单眼与双眼及两侧单眼间的差异用配对t检验.视力水平与月龄的关系用Spearman曲线回归分析.结果 Teller acuity cards检查双眼视力完成率98.77％,单眼检查完成率89.2％.平均检查时间2～5 min.分别测得5至24个月龄婴幼儿双眼及单眼视力均值.单眼视力略低于双眼视力,差异小于或等于1个倍频;两眼间视力差异无统计学意义.正常婴幼儿双眼及单眼视力随年龄增长而提高,5月龄至14月龄视力增长平缓,平均视力由0.17(5.1 cpd)增长到0.32(9.6 cpd),提高约1倍频,15月龄以后视力水平提高速度加快,2岁时达到略低于成人视力水平0.833( 26 cpd),视力水平与12月龄时相比增加1.5倍频.结论 Teller acuity cards TMⅡ可以有效地检测2岁以内婴幼儿的双眼及单眼视力.正常婴幼儿双眼及单眼条栅视力随年龄增长而不断提高.不同时期,婴幼儿视力发育具有不同的增长速率.单眼视力等于或略低于双眼视力水平,两眼视力发育比较平衡.     

拥挤Kay图片视力表在学龄前儿童视力筛查中的应用

目的：采用拥挤Kay图片视力表检测学龄前儿童视力,并和标准对数视力表检测结果进行比较,探讨2种视力表检测结果是否具有一致性,以补充不能完成标准对数视力表检测的学龄前儿童的视力筛查。方法：前瞻性自身对照研究。于2021年1─5月随机选取济南市章丘区某幼儿园152名学龄前儿童进行全面眼科筛查,分别使用拥挤Kay图片视力表及标准对数视力表对其进行视力检测,并采用Wilcoxon检验进行2种视力差异性的比较,Spearman秩相关分析及Bland-Altman分析进行相关性及一致性分析。结果：152名儿童参与筛查,其中129名儿童屈光状态正常且能配合2种视力表检测。129名儿童中男74名,女55名,年龄为（52.3±7.0）个月;拥挤Kay图片测得LogMAR视力为0.10（0.09,0.10）,标准对数视力表视力为0.10（0.10,0.22）;2种视力检查方法有较好的相关性（r=0.436,P<0.001）,拥挤Kay视力表检测结果略高于标准视力表约0.04 LogMAR,差异有统计学意义（Z=-6.124,P<0.001）,Bland-Altman散点图显示98.4%的点均在一致性范围内;参与筛查儿童Kay图片视力检查配合度更高（χ2=18.007,P<0.001）。不同月龄拥挤Kay图片视力检测结果差异有统计学意义（H=13.791,P=0.003）,随年龄增长,视力呈递增趋势。结论：拥挤Kay图片视力表用于学龄前儿童视力检测,患儿配合程度高,其结果与标准对数视力表相比有较好的一致性,但Kay图片视力表所检查的视力结果高于标准视力表约0.04 LogMAR,在参考视力结果时应相应调整视力标准。     

Lea Symbols视力表在42～78个月儿童视力检查中的重复测量可信度分析

目的：探讨Lea Symbols视力表在学龄前儿童视力检查中的重复测量可信度。方法：横断面研究。 2017年4-5月对泉州市泉港区实验幼儿园的250名42～78（61.9±10.3）个月的学龄前儿童进行全面 的眼科检查,使用Lea Symbols视力表重复测量右、左眼的单眼远视力,采用LogMAR记录法记录 视力值。采用Bland-Altman分析、加权Kappa检验、组内相关系数3种统计分析方法衡量2次测量之 间的重复测量可信度。结果：3种分析方法均显示Lea Symbols视力表在学龄前儿童视力检查中的重 复测量可信度较好,2次测量间视力的差值94.3%在1行以内,2次测量的视力值之间的相关性较高 （r=0.753,P<0.001）。在139名屈光正常儿童中,2次测量的视力值（LogMAR）平均相差0.014。在 139名屈光正常儿童中,视力与月龄的相关性是显著的,月龄越大视力越好（r第1次=-0.335,P<0.001; r第2次=-0.424,P<0.001）;性别对可重复性没有影响（P=0.197）。结论：Lea Symbols视力表可用于 中国42个月及以上学龄前儿童的视力检查,可以在临床视力检查中推广使用。     

儿童非弱视性功能性视力低下的原因分析

分析儿童非弱视性功能性视力低下的形成原因。方法：系列病例研究。选取2015年6月至 2019年5月期间在濮阳市眼科医院就诊的非弱视性功能性视力低下儿童107例，年龄（8.3±1.9）岁。分别测量患者初始的最佳远近矫正视力（BCDVA、BCNVA）、单双眼调节灵敏度（MAF、BAF）、调节幅度（AMP）、调节反应（BCC）、正负相对调节（PRA、NRA）、远近水平隐斜（DLP、NLP）、调节性集合与调节比率（AC/A）、等效球镜度（SE）等数据。小数视力换算成5分记录法表达。用一元多重线性回归分析法研究训练前矫正视力与相关视功能参数自变量的关系。结果：双眼BCDVA均低于5.0者79例（73.8%），单眼BCDVA低于5.0者28例（26.2%）；双眼BCNVA低于5.0者71例（66.4%），单眼BCNVA低于5.0者22例（20.6%）。视功能检查显示所有视力低下眼的AMP均低于正常，诊断为集合不足和单纯性外隐斜者分别为59例和18例，分别占总例数的55.1%和16.8%，共占双眼BCDVA 均低于5.0例数的97.5%；单纯调节异常者27例，占总例数25.2%，占单眼BCDVA低于5.0例数的者 96.4%；BCDVA、BCNVA与AMP均呈正相关（r=0.563，P=0.035；r=0.587，P=0.029），与NLP均呈负相关（r=-0.413，P=0.031；r=-0.409，P=0.030），与BCC、PRA、NRA、DLP、AC/A、SE均无明显相关性（P均>0.05）。结论：①集合不足和单纯性外隐斜患者主要表现为双眼BCDVA均异常，单纯调节异常患者主要表现为单眼BCDVA异常。②儿童非弱视性功能性视力低下的形成和AMP、NLP异常有关，其中AMP异常是根本原因，NLP异常是继发原因。     

婴幼儿主观认知视力可测性年龄发生与视力发育的探讨

目的探讨婴幼儿主观认知视力可测性年龄的发生以及视力随月龄增长的变化规律。方法采用横断研究设计。以随机顺序对264名正常婴幼儿用带围栏的HOTV视频和由电脑控制的闭路式强化优先注视法（COPL）进行单眼视力检测及影响因素调查。采用配对t检验、独立样本t检验、Pearson相关、直线回归及Logistic回归对数据进行分析。结果26％的婴幼儿自24月龄开始接受主观认知视力检测,至46月龄时,已达到100％;24月龄右眼和左眼的平均主观视力分别为4．86＋0．05和4．881-0．08,至46月龄时均达5．0。左右眼间主观视力值比较,差异无统计学意义,男女间的主观视力值差异无统计学意义。主观视力与月龄呈正相关关系（r=O．526,P〈0．01）,主观视力（Y）与月龄（X）之间的直线回归方程为Y_4．699＋0．006X。应用Logistic回归分析,发现母亲教育背景（B=0．460,P=0．05）、A＇JL受教育程度（B=0．386,P〈0．01）对主观视力检测配合度的影响具有显著性。结论电脑控制的带围栏的HOTV认知视标检测系统为观察婴幼儿主观视力可测性的发生及其演绎提供了一种方法,婴幼儿主观视力检测应根据婴幼儿的年龄、认知水平选择不同的方式进行。     

闭路式强化优先注视法用于早产儿早期视力发育的观察

目的用闭路式强化优先注视（COPL）法检测早产儿6月龄前的条栅视力，探讨其发育情况。方法前瞻性病例对照研究。符合筛选标准且能完成条栅视力检查，随访1〉6个月的早产儿48名，用COPL法检测条栅视力，年龄7d～8个月，体重（2233．4±448．0）g，分组段定期测试每一名早产儿单、双眼视力。另外筛选正常足月儿34名作为对照组，体重（3443．3_＋553．0）g，定期作检测。视力结果以5分法记录。数据采用独立样本t检验、配对t检验、单因素方差分析、Pearson相关、直线回归及Mann—Whitney检测进行分析。结果早产儿出生2周内、校正孕周满38周、出生后14周、校正孕周满52周、出生后6个月、校正孕周满63周的右眼和左眼条栅视力分别为2．48±0．02和2．49±0．02，2．70±0．01和2．70±0．01，3．54±0．03和3．51±0．03。3．70±0．03和3．69±0．03，3．98±0．03和3．95±0．03，4．10±0．02和4．09±0．02，同一个体左右眼视力差异无统计学意义；各组段双眼条栅视力分别为2．51±0．02、2．70±0．01、3．55±0．03、3．69±0．03、3．96±0．03、4．18±0．02。早产儿的视力与月龄之间存在高度正相关关系（r=0．928，P〈0．01），视力（V）与月龄（X）之间的直线回归方程为Y=0．248X＋2．457（R。=0．861，F=1769．743，P〈0．01）；视力与孕周呈高度正相关（r=0．725，P〈0．01），视力（Y）与孕周（X）之间的直线回归方程为Y=0．017X＋1．457（R。=O．261，F=11．743，P〈0．01）。与出生体重、性别的相关性无统计学意义。足月儿出生后2周、出生后3个月、出生后6个月右眼和左眼视力分别为2．60±0．02和2．63±0．02，3．71±0．02和3．72±0．02，4．06±0．02和4．05±0．02，同一个体左右眼间视力差异无统计学意义；足月儿各组段双眼视力分别为2．60±0．02、3．72±0．02、4．14±0．02。比较同组段平均单双眼条栅视力，各月龄早产儿平均单双眼条栅视力与同组段正常足月儿相比，均较低，差异均有统计学意义（t=0．81、0．79、0．87，P〈0．05）。结论无眼底病变早产儿的单眼条栅视力与眼别无关，单、双眼条栅视力均低于同龄正常足月儿，条栅视力发育与月龄、孕周呈高度正相关，与性别、体重和屈光状态无相关性。电脑控制强化优先注视检测系统是检测0～6月龄早产儿视力的有效手段。     

选择观看法(PL)对婴幼儿正常视力的测定

用日本制造的ＮｉｔｅｎＰＬＶｉｓｕａｌＴｅｓｔｅｒ对天津市区和郊区１～２４月龄正常发育的婴幼儿８１０例（１６２０只眼）进行了视力检查。并对１月龄组婴幼儿２１例（４２只眼）的视力进行了纵向追踪观察。获得了婴幼儿各月龄的正常视力值及视力发育曲线。婴幼儿的视力随月龄增加而增长。婴幼儿正常视力的测定，不仅了解其增长规律，而且为婴幼儿眼疾早期视力受损程度提供了客观依据。     

单眼视力下降对双眼对比敏感度的影响

目的 研究单眼视力下降时双眼对比敏感度（CS）的变化规律,初步探讨单眼视力下降对双眼视功能及双眼相互作用的影响,并且探讨其在司法鉴定中的运用价值。方法 实验研究。于2016年3月至2017年8月选择司法鉴定科学研究院志愿者46例（男24例,女22例）。单眼矫正视力或裸眼视力均达4.9以上,主导眼前放置试验透镜,用插片法诱导实验性单眼视力不同程度下降。分别测试其左眼、右眼及双眼的视力、CS,计算对比敏感度双眼总和比（BSR）。数据进行球形检验、方差分析及秩和检验。结果 单眼视力下降可引起双眼视力一定程度下降,但是双眼视力仍优于单眼。当视力下降至轻度损害水平时,全频段正常倒“U”形CS曲线形态已破坏,且相较低空间频率而言,中、高空间频率时CS下降程度更为明显;在高频区且两眼视力均正常时,出现最大的BSR,为1.48。当单眼视力逐渐下降时,出现双眼平均及抑制（BSR<1）。提示双眼相互作用的形式存在一定程度的容忍性及空间依赖性。结论 单眼视力下降对双眼CS、双眼相互作用的形式及程度具有一定程度的影响。运用双眼CS检测,能够反映单眼视力的损害程度,具有临床及司法鉴定运用价值。     

前部缺血性视神经病变患者动态血压与视力损害关系的临床研究

 目的 探讨非动脉炎性前部缺血性视神经病变（NAION）患者动态血压参数与视力损害的关系。设计 回顾性病例系列。研究对象 63例确诊为NAION的患者,其中男性41例,女性22例。方法 将研究对象分别按视力下降程度（0.3为界）分为低视力组（44例）和高视力组（19例）;按就诊时发病眼别分为双眼发病组（20例）及单眼发病组（43例）。分别比较两组患者的一般情况、生化指标及动态血压参数。主要指标 年龄、性别、体重指数、甘油三脂（TG）、总胆固醇（TC）,24小时动态血压曲线形态及参数。结果 双眼发病组患者的夜间舒张压（78.5±11.3 mm Hg）明显高于单眼发病组（72.2±10.8 mm Hg）（P=0.044）。低视力组患者发病年龄（57.1±10.3岁）较高视力组（47.6±9.7岁）大（P=0.001）,低视力组中昼夜节律正常者比例（11.4%）明显低于高视力组（36.8%）（P=0.018）。结论 NAION患者中发病年龄大及血压24小时昼夜节律异常者视力损害更加严重。     

The Sonksen logMAR Test of Visual Acuity: I. Testability and reliability

PURPOSE: To develop a standardized logMAR test of visual acuity for young children and establish testability and reliability. METHODS: Two thousand nine hundred ninety-one children, aged 2 to 8 years 6 months, from a population sample of 4671 were recruited from schools and preschool facilities and tested. Ability to name or match letters, accept occlusion, and achieve binocular single and binocular and monocular measures of linear visual acuity were recorded. Inter- and intratester reliability was assessed for a random selection of 215 children. RESULTS: Two thousand nine hundred seventy-four (99.4%) matched or named letters, 2966 (99%) achieved binocular single, 2940 (98%) achieved binocular linear, and 2807 (94%) achieved monocular linear (for both eyes) measures. Binocular linear measures were achieved in 50% aged less than 3 years, 80% aged 3 to 3(1/2), 92% aged 3(1/2) to 4, and 99% aged 4 years and over. Binocular linear measures were achieved in 86% of 2- to 3-year-olds and 96% of 3- to 3(1/2)-year-olds who matched or named letters; monocular linear measures were achieved in 86 and 95%, respectively, of these age groups who then accepted occlusion. The median time for completion of the test (binocular and monocular) was 3 minutes 55 seconds. The 95% limits of agreement for the same observer and for different observers were +/-0.13 and -0.19, +0.15 for binocular linear and -0.16, +0.15, and -0.17, +0.13 for monocular linear measures, respectively. CONCLUSIONS: The Sonksen logMAR Test provides reliable binocular and monocular measures of linear visual acuity in a high proportion of children from the age of 2.5 years.     

Binocular Training Reduces Amblyopic Visual Acuity Impairment

Amblyopia is the most common cause of monocular visual impairment. Patching, which is modestly effective, is the current treatment of amblyopia in children. There is no clinically approved treatment for adults. The present study is a clinical trial (non-sham controlled and non-randomized) that assessed the efficacy of binocular training for improvement of the visual acuity in children and adults with amblyopia. Twenty-two amblyopic subjects ranging in age from 5 to 73 (mean: 36.2) years for whom patching and/or surgical treatments did not correct their visual impairment completed an average of 14.5 sessions of binocular training over a period of 4 to 6 weeks. Random dot kinematograms were presented dichoptically to the two eyes and the participants’ task was to identify the direction of motion of the targets. Mean visual acuity improvement was 0.34 LogMAR (range: 0.1–0.58 LogMAR) and was shown to persist 6 months following the cessation of binocular training. Our study provides results in a large number of patients that confirm the clinical effectiveness of binocular training as a treatment for amblyopia in improving visual acuity in both children and adults. Moreover, this study is the first to demonstrate that the improvements in visual function were maintained for 6 months in the absence of any additional treatment.     

Measurement of visual acuity in infants in 6 minutes: Teller's Acuity Cards

Most of the development of infant visual function occurs during the first year of life. Early pathological symptoms affecting visual or oculomotor processes, particularly ocular misalignment or amblyopia, should be detected and treated at the earliest age. Orthoptic and ophthalmological tests have been available for a long time but there remained a need for a convenient test for measuring visual acuity. Preferential looking techniques fulfill this demand and have been proven reliable and convenient to estimate visual acuity in preverbal infants. A new commercial presentation of the test, called Teller Acuity Cards, is described. Testing an infant was rapid, 5 to 6 minutes for a normal child, and easy because the child enjoys the convivality of the situation. Space requirement is reduced. Measures were taken from a population of 50 normal children aged 4 to 12 months. All children responded in the three situations, binocular and monocular (there was no blind eye in the group). Grating acuity values were higher than those obtained by projection preferential looking techniques. Binocular acuity was 6.5 cycles/deg (approximately 2.5/10) at 4 months of age, 9.8 cycles/deg (approximately 3.3/10) at 9 months and up to 13 cycles/deg (approximately 5/10) around 12 months. Acuities were found to be half an octave lower in monocular condition as compared to binocular. Orthoptic and ophthalmological check-up of infants is important, especially in case of children at risk of visual disorder. In most instances acuity can be preserved by therapeutic action provided it is initiated during the first year of life, when sensitivity to appropriate stimulation is at its peak.(ABSTRACT TRUNCATED AT 250 WORDS)     

Probability summation of acuity in the human infant.

Raw data from two studies of monocular and binocular acuity development were used to determine whether a binocular acuity advantage as a function of age is predicted by probability summation and whether these predictions accurately describe the course of binocular acuity development. Two decision rules for the combination of the outputs of right eye and left eye "channels" were evaluated, the decision-threshold rule and the integration rule. Both decision rules predicted a binocular acuity advantage for infants and children aged 0-60 months. However, both rules failed to adequately describe the normal course of monocular and binocular acuity development. No binocular acuity advantage was found prior to 6 months of age while, after 6 months of age, binocular acuity was superior to monocular acuity by 0.12 log unit (0.4 octave). The absence of binocular acuity superiority prior to 6 months of age is consistent with suggestions by other authors that the immature human visual system combines information from the two eyes nonselectively.     

Study to establish visual acuity norms with Teller Acuity Cards II for infants from southern China

ObjectivesTo establish the norms of binocular and monocular acuity and interocular acuity differences for southern Chinese infants and compare these norms with the results for northern Chinese infants.MethodsA prospective, comparative, and noninterventional study was conducted from January to August 2018. Teller Acuity Cards II were used to determine the binocular and monocular acuity of infants. The tolerance intervals and limits with a stated proportion and probability were used to evaluate the norms of binocular and monocular acuity and interocular acuity differences. An unpaired t-test was used to compare the obtained norms with the reported northern Chinese norms.ResultsThe tolerance intervals of binocular acuity (mean acuity of 3.73, 7.35, and 12.01 cpd, respectively, at 12, 24, and 36 months), monocular acuity (mean acuity of 2.88, 6.91, and 10.75 cpd, respectively, at 12, 24, and 36 months), and interocular acuity differences (mean difference of 0.92, 2.89, and 3.99 cpd, respectively, at 12, 24, and 36 months) were obtained, exhibiting an increasing trend with age. The binocular visual acuity norms of southern Chinese infants were significantly lower than those in northern China (4.37 vs. 6.9 cpd at 8 months and 7.35 vs. 26 cpd at 24 months) (P = 0.011).ConclusionsNorthern and southern Chinese infants exhibited distinct acuity norms and visual development patterns. The establishment of population-specific visual acuity norms is necessary for current populations of infants from different regions.Subject terms: Physiology, Outcomes research     

Visual acuity in 5–7-year-old children: individual variability and dependence on observation distance

Accurate measurements of uncorrected binocular and monocular visual acuity were performed in 65 children aged 5-7 years at five viewing distances in the range 0.5-5.0 m by means of the test charts containing widely spaced E stimuli in four orientations. It was found that, in most children of this age, visual acuity (V) changed with test distance, as had been reported previously with older subjects. Visual acuity could be considered as practically independent of observation distance (Vmax-Vmin相似文献   

球后视神经炎的游标高敏视力特征

目的:探讨球后视神经炎游标高敏视力的临床特征及其在临床诊断、治疗中的应用价值。方法:采用自行研究设计的游标高敏视力检查系统软件,对15例25只眼(急性球后视神经炎6例8只眼;慢性球后视神经炎9例17只眼)球后视神经炎患者治疗期间进行动态游标高敏视力检查,受检者按要求判断计算机显示屏上活动光标与固定光标的相对位置关系,并通过移动轨迹球调整光标,计算机自动分析活动光标和固定光标位置之偏差,得出平均阈值及其变异度。结果:球后视神经炎急性期的游标高敏视力阈值及其变异度与正常值相比差异有非常显著性(P<0.01);恢复期差异有显著性(P<0.05)。球后视神经炎急性期视力与游标高敏视力阈值的相关系数为-0.88(P<0.01);与阈值变异度的相关系数为-0.46(P<0.05)。球后视神经炎恢复期,游标高敏视力的阈值及其阈值变异度与急性期相比差异有非常显著性(P<0.01)。恢复期游标阈值与恢复期视力的相关系数为-0.93(P<0.01);阈值变异度与恢复期视力的相关系数为-0.84(P<0.01)。急性期游标阈值与恢复期游标阈值经相关性分析,其相关性无统计学意义(P=0.261);急性期视力与恢复期视力的相关性亦无统计学意义(P=0.11);急性期阈值变异度与恢复期阈值变异度的相关系数为0.67(P<0.01)。急性期游标阈值与恢复期游标阈值、