单眼视设计的人工晶状体眼视功能临床研究

目的 探讨应用单眼视原理设计双眼白内障超声乳化联合植入单焦点人工晶状体术后的视功能情况.方法 对双眼年龄相关性白内障患者42例(84只眼),分为常规组21例(42只眼)及单眼视组21例(42只眼).常规行白内障超声乳化联合折叠式人工晶状体植入术.分别记录术前最佳矫正视力及术后1周单眼裸眼远、近视力及双眼裸眼远、近视力.采用SAS8.2统计软件对结果进行统计学分析.结果 (1)术前平均最佳矫正视力常规组4.44,单眼视组4.47(P ＞0.05),患者平均年龄常规组71岁,单眼视组69.5岁(P ＞0.05),差异无统计学意义.(2)术后1周单眼裸眼远视力常规组4.90,单眼视组:优势眼4.94(P ＞0.05),与常规组比较差异无统计学意义;非优势眼4.71(P < 0.05),与常规组比较差异有统计学意义.术后1周单眼近视力常规组4.36,单眼视组:优势眼4.37(P＞0.05),与常规组比较差异无统计学意义;非优势眼4.78(P < 0.05),与常规组比较差异有统计学意义.(3)术后1周双眼裸眼远视力常规组4.91,单眼视组4.91(P ＞0.05),与常规组比较差异无统计学意义;术后1周双眼近视力常规组4.42,单眼视组4.78(P < 0.05),与常规组比较差异有统计学意义.结论 单眼视设计的人工晶状体眼术后双眼远视力与常规设计人工晶状体眼相同,但近视力明显好于常规设计.按照单眼视原理设计人工晶状体可以较好的临床应用.     

Factors influencing interocular blur suppression

An Important feauture of monovision correction is the ability of the binocular system to suppress blur from the defocused eye (interocular blur suppression). We conducted a study with three subjects and found that interocular blur suppression improved with higher levels of monocular defocus (addition powers in monovision) but was not affected by the eye defocused (sighting dominant or non-domninant) or by pupil size. The selection and management of monovision patients may be assisted by an understading of the understanding of the underlying suppression preocesses.     

Distance impairs postural stability only under binocular viewing

Prior studies indicate that postural stability under binocular viewing is not better than under monocular viewing. This was tested at the distances of 145 cm [Fox, C.R. (1990). Some visual influences on human postural equilibrium: binocular versus monocular fixation. Perception and Psychophysics, 47 (5), 409-422] and 90 cm [Isotalo, E., Kapoula, Z., Feret, P.H., Gauchon, K., Zamfirescu, F., & Gagey, P.M. (2004). Monocular versus binocular vision in postural control. Auris Nasus Larynx, 31 (1), 11-17]. On the other hand, postural stability is known to decrease with distance increase. We re-examined the effect of binocular versus monocular viewing on postural stability at near and far distances (40 and 200 cm), and for both young (25.7+/-2.7 years), and old subjects (61.2+/-4.6 years). For both groups of subjects, proximity decreased the area of CoP, the standard deviation of antero-posterior sway (SDy) and the variance of speed. The group of elderly presented increased variance of speed at far distance in comparison with young subjects. The novel finding is the interaction between distance and viewing condition. Under binocular viewing, the area of CoP was significantly higher at far distance than at near; in contrast, monocular viewing produced similar CoP values at both distances. Increased instability at far distance when both eyes are viewing is attributed to decreased sensitivity to binocular disparity cues and to visual motion in depth resulting from body sway. Monocular viewing would provide similar stability at far and at near distance, because sensitivity to lateral visual motion, detected monocularly, decreases less with distance than sensitivity to binocularly detected motion in depth. Alternatively, such monocular viewing could increase subject's attention and lead to tighter postural control regardless of the distance.     

Patterns of binocular suppression and accommodation in monovision

The binocular depth of focus of monovision wearers was compared to the sum of the two monocularly determined depths of focus. Observers fell into three groups based upon ocular sighting dominance. Complete binocular summation of the monocular depths of focus was observed in subjects without a preferred fixating eye. Subjects who preferred to fixate with one eye had difficulty suppressing blur of that eye while the binocular target was within the depth of focus of the nonpreferred eye. A third group showed partial summation of the two monocular depths of focus. Similar patterns of accommodative response, measured objectively with the SRI optometer, were observed in subjects wearing monovision corrections. Accommodative response to sinusoidal variations in blur was controlled primarily by the dominant sighting eye. These results demonstrate the effectiveness of interocular suppression of anisometropic blur in monovision correction and the influence of ocular dominance upon this suppression process.     

Comparison of suppression, stereoacuity, and interocular differences in visual acuity in monovision and acuvue bifocal contact lenses.

PURPOSE: The relationship between visual acuity and stereoacuity has been well documented: as binocular visual acuity increases, stereoacuity improves. We compared interocular differences in visual acuity and stereoacuity in two presbyopic soft contact lens modalities, monovision and a new soft bifocal contact lens, the Acuvue Bifocal. The Acuvue Bifocal is hypothesized to show a smaller interocular acuity difference, increased stereoacuity, and decreased suppression over monovision at distance and near. METHODS: Monovision patients wearing Acuvue or Surevue soft contact lenses were tested for visual acuity, stereoacuity, and suppression at distance and near. Stereoacuity was tested with the Randot Stereotest (near) and the BVAT (distance). Suppression was evaluated with the Acuity Suppression Vectogram (near) and the BVAT (distance). Patients were then fit with the Acuvue Bifocal in each eye. After wearing the lenses for 1 week, the same tests of visual acuity, stereoacuity, and suppression were performed. RESULTS: The mean interocular acuity difference (IAD) at distance with monovision was 0.712 logarithm of the minimum angle of resolution (logMAR) (SD = 0.275) and 0.188 logMAR (SD = 0.252) (p < 0.001) with the Acuvue Bifocal. At near, the mean IAD with monovision was 0.420 logMAR (SD = 0.183) and 0.137 logMAR (SD = 0.147) (p < 0.001) with the Acuvue Bifocal. Of the monovision subjects, 89% (17 of 19) demonstrated suppression at near while only 26% (5 of 19) did with the bifocal lenses (statistically significant at p < 0.001). Stereoacuity at near improved from a median of 200 sec arc with monovision to 50 sec arc with the bifocal lenses. CONCLUSIONS: In this study, correcting presbyopia with the Acuvue Bifocal versus monovision resulted in a statistically significant decrease in the interocular difference in visual acuity at distance and near. The decreased interocular difference in visual acuity improved certain aspects of binocularity as demonstrated by a decrease in suppression and an increase in stereoacuity.     

The influence of ocular dominance on monovision--the influence of strength of ocular dominance on visual functions

PURPOSE: Monovision is a method of correction for presbyopia. We have reported the advantage of conventional monovision (the dominant eye is corrected for distance). In this study, we investigated the influence of interocular imbalance of dominancy on the visual function. SUBJECTS AND METHODS: Ten healthy subjects without any ophthalmologic disease participated. After cycloplegia, the eyes of the subjects were corrected by soft contact lenses with an artificial pupil (diameter: 3.0mm). The dominant eye was corrected for distance, and the difference in lens power between the lenses was 2.5 D. The subjects were classified into two groups by strength of the imbalance of sensory dominance, which was determined by using binocular rivalry. Binocular visual functions (visual acuity at various distances, contrast sensitivity, near stereoacuity) were compared between the two groups. RESULTS: Subjects with strong imbalance of sensory dominance showed decreased near visual acuity as well as decreased binocular summation of contrast sensitivity at low spatial frequencies. On the other hand, near stereoacuity was not affected by the imbalance of sensory dominance. CONCLUSION: These results suggest that strong imbalance of sensory dominance interferes with binocular visual functions in monovision. Thus, the evaluation of ocular dominance is crucial for clinical applications of monovision.     

Q值优化非球面切削单眼视LASIK术后视觉效果分析

目的：评价利用Q值优化的非球面切削单眼视LASIK手术方式矫正近视散光联合老视的单眼及双眼视觉效果。 方法：选择2006-08-01/2009-03-31之间在我院利用Carl Zeiss Meditec CRS-Master软件及MEL80准分子激光进行Q值优化的非球面切削单眼视LASIK手术的近视或者近视散光联合老视的40名连续随访患者（80眼）,术后1d;1wk;1,3,6mo及1a进行验光、单眼及双眼视近及视远裸眼视力、角膜曲率、像差检查,术后1wk;1,3,6mo及1a进行对比敏感度及立体视觉检查进行视觉质量评估, 并在术后6mo进行患者近距离工作视觉疲劳问卷调查。 结果：Q值优化的非球面切削单眼视LASIK术后视觉质量研究结果如下：术后6mo等效球镜屈光度与目标屈光度相比92%在±0.50D以内,99%在±1.00D,术后3mo~1a的屈光值的变化为-0.06±0.37D。术后1mo主视眼的裸眼远视力95%达到20/20;双眼裸眼近视力87.5%达到J2,100%达到J5。术后1wk, 双眼对比敏感度与术前矫正后相比有下降趋势,术后1~3mo逐渐恢复。术后1wk时,近立体视锐度有所降低(P<0.05),其他立体视锐度均无明显改变(均为P>0.05)。术后患者近距离工作视疲劳症状明显改善。 结论：Q值优化的非球面切削单眼视LASIK手术方式,对于中度近视至高度近视及散光联合老视患者,是一种耐受性好,稳定安全有效的治疗方法。     

The influence of ocular dominance on monovision--the interaction between binocular visual functions and the state of dominant eye's correction

PURPOSE: To examine the interaction between binocular visual functions and the correction of the dominant eye, i.e., for far vs. near vision in monovision. SUBJECTS AND METHODS: Ten healthy subjects without any ophthalmological disease were examined. After cycloplegia, the eyes of the subjects were corrected by soft contact lenses (difference in lens power between the lenses: 2.5 D) with an artificial pupil(diameter: 3.0 mm). Visual acuity at various distances, contrast sensitivity, and near stereoacuity were measured while the dominant eye determined by the hole-in-card test (sighting dominance) was corrected for far and near vision. RESULTS: Binocular visual acuity was better than 1.0(20/20) at all distances. When the dominant eye was corrected for distance, the binocular visual acuity at 0.7 m was better than the monocular visual acuity; contrast sensitivity was better within the spatial frequency range of 0.5-4.0 cycles per degree, and near stereoacuity by Titmus stereo tests improved. CONCLUSION: These results suggest that dominant eyes should be corrected for far vision for better binocular summation at middle distances, and near stereoacuity.     

Monovision: a review

In presbyopia, patients can no longer obtain clear vision at distance and near. Monovision is a method of correcting presbyopia where one eye is focussed for distance vision and the other for near. Monovision is a fairly common method of correcting presbyopia with contact lenses and has received renewed interest with the increase in refractive surgery. The present paper is a review of the literature on monovision. The success rate of monovision in adapted contact lens wearers is 59-67%. The main limitations are problems with suppressing the blurred image when driving at night and the need for a third focal length, for example with computer screens at intermediate distances. Stereopsis is impaired in monovision, but most patients do not seem to notice this. These limitations highlight the need to take account of occupational factors. Monovision could cause a binocular vision anomaly to decompensate, so the pre-fitting screening should include an assessment of orthoptic function. Various methods have been used to determine which eye should be given the distance vision contact lens and the literature on tests of ocular dominance is reviewed. It is concluded that tests of blur suppression are most likely to be relevant, but that ocular dominance is not fixed but is rather a fluid, adaptive, phenomenon in most patients. Suitable patients can often be given trial lenses that allow them to experiment with monovision in real world situations and this can be a useful way of revealing the preferred eye for each distance. Of course, no patient should drive or operate machinery until successfully adapted to monovision. Surgically induced monovision is less easily reversed than contact lens-induced monovision, and is only appropriate after a successful trial of monovision with contact lenses.     

Factors influencing success and failure in monovision

This study compared the visual performance of 70 successful and 18 failed monovision (MV) wearers, measured before contact lens dispensing. Compared with successful MV wearers, the failed group showed greater levels of ghosting at distance and near, lost more stereoacuity at 6 m, and lost slightly more near visual acuity. The failed MV group was also older on average than the successful group. Both groups showed worse visual acuity at distance and near with MV than at spectacle baseline, as well as worse stereoacuity at 6 m and 40 cm. Discriminant analysis indicated that distance ghosting, distance stereoacuity, and age were predictive of both success and failure (78% sensitivity; 82% specificity). An investigation, before lens fitting, of other effects of monocular blur on binocular function, as well as an assessment of personal characteristics such as motivation and the nature of visual demands, may further improve the accuracy of prediction of patient success with MV found in this study.     

Visual performance of subjects wearing presbyopic contact lenses.

PURPOSE: The purpose of this study is to assess the visual performance of subjects wearing gas-permeable (GP) multifocal contact lenses, soft bifocal contact lenses, GP monovision lenses and spectacles. METHODS: The study included 32 subjects between the ages of 42 and 65 years wearing GP monovision, the Acuvue Bifocal (Vistakon), the Essentials GP Multifocal (Blanchard), and progressive addition lenses (PAL; spectacles group). There were eight subjects in each of these groups who were already wearing these modalities. Binocular low (18%) and high (95%) contrast acuities were recorded using the Bailey-Lovie chart; binocular contrast sensitivity from 1.5 to 18 cycles per degree (cpd) measured with the Vistech VCTS 6500 system, and monocular glare sensitivity at three luminance settings (400, 100, and 12 foot lamberts) was measured using the brightness acuity tester (BAT). Binocular near visual task performance (a modified version of letter counting method used in previous presbyopic studies) was also assessed. RESULTS: For the contact lens-wearing groups, subjects wearing GP multifocals provided the best binocular high and low contrast acuity followed by soft bifocal wearers. There was relative parity between the binocular high and low contrast acuity with PAL and GP multifocal wearers. Monovision acuity, measured binocularly, was determined to be lower than the other three groups with this difference being most significant with high contrast acuity. Among contact lens-wearing groups, it was observed that GP multifocal lens wearers experienced the lowest amount of monocular disability glare followed by soft bifocal wearers and monovision wearers. Subjects wearing soft bifocal lenses and monovision demonstrated slightly reduced binocular contrast sensitivity at all spatial frequencies. In the contact lens groups, GP multifocal lens wearers had the highest binocular contrast sensitivity at all spatial frequencies, on parity with PAL wearers, except at the highest spatial frequency (18 cpd) at which PAL wearers had better vision. Error scores for the binocular near visual task performance between the four groups revealed subjects with GP multifocal lenses and PAL wearers to have the least errors, followed by monovision users and then soft bifocal wearers with the most errors. CONCLUSION: Subjects wearing GP multifocals, soft bifocals, monovision, and PAL spectacles have good binocular contrast sensitivity, satisfactory binocular low and high contrast acuity, and increased sensitivity to glare. Presbyopic subjects requiring the use of contact lenses under dim light levels could benefit from GP multifocal lenses. Contrast and glare sensitivity evaluations provide significant information regarding the visual performance of the presbyopic contact lenses and should be included in regular presbyopic contact lens fitting.     

Familiar size affects the perceived size and distance of real objects even with binocular vision

Although the familiar size of real-world objects affects size and distance perception, evidence is mixed about whether this is the case when oculomotor cues are available. We examined the familiar size effect (FSE) on both size and distance perception for real objects under two viewing conditions with full or restricted oculomotor cues (binocular viewing, which provides vergence and accommodation cues, and monocular viewing through a 1-mm pinhole, which removes those cues). Familiar objects (a playing die versus a Rubik''s cube) were manufactured in their typical (1.6-cm die and 5.7-cm Rubik''s cube) and reverse (5.7-cm die and 1.6-cm Rubik''s cube) sizes and shown at two distances (25 cm versus 91 cm) in isolation. Small near and large far objects subtended equal retinal angles. Participants provided manual estimates of perceived size and distance. For every combination of size and distance, Rubik''s cubes were perceived as larger and farther than the dice, even during binocular viewing at near distances (<1 meter), when oculomotor cues are particularly strong. For size perception but not distance perception, the familiar size effect was significantly stronger under monocular pinhole viewing than binocular viewing. These results suggest that (1) familiar size affects the accuracy of perception, not just the speed; (2) the effect occurs even when oculomotor cues are available; and (3) size and distance perception are not perfectly yoked.     

Changes in accommodative and vergence responses when viewing through near addition lenses.

It has been proposed that near addition lenses reduce the lag of accommodation and may slow myopia progression. In this study, we investigated the differences in accommodative response and near phoria in subjects with and without near addition lenses. Fourteen subjects (7 emmetropic and 7 myopic) participated in the study. Monocular and binocular accommodative responses to a target at 40 cm were measured with and without +2.00 diopter (D) lenses using a Canon R-1 optometer (Canon Europe N.V., Amsterdam, The Netherlands). Near dissociated phoria was measured using 3 testing methods: Maddox rod, cover test, and Von Graefe technique. The differences in accommodative response and near phoria between the 2 viewing conditions with and without the near addition lens were significant (P < 0.0001). No significant differences were revealed in accommodative response and near phoria between refractive error groups. The average accommodative responses of all subjects were 2.03 +/- 0.06 (SE) D (without +2.00 D lens) and 0.60 +/- 0.07 D (with +2.00 D lens) under monocular viewing conditions and 2.11 +/- 0.06 D (without +2.00 D lenses) and 0.77 +/- 0.07 D (with +2.00 D lenses) under binocular viewing conditions. The average near phorias of all subjects were -2.08 +/- 0.69 prism diopters (PD, without +2.00 D lenses) and -7.90 +/- 0.68 PD (with +2.00 D lenses). We discuss the effect of near addition lenses on the defocus of the retinal image, accommodative response, and near phoria. In addition, we propose that the observed difference between binocular and monocular accommodation, when viewing through near addition lenses, is caused by an increased vergence accommodation.     

Restoration of Binocular Vision in Amblyopia

Purpose: To develop a treatment for amblyopia based on re-establishing binocular vision.

Methods: A novel procedure is outlined for measuring and reducing the extent to which the fixing eye suppresses the fellow amblyopic eye in adults with amblyopia. We hypothesize that suppression renders a structurally binocular system, functionally monocular.

Results: We demonstrate that strabismic amblyopes can combine information normally between their eyes under viewing conditions where suppression is reduced by presenting stimuli of different contrast to each eye. Furthermore we show that prolonged periods of binocular combination leads to a strengthening of binocular vision in strabismic amblyopes and eventual combination of binocular information under natural viewing conditions (stimuli of the same contrast in each eye). Concomitant improvement in monocular acuity of the amblyopic eye occurs with this reduction in suppression and strengthening of binocular fusion. Additionally, stereoscopic function was established in the majority of patients tested. We have implemented this approach on a headmounted device as well as on a handheld iPod.

Conclusion: This provides the basis for a new treatment of amblyopia, one that is purely binocular and aimed at reducing suppression as a first step.     

Binocular reaction times to contrast increments

Binocular and monocular reaction times were measured in response to an abrupt increment in the standing contrast of a grating. For near threshold contrast increments the advantage of binocular over monocular viewing was substantial when the standing contrast was low, but this advantage was reduced at higher standing contrasts. With high contrast increments the advantage of binocular over monocular viewing was uninfluenced by standing contrast and exceeded the level expected from probability summation.     

The role of binocular vision in prehension: a kinematic analysis.

This study examined the contribution of binocular vision to the control of human prehension. Subjects reached out and grasped oblong blocks under conditions of either monocular or binocular vision. Kinematic analyses revealed that prehensile movements made under monocular viewing differed substantially from those performed under binocular conditions. In particular, grasping movements made under monocular viewing conditions showed longer movement times, lower peak velocities, proportionately longer deceleration phases, and smaller grip apertures than movements made under binocular viewing. In short, subjects appeared to be underestimating the distance of objects (and as a consequence, their size) under monocular viewing. It is argued that the differences in performance between the two viewing conditions were largely a reflection of differences in estimates of the target's size and distance obtained prior to movement onset. This study provides the first clear kinematic evidence that binocular vision (stereopsis and possibly vergence) makes a significant contribution to the accurate programming of prehensile movements in humans.     

单眼与双眼老年性白内障摘除人工晶状体植入术后的双眼视觉比较分析

目的　比较分析单眼与双眼老年性白内障摘除人工晶状体植入术后双眼视功能恢复状况。方法　对单眼和双眼人工晶状体手术患者各 6 0例分别检测矫正视力、屈光状态、双眼影像 ,以及用同视机等方法检查双眼视功能。结果　两组患者的双眼同时视功能、融合功能无显著差异。双眼手术组患者的远近立体视功能显著优于单眼组。影响单眼手术患者双眼视功能恢复的主要原因是另侧非手术眼的白内障所导致的视力低下和两眼屈光参差。结论　双眼视功能恢复水平是评价人工晶状体术后视觉质量和生活能力改善的重要指标。单眼手术和双眼手术者双眼视觉的差异主要体现在立体视功能上     

Stereoacuity and foveal fusion in adults with long-standing surgical monovision

PURPOSE: Although binocular vision deficits occur in children who have a constant esotropia onset following significant maturation of stereopsis, it is uncertain whether adults are susceptible to changes to binocular vision. We examined binocular vision in adults with longstanding surgical monovision (> or =6 month's duration) to determine whether the binocular visual system remains susceptible to change. METHODS: Participants included 32 adults with longstanding monovision through laser-assisted in situ keratectomy or photorefractive keratectomy and 20 age-matched control subjects. After full binocular correction, binocular function was measured by using the Randot Stereoacuity Test, the Randot Preschool Stereoacuity Test, and the Worth 4-dot test at near and distance. Monovision patients were grouped as having low anisometropia (<1.5 spherical D) or moderate anisometropia (> or =1.5 spherical D). RESULTS: Non-parametric analysis of variance revealed a significant difference between group median stereoacuity (H = 16.062; P <.001). Pairwise multiple comparisons indicated both groups with monovision had significantly worse stereoacuity compared with control subjects (P <.05). Median stereoacuity values were 100 seconds of arc for patients with low anisometropia, 150 seconds of arc for patients with moderate anisometropia, and 40 seconds of arc for control subjects. A larger proportion of patients with moderate anisometropia failed the Worth-4 dot test at distance than control subjects (z = 2.619; P =.009). CONCLUSIONS: Reduced stereoacuity and an absence of foveal fusion in adults with longstanding surgical monovision suggest continued susceptibility of the binocular visual system to anomalous binocular experience.     

Effects of ocular dominance on binocular summation after monocular reading adds

PURPOSE: To investigate the relationship between ocular dominance and binocular summation with monocular reading adds. SETTING: Department of Orthoptics and Visual Science, School of Allied Health Sciences, Kitasato University, Sagamihara, Kanagawa, Japan. METHODS: Contrast sensitivities were measured by having subjects view contrast charts at spatial frequencies of 1.5, 3.0, 6.0, 12.0, and 18.0 cycles per degree after the addition of positive spherical lenses that ranged from +1.0 to +3.0 diopters (D). Through the use of a balance technique, the test group was quantitatively divided into 12 weak and 8 strong ocular dominance subjects on the basis of binocular rivalry. In study 1, binocular contrast sensitivity was measured in the weak and strong ocular dominances by adding a positive spherical lens in front of 1 eye, whereas the other eye was fixed at a corrected distance. RESULTS: In study 1, the binocular summation was observed only after adding positive spherical lenses in the nondominant eye. The differences in binocular contrast sensitivity that occurred after adding a positive spherical lens in the dominant eye versus that seen in the nondominant eye were statistically significant in the strong ocular dominance subjects who had +1.5 D and +2.0 D defocuses (P<.05; analysis of variance). CONCLUSIONS: Binocular summation was effectively maintained with reading adds in the nondominant eye and was significantly influenced by the magnitude of ocular dominance. Evaluating binocular summation after monocular reading adds seems to be a good method to evaluate adaptability to monovision.