间歇性外斜视的调节灵活度和调节反应

目的：比较间歇性外斜视和正常眼位人群之间,间歇性外斜视注视眼和非注视眼之间的调节灵活度和调节反应。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门诊就诊的35例间歇性外斜视患者作为间歇性外斜视组,另选取24例正位眼或外隐斜斜视度≤6 △ 的门诊患者作为对照组。采用±2.00 D的反转拍和开放视野式自动验光仪分别测量受试者在单眼和双眼注视近距视标时的调节灵活度和调节反应。采用t检验对数据进行分析。结果：间歇性外斜视组的双眼调节灵活度为（8.8±4.1）cpm,显著低于对照组[（10.9±3.1）cpm],两者差异有统计学意义（t=-2.165,P=0.035）。间歇性外斜视组的非注视眼调节灵活度显著低于注视眼（t=4.657,P<0.001）。双眼注视40 cm处视标时,间歇性外斜视组的注视眼调节反应高于对照组的主导眼（t=-2.163,P=0.035）。双眼注视状态下,间歇性外斜视组注视眼的调节反应为（1.89±0.30）D,高于其在单眼注视状态下的调节反应[ （1.64±0.34）D],两者差异有统计学意义（t=3.801,P=0.001）。结论：间歇性外斜视患者的双眼调节灵活度低于对照人群,其注视眼和非注视眼的调节灵活度和调节反应均不一致,且双眼注视时调节反应高于单眼注视状态。     

视标呈现方式和注视方式对调节及调节微波动的影响

背景 研究表明,作为非光学因素,认知对调节系统存在一定的影响,因此客观、准确的实验设计是评价非光学因素对调节系统影响的关键步骤之一. 目的 研究视标呈现方式和注视方式对调节及调节微波动的影响,并进一步探讨认知中专注注视这一高水平注意因素对调节系统影响及近距离工作下专注注视的注视状态与近视发生发展的可能关系.方法 选择健康志愿者30例,平均年龄(24.80±1.98)岁,平均等效屈光度为(-1.92±2.02)D,平均柱镜屈光度为(-0.19±0.58)D.所有测量在屈光全矫下进行.采用开放视野红外自动验光仪测量受试者双眼注视40 cm处随机呈现的不同视标注视状态下右眼的调节反应.视标设计为专注注视状态和放松注视状态. 结果 受试者在专注注视状态下的调节反应均值为(1.86±0.26)D,放松注视状态下的调节反应均值为(1.27±0.39)D,差异有统计学意义(t=-8.052,P=0.000).受试者在专注注视状态下的调节微波动均值为(0.17±0.06)D,放松注视状态下的调节微波动均值为(0.28±0.17)D,差异有统计学意义(t=3.600,P=0.001).结论 视标的呈现方式和注视方式可影响调节反应,专注注视这一高水平注意因素使调节系统的调整更加精确、稳定.     

绘图深度线索对调节反应及调节微波动的影响

目的 研究绘图深度线索对调节反应及调节微波动的影响.方法 利用计算机编程及绘图软件制作出2组动态视标,视标1背景具有绘图深度线索,视标2背景无绘图深度线索.受试者双眼注视40cm处随机呈现的视标,采用开放视野红外自动验光仪测量受试者右眼的调节反应及调节微波动.录用健康自愿者30名,平均年龄(24.80±1.98)岁,所有测量在屈光全矫下进行.结果 视标1及视标2的调节反应均值分别为(1.39±0.38)D及(1.27±0.39)D,差异有统计学意义(t=-2.127,P=0.042);视标1及视标2的调节微波动均值分别为(0.30±0.16)及(0.28±0.17),差异无统计学意义(t =0.627,P=0.536).结论 绘图深度线索所传递的深度知觉对调节反应存在一定的影响,认知因素对调节系统存在影响.     

近目标吸收视轴如视远散开时眼调节状况的研究

用距离检影法给３０例青少年６０只正位正视眼测定了双眼共视一近目标，双眼共视一远目标和双眼各视其前一能使受试者视线按视远散开的近目标三种条件下眼调节的屈光度。实验发现：当双眼各视其前一能使其视线按视远散开的近目标时，眼的调节与视６Ｍ远一样，比视近目标明显放松。提示，可利用此原理及方法放松调节，增进近视者的远视力，减轻调节引起的视疲劳和减少调节对包括电脑验光在内的各种验光法的干扰。     

不同测量方法测得调节反应的比较

目的 研究分析不同测量方法对矫正视力≥1.0且眼位正常的人的调节反应的影响.方法 63位志愿者参加研究,分别使用开放视野式红外线自动验光仪和综合验光仪交叉柱镜法测量受试者眼在双眼视和单眼视状态下注视40cm处视标的调节反应值.测量时区分主导眼和非主导眼.结果 四种不同测量方法下正常人主导眼和非主导眼的调节反应值之间进行比较,差异均无统计学意义(P＞0.05).采用主导眼在不同方法下测得的调节反应值进行方差分析,发现不同方法之间差异有统计学意义(F =80.926;P=0.000).结论 正常人主导眼和非主导眼的调节反应之间无明显差异.不论是在双眼视还是单眼视状态下,主观的交叉柱镜法测得的调节反应均大于客观的开放视野式红外线自动验光仪方法所得;主观的交叉柱镜法较难真实反应调节活跃的青年人的调节状态.     

立体显示中深度线索对调节反应及其微波动的影响

目的 通过评估绘图深度线索和视差深度线索对调节反应的影响,分析线索冲突对调节及其微波动的影响方法 实验研究.采用开放视野的红外自动验光仪测量30例被检者双眼注视50 cm处不同视标下右眼的调节反应.视标分为无绘图深度线索和有绘图深度线索,并且分别以2D和3D的形式呈现(视标1:无绘图深度线索无视差深度线索;视标2:仅有绘图深度线索;视标3:仅有视差深度线索;视标4:既有绘图深度线索又有视差深度线索).采用重复测量的方差分析 结果 视标1～4的调节反应均值分别为(1.35±0.24)D、(1.42±0.27)D、(1.40±0.27)D和(1.36±0.25 )D,4种视标的调节反应差异有统计学意义(F=3.48,P＜0.05).有无视差深度线索或绘图深度线索对调节反应的影响差异有统计学意义(P＜0.05),但是当两个线索组合时对调节反应的影响差异无统计学意义.结论 双眼视差深度线索和绘图深度线索在一定程度上增加了被检者的调节反应,但当两者结合同时作用时,对人眼调节反应的影响不是简单叠加作用,可　能与调节所接受的生理和心理共同作用的复杂性有关.与平面图像相比,短暂3D视觉刺激,调节微波动相对比较稳定,可能与短期内3D丰富的画面比较吸引专注注视和视觉系统积极适应有关.     

成年近视患者主视眼与调节因素间关系的研究

背景 主视眼是人类具有功能不对称行为的器官之一,它和非主视眼在很多方面的差异一直是基础研究和临床研究的热点,但基于成年近视患者调节功能方面的研究相对较少. 目的 研究成年近视患者主视眼和非主视眼与调节相关各因素之间的关系.方法 采用描述性系列病例观察的研究方法,纳入35例年龄为18～ 35岁、双眼屈光不正球镜度为-2.00 ～-10.00 DS、散光度≤1.50 DC且双眼屈光参差≤1.5 DS、最佳矫正视力(BCVA)≥1.0的单纯近视患者,采用卡洞法并结合拇指法判断主视眼的眼别,采用主观、客观综合验光法获得受检眼屈光不正的度数,用移近法测量单眼的调节幅度,以附加±0.50 D融合交叉柱镜(FCC)法测量受检眼的调节滞后情况,采用翻转法测量各眼的调节灵敏度. 结果 本组患者的主视眼与非主视眼调节幅度分别为(9.69 ±2.30)D和(9.60±2.37)D,调节灵敏度分别为(11.08±4.20) cpm和(10.63±4.60) cpm,调节滞后量分别为0和0.25 D,主视眼与非主视眼间的差异均无统计学意义(P=0.294、0.260、0.141).右眼为主视眼的患者双眼调节幅度分别为(9.48±2.29)D和(9.33±2.49)D,调节灵敏度分别为(10.50±4.70)cpm和(9.99±4.90) cpm,差异均无统计学意义(P=0.319、0.116),双眼调节滞后量的差异无统计学意义(P=0.590).左眼为主视眼的患者双眼调节幅度分别为(9.91±2.35)D和(9.88±2.26)D,调节灵敏度分别为(10.70±3.77) cpm和(11.25±4.27) cpm,差异均无统计学意义(P=0.749、0.295),双眼调节滞后量间的差异无统计学意义(P=0.238).结论 对于无或有较小屈光参差的成年近视患者,主视眼和非主视眼在调节幅度、调节灵敏度及调节准确性方面无差别.     

快速序列视觉呈现方式与其他类型视标实时调节反应的差异

目的：分析受检者在阅读快速序列视觉呈现方式（RSVP）与其他不同类型视标进行实时调节反应及调节微波动测量差异。方法：前瞻性研究。收集2019年4─10月期间在温州医科大学附属眼视光医院就诊的近视患者33例，年龄15～28（22.1±4.8）岁，等效球镜度（SE）为（-3.81±1.67）D。试验视标分为以下4类：RSVP、随机字符RSVP、马耳他视标和文本窗。每组视标试验时间为5 min，使用Grand Seiko WAM-5500红外验光仪进行实时的调节反应、调节微波动的测量。使用单因素方差分析比较受检者阅读或者注视不同视标时调节参数的差异，使用配对t检验比较试验初期10 s内与5 min内平均调节反应值的差异。结果：5 min试验显示，与RSVP、随机字符RSVP和文本窗比较，马耳他视标调节反应最低，差异均有统计学意义（t=2.45，P=0.016；t=2.57，P=0.011；t=3.85，P<0.001）；注视马耳他视标时，调节变异度大于阅读RSVP和文本窗，差异均有统计学意义（t=4.32，P<0.001；t=2.93，P=0.04）。调节微波动能量分析显示，与RSVP相比，注视马耳他视标时低频区能量明显增高（t=30.32，P<0.001）；与RSVP相比，阅读文本窗时中频及高频区能量明显增高（t=32.41，P<0.001；t=38.26，P<0.001）。RSVP、随机字符RSVP及马耳他视标在最初10 s的调节反应均高于5 min内调节反应的均值（t=2.30，P=0.028；t=2.45，P=0.020；t=3.71，P=0.001）。结论：阅读或注视不同类型的视标时，人眼的调节反应及调节微波动存在差异。阅读或注视持续一段时间后，调节反应会随着时间发生变化，最初的测量结果无法完全代表持续阅读或者注视时的调节反应。     

不同调节视标下调节反应的比较

目的分析人眼在马耳他十字视标(Maltese cross)、E视标及快速序列视觉呈现(rapid serial verbal presentation,RSVP)系统汉字三种调节视标下的调节反应,探讨注视状态和阅读状态调节反应的差异。方法31位志愿者参加本实验,其中正视15位,等效球镜屈光力为-0.25～ 0.50D;近视16位,均为稳定性近视,等效球镜屈光力为(4.06±2.00)D。利用精工SEIKO-WV500开放视野式自动验光仪测量调节反应,比较33cm处不同调节视标下,注视状态和阅读状态调节反应的差异。结果Maltesecross视标、E视标、RSVP汉字视标作为调节视标,调节反应分别为(2.07±0.35)D、(2.08±0.30)D、(1.88±0.42)D。其中RSVP汉字视标与E视标相比较,调节反应的差异有显著性(P=0.001),RSVP汉字视标与Maltese cross视标相比,调节反应的差异亦有显著性(P=0.003),而Maltese cross视标与E视标之间,调节反应差异无显著性。RSVP汉字作为调节视标时,个体间存在较大差异。不同调节视标下,正视组和稳定性近视组之间的调节反应均无显著差异。结论RSVP中汉字作为调节视标,在模拟阅读状态时和在低注意力情况下正自主性调节成分减少,调节反应降低。     

双眼分光同时视装置的研制及在双眼调节测定中的应用

目的 探索一种可用于临床测试简便可行的双眼分光同时视装置，评价这种装置在双眼调节测定中的应用。方法 自制分光式验光镜架和双眼分光同时视装置，做23只正视眼的1／3m双眼调节测量；同时做注视1／3m1.0视标的单眼调节和双眼调节的测量及运用直接法做1／3m反应调节的测定。结果 （1）双眼调节大于单眼调节（t检验，P＜0．01）；（2）双眼分光同时视法1/3m反应调节与直接法无差别；小于注视1／3m 1.0视标的双眼调节有差别（F＝134．65，P＜0．01）。结论 双分光同时视装置是一种可靠而又简便可行的双眼调节的测定装置；双眼调节优越于单眼调节。     

Binocular accommodative response with extended depth of focus under controlled convergences

Vergence and accommodation can be mismatched under virtual reality viewing conditions, and this mismatch has been thought to be one of the main causes of visual discomfort. The goal of this study was to investigate how optical conditions of the eyes affect accommodative responses to different convergence. Specifically, we hypothesized that extending the depth of focus (DoF) could weaken the control of the screen on accommodation, so that accommodation could be induced by convergence. To test this hypothesis, we extended the DoF using Zernike spherical aberrations (fourth and sixth orders) induced by a binocular adaptive optics (AO) vision simulator. Nine normal subjects between the ages of 21 and 34 (26 ± 5) years were recruited. Three optical conditions were generated: AO condition (aberration-free), monovision condition, and extended depth of focus (EDoF) condition. Binocular accommodative responses, along with binocular visual acuity and stereoacuity, were measured under all three optical conditions with varied binocular vergence levels. At 3 diopters of binocular convergence, the EDoF condition was the most efficient in inducing excessive accommodative response compared with the monovision condition and the AO condition. Visual acuity was impaired with EDoF as compared with the other two conditions. The average stereoscopic thresholds (at 0 vergence) under the EDoF condition were degraded compared with the AO condition but were superior to those of the monovision condition. Therefore, despite some compromise to visual performance, extending the DoF could allow for a more natural vergence–accommodation relationship, providing the potential for alleviating the vergence–accommodation conflict and associated visual fatigue symptoms in virtual reality.     

Interocular equality of tonic accommodation and consensuality of accommodative hysteresis

Interocular differences in tonic accommodation were assessed before and after a 10 minute period of sustained monocular fixation. The fixation task was carried out once for each eye using a high-contrast target at near, and once for each eye using an empty illuminated field. Tonic accommodation increased significantly as a result of fixating the high contrast target at near, but remained stable when viewing the empty field. Close correspondence was found between the two eyes with respect to both prefixation tonic level and magnitude of tonic after-effect. Absence of interocular differences clearly demonstrates the consensuality of accommodative hysteresis.     

近视性屈光参差者双眼调节反应的研究

目的 研究在辐辏闭环情况下,近视性屈光参差者的调节滞后、调节反应/调节刺激曲线线性部分的斜率等眼动参数与正视者调节参数之间的差异的关系.方法 病例对照研究.40名志愿者(年龄18岁至31岁),其中正视者20人(等效球镜度+0.37至-0.25 D),20例近视性屈光参差者(双眼球镜度数差>2.50 D且<7.00 D,散光度数<1.00 D).在辐辏闭环状态下用WV-500双目自动验光仪测量1.00、2.00、3.00、4.00 D各调节刺激下的调节反应并得出AR/AS曲线及其线性部分的斜率.对正视组和屈光参差组的高低度数眼的客观调节滞后量、调节反应/调节刺激斜率、主观调节滞后量进行独立样本t检验.结果 在闭环条件下,屈光参差者高度数眼调节滞后量最大,其次是低度数眼、正视眼.在3.00和4.00 D刺激水平,屈光参差组高度数眼与正视眼调节滞后量之间差异有统计学意义(t=2.055,2.410;P<0.05).屈光参差者两眼之间AR/AS斜率差异无统计学意义(P>0.05),但屈光参差高度数眼的斜率低于正视眼的AR/AS斜率(t-2.550,P<0.05).结论 屈光参差者两眼调节反应不等,高度眼表现出更多的调节滞后.屈光参差者双眼在等量调节刺激下,表现为不等量的调节反应,高度数眼要产生相同的调节反应,需要更多的调节刺激.可能与调节中枢的控制增益不同有关,也可能与"睫状肌一晶状体"系统调节反应阈值较高有关.(中华眼科杂志,2009,45:612-615)     

Role of attention and eye preference in the binocular coordination of saccades in strabismus

This study examines squint change and the binocular coordination of horizontal and vertical saccades in an adult subject with incomitant strabismus (20 or 40 prism diopters) strongly depending on the eye used for fixating. The patient had no binocular vision and was diagnosed ‘horror fusionis’ since her childhood. We found the angle of horizontal squint to be smaller when the patient was fixating with the preferred eye than with the nonpreferred eye. The squint was smaller when both eyes viewed and one eye fixated attentionally than when the nonfixating eye was closed. This suggests the importance of binocular visual stimulation. We found no significant changes in the amplitude of the disconjugacy of the saccades. However, when the preferred, left eye fixated attentionally (under binocular viewing) or monocularly, the pattern of the disconjugacy changed: the majority of the saccades showed divergent disconjugacy. This pattern is qualitatively similar to that seen in normal subjects. In this patient, divergent disconjugacy helped to decrease the convergent squint at the end of the saccades. Interestingly, vertical squint was small and did not depend on viewing conditions. The binocular coordination of vertical saccades was almost normal, at least in the binocular viewing condition. We conclude that the visual input from both eyes allows a rudimentary binocular cooperation that helps to keep the squint small and renders disconjugacy of horizontal saccades strategically divergent to reduce temporally the squint.     

The influence of tinted lenses upon ocular accommodation

We determined the effect upon accommodative responses of tinted lenses prescribed for the relief of visual discomfort in a group of five long term lens wearers. Static and dynamic responses were measured under four viewing conditions (1) prescribed tinted lens (2) neutral density filter (3) tinted lens of complementary colour and (4) no absorptive lens. While similarity and normality of the mean stimulus-response functions between the four viewing conditions were evident, the low frequency component of the accommodation microfluctuations was significantly greater while viewing the target in the 'no lens' viewing condition. These increases in the low frequency components (LFC) of the accommodation may be a subtle indicator of visual stress in these patients. Colour specificity is not supported by this finding.     

视知觉学习联合调节灵敏度训练治疗屈光参差性弱视患者的临床疗效

目的　探讨视知觉学习联合调节灵敏度训练治疗屈光参差性弱视患者的临床疗效。方法　收集２０１３年至２０１５年在我院就诊的屈光参差性弱视患者８６例（８６眼）,随机分为对照组（４２眼）与观察组（４４眼）。对照组进行视知觉学习训练,观察组进行视知觉学习联合调节灵敏度训练,比较两组患者治疗３个月后的最佳矫正视力,对比敏感度,正、负相对调节以及调节灵敏度、Ｔｉｔｍｕｓ立体视的变化。结果　对照组弱视眼经过３个月的训练后,最佳矫正视力提高２行及２行以上的患者为２４眼。观察组则为３６眼,两组比较差异有统计学意义（χ２＝５．６０２,Ｐ＜０．０１）。训练后两组患者对比敏感度均有所提高。观察组对比敏感度的升高以低、中空间频率升高表现突出,两组比较差异有统计学意义（均为Ｐ＜０．０５）,高频区对比敏感度升高不明显（Ｐ＞０．０５）。与对照组相比训练后观察组患者正、负相对调节以及调节灵敏度均有所改善,差异均有统计学意义（均为Ｐ＜０．０５）。观察组训练３个月后,拥有＞８０″～２００″黄斑立体视１２眼,＞４００″～８００″周边立体视１８眼,与对照组相比差异均有统计学意义（均为Ｐ＜０．０１）。恢复≤６０″正常立体视６眼,对照组为４眼,两组比较差异无统计学意义（Ｐ＞０．０５）。结论　视知觉学习联合调节灵敏度训练在提高屈光参差性弱视患者的视力、对比敏感度、调节力以及立体视方面具有显著的疗效。     

Spatial localization in esotropia: does extraretinal eye position information change?

PURPOSE: To investigate the accuracy of spatial localization in children with a specific type of convergent strabismus, fully accommodative esotropia. METHODS: Two groups of children, with right and left fully accommodative esotropia, respectively, pointed at targets located centrally and eccentrically on a computer touchscreen without being able to see their hands. The size and the direction of the horizontal pointing responses were recorded under two conditions: when their eyes were aligned (wearing spectacles) and when they were squinting (not wearing spectacles). A group of children without strabismus but with hypermetropia were assessed as controls. RESULTS: For both fully accommodative groups, the pointing responses to the central target shifted in the direction of the nonsquinting eye when deviations were manifest. No difference was found for the eccentric targets. No difference was found for the hypermetropia group with any target. CONCLUSIONS: These results are consistent with an alteration in the extraretinal eye position information (efference copy, extraocular muscle proprioception, or both) that is used in spatial localization.     

维生素B12滴眼液缓解视频终端视疲劳的临床观察

目的：观察维生素 B12滴眼液缓解视频终端视疲劳的临床疗效。
　　方法：纳入患者50例100眼,治疗组及对照组各25例50眼。对照组给予生理盐水点眼,治疗组给予维生素 B12滴眼液点眼。使用方法均为每日3次,每次1滴,点双眼,连续用药60d。测定各组患者用药前后眼调节参数及泪液分泌量。
　　结果：用药后,治疗组与对照组相比泪液分泌量增加,调节幅度加大,调节灵敏度增加,调节滞后减少,差异均具有统计学意义(P<0.05)。
　　结论：维生素 B12滴眼液可以改善干眼症状,提高眼调节能力,治疗视频终端视疲劳。     

Accommodative lag under habitual seeing conditions: comparison between adult myopes and emmetropes

PURPOSE: To clarify whether myopes show poor accommodative response and thus have a larger accommodative lag under natural seeing conditions. METHODS: Forty-three adults without other ocular abnormalities were classified into the early-onset myopia (EOM, n=28) and the emmetropia (EMM, n=15) groups. The subjects wore glasses or contact lenses that they habitually used, and accommodative responses to four accommodative targets (16.0-50.5 cm from their eyes) were measured under a monocular or binocular condition using an open-field infrared autorefractometer. RESULTS: Under a binocular condition, the accommodative lag for each target was significantly smaller in the EOM group (analysis of variance, P<.01), but the mean slope of the accommodative stimulus-response function did not significantly differ between the EOM and EMM groups (1.05+/-0.11 and 1.02+/-0.10 D/D, respectively). The mean slope under a binocular condition was significantly steeper than that under a monocular condition in both groups (paired t-test, P<.05). CONCLUSIONS: In adults with EOM, the accommodative stimulus-response function was not impaired, and the habitual accommodative lag was rather small, probably due to the reduced accommodative demand by a vertex distance and/or the intentional undercorrection of spectacles.