屈光矫正对近视儿童近距融合功能及水平位均衡的影响

目的探讨屈光矫正前后近视儿童近距融合功能的变化以及评价双眼水平位均衡状态。方法横断面研究。检测60例近视儿童屈光矫正前后近距融合功能和双眼水平位均衡的情况,按照近视程度分为：A组,-0.50~-1.00 D 20例;B组,-1.25~-2.00 D 20例;C组,-2.25~-3.00 D 20例。另选择年龄相匹配的30例正视儿童作为对照。采用单因素方差分析比较正、负融像性集合,采用卡方检验评价双眼水平位均衡情况,分析屈光矫正对近距融合功能和双眼水平位均衡的影响。结果近视组未矫正状态与正视组近距正融像性集合差异有统计学意义（F=85.88,P＜0.01）,且从A组起差异明显。而近距负融合像集合差异无统计学意义（F=1.48,P＞0.05）。近视组矫正状态仅C组与正视组在近距正融像性集合方面差异有统计学意义（F=97.87,P＜0.01）。近视组未矫正状态表现为近距融合范围明显变小,近距融合范围为（+12.50~-15.89 △）。近视组未矫正状态与正视组相比双眼水平位失衡率显著增高（?字2=47.27,P＜0.01）。结论看近时未矫正的近视对融合功能的影响在低度近视时就已经非常显著,尤其是对近距正融像性集合的影响;且双眼水平失衡率显著增高。     

集合不足型外隐斜合并调节不足三种治疗方法的比较

目的 比较集合调节训练、三棱镜配戴矫正和近视屈光过矫在集合不足型外隐斜合并调节不足患者中的疗效.方法 横断面研究,将10～35岁的60名确诊为集合不足型外隐斜合并调节不足患者随机分为3组,每组20例,A组行三棱镜配戴矫正,B组行近视屈光过矫-0.50 D戴镜矫正,C组行集合调节视功能训练,于3个月后复查隐斜度和视功能采用配对t检验和单因采方差分析 结果 复查各项视功能参数3组患者之间差异有统计学总义 A组患者隐斜度增加(t=1 2.65,P＜0.01),近距正相对融合范围减小(t=12.65,P＜0.01),症状先短暂缓解后加重;B组患者隐斜度增加(t=4.63,P＜0.01),近距正E相对融合范围减小(t＝6.71,P＜0.01),调节幅度减小(t=14.3,P＜0.01),症状明显加重;C组患者隐斜度显著减小(t=-11.61,P＜0.01),近距正相对融合范围显著增大(t=-22.40,P＜0.01),调节幅度显著增大(t=-31.06,P＜0.01),症状明显改善 结论 集合不足型外隐斜合并调节不足患者采用集合调节视功能训练能明显改善症状,减少近距隐斜度,增加近距正相对融合范围和调节幅度,是一种有效可行的治疗方法.     

近视儿童调节滞后与隐斜状态及相关因素研究

目的 研究近视儿童近距注视下的调节滞后和隐斜量,分析近视儿童调节滞后与近隐斜的关系及相关因素.方法 受试者为250名近视儿童,等效球镜屈光力范围为-0.50～-5.25D.采用MEM动态检影法测量受试者右眼近距的调节滞后;分别采用Howell测量法(HT)和改良Thorington测量法(MTT)测量近隐斜;通过问卷调查受试者父母的屈光状态.各重复测量三次,取均值.结果 受试者近距调节滞后为(+0.97±0.43)D,近隐斜为(-0.94±4.55)△(外隐斜,HT)和(-1.71±4.85)△(外隐斜,MTT).伴近内隐斜者占28.0％(HT)和22.8％(MTT).伴近内隐斜者的调节滞后和内隐斜呈正相关(r=0.353,P=0.003,HT;r =0.461,P＜0.001,MTT);受试者调节滞后和近视程度呈负相关(r=-0.241,P＜0.001).23％近视者父母均为近视,其调节滞后显著大于其父母组儿童(F =4.90,P=0.009).结论 近视儿童在近距注视状态下调节滞后较高.近隐斜状态和遗传因素都可能影响近视儿童的调节滞后,调节滞后量与近视程度可能存在相互作用.临床上应将近距调节反应和隐斜测量纳入儿童的常规视功能检查项目.     

近视伴共同性外斜视戴矫正镜后斜视角大于矫正前的相关因素研究

目的 研究双眼近视伴共同性外斜视患者戴矫正镜后的斜视角大于戴矫正镜前的相关因素,探讨其可能存在的原因.方法 回顾性分析15例双眼近视伴共同性外斜视戴矫正镜后斜视角大于矫正前的患者资料,总结其视力状态、屈光状态、调节与集合功能以及比较矫正前与戴矫正镜状态下使用三棱镜加遮盖法检查视远及视近的斜视角.结果 15例患者矫正视力正常,屈光状态呈现高度近视及近视性屈光参差,调节超前,斜视角检查:视近时屈光矫正后与矫正前斜视角平均相差为(2.7±2.1)△,差异无统计学意义,视远时屈光矫正后的斜视角大于矫正前的斜视角,平均相差为(11.8±4.3)△,差异具有显著统计学意义(P<0.01).结论 双眼近视伴共同性外斜视患者视力矫正后的斜视角可大于未矫正情况下的斜视角,此种现象可能与模糊像性调节有关.     

青少年近视足矫与欠矫配镜的临床观察

目的：观察青少年近视患者足矫或欠矫配镜的近视发展程度。

方法：选取2008-01/2012-09在我科就诊的青少年近视患者132例264眼。分为足矫与欠矫两组,足矫组给予完全矫正并要求配镜后常戴,欠矫组给予低矫-0.25～-0.50D。每隔6mo复查,随访12mo对比两组患者近视屈光度。

结果：足矫组与欠矫组相比,6mo时两组间平均近视度无明显差异(P=0.0693); 12mo时两组间比较有显著性差异(P=0.0013)。

结论：足矫并且常戴镜患者的近视发展相对较慢。     

不同程度近视青少年儿童双眼视功能的差异

目的通过比较不同程度近视儿童双眼协动参数的差异性及其与近视程度相关性,进一步探索近视发展的原理。方法横断面研究。研究对象包括128例7～14岁近视青少年儿童,根据等效球镜度分为低度近视组（-0.50～-3.00 D）、中度近视组（-3.25～-6.00 D）和高度近视组（>-6.00 D）。双眼协动参数测量包括远距及近距水平聚散力,远距及近距水平隐斜,梯度性调节性集合与调节的比率（AC/A比率）。采用单因素方差分析和卡方检验对3组数据进行分析。结果在融像性聚散范围中,远距散开力的破裂点、近距散开力的恢复点、远距集合力的恢复点、近距集合力的模糊点及破裂点随近视程度加深而减小（F=3.271、3.579、4.931、6.507、4.887,P<0.05）,其余参数的差异无明显统计学意义（P>0.05）;在隐斜视类型的构成比中,远距及近距隐斜类型构成比例的差异在3组中无明显统计学意义（P>0.05）,总体上近距内隐斜构成比例高于远距内隐斜（χ²=6.609,P<0.05）;梯度性AC/A随近视程度的增加而增加（F=3.625,P<0.05）,其中高度近视组明显高于低度近视组（P<0.05）。结论随着青少年儿童近视程度的增加,融像性聚散范围减少,梯度性AC/A比率增高。近视儿童表现出的近距内隐斜可能与近视发展相关。     

视觉训练对功能性视力下降患者的疗效

目的 分析功能性视力不良患者集合功能、调节功能特点,研究双眼视觉训练对功能性视力不良患者的疗效.方法 回顾性研究.收集2012年7月至2013年10月于天津市眼科医院视光中心视觉训练工作室就诊的功能性视力不良的患者20例,平均年龄(11.2±5.9)岁.所有患者均排除眼部疾病、弱视危险因素和全身性疾病.在屈光矫正的基础上进行双眼视功能检查.分析、诊断后进行视觉训练治疗以提高矫正视力.采用配对t检验、Spearman相关性分析等进行统计分析.结果 患者右眼屈光度为+2.25～-8.75 D,左眼屈光度+2.87～-8.63 D.根据双眼视功能检查结果发现20例患者中,有13例诊断为集合不足并伴调节功能异常,有4例诊断为调节过度,2例为基本型外隐斜,1例为散开不足.经过2个月的视觉训练治疗,所有患者远、近矫正视力均提高到1.0(Z=-3.948,P＜0.01;Z=-3.193,P＜0.01).视力恢复后集合功能指标近距离融像范围(PRV)破裂点增加(t=-5.173,P＜0.01);单眼调节灵敏度(MAF,Z=3.928,P＜0.01)、双眼调节灵敏度(BAF,Z=-3.835,P＜0.01)、正负相对调节(PRA,t=4.094,P＜0.01;NRA,t=-4.254,P＜0.01)等调节功能均恢复到正常,差异有统计学意义.进行相关分析发现,训练前矫正远视力(r=-0.584,P＜0.01;r=-0.658,P＜O.01)、训练前矫正近视力(r=-0.451,P＜0.01;r=-0.540,P＜0.01)均与远隐斜、近距离融像范围呈负相关.结论 功能性视力不良患者通常伴有集合功能、调节功能不良,进行有效的视觉训练治疗,可以提高视力.     

Von Garaefe法测定近视青少年隐斜视

目的介绍一种测定隐斜的方法,了解近视青少年隐斜状态.方法242名近视青少年按屈光度分为4组,采用VonGraefe法测定视远和视近的隐斜状态.结果近视青少年视远水平隐斜范围-11     

影响近视性屈光不正调节滞后的相关因素探讨

目的 探讨近视眼在不同状态下,调节刺激与调节滞后的变化关系.方法 临床病例对照研究.对2011年4～7月在天津眼科医院就诊病人,选取25只正视眼,72只近视眼,并按屈光度数分成低中高三组.注视调节E视标,同时使用开视野红外验光仪,测量不同距离以及不同近用附加状态下双眼的实际调节反应;应用综合验光仪测量近用隐斜度,比较近用隐斜与调节滞后的关系.结果 双眼视状态下,高度近视组和正视组在4 D (P =0.049)、5 D(P=0.018)的调节刺激下,调节滞后量差异有统计学意义(P＜0.05),而正视组、低度近视组、中度近视组间的调节滞后量无统计学意义;受试者40 cm处右眼的调节滞后量与40cm处的隐斜量呈线性相关(y=O.0606x+0.9655,r=0.483 P=0.001,P＜0.05); 比较正视眼组和近视眼组在40cm处无附加,+1 D以及-1 D附加的三种情况下的平均调节反应,在-1 D附加时,正视组(-1.74±0.47)与近视组(-2.02±0.35)的调节反应差异有统计学意义(P =0.000).结论 在相同调节刺激下,近视眼的调节滞后量大于正视眼,其中高度近视眼表现尤为明显;近用隐斜度数影响近用调节滞后的幅度,外隐斜使调节滞后量相对减少,内隐斜使调节滞后量相对增多;正性近用附加使调节滞后量减小,负性附加使调节滞后量增大,且近视组的滞后量明显大于正视组.     

近视学生的水平隐斜及屈光矫正对隐斜的影响

目的:了解近视学生同正常学生水平隐斜的差异,不同近视程度学生隐斜度的变化,屈光矫正对隐斜的影响。方法:采用隐斜仪(Maddox杆旋转三棱镜)测定825名青少年学生的远近隐斜度,比较近视与正常学生的隐斜发生率,再将近视学生按近视程度、矫正情况分类、分组,分别同正常学生进行隐斜度比较。结果:远外隐斜发生率:正常学生19.8%,近视学生28.8%;近外隐斜发生率:正常学生52.9%,近视学生64.7%。远隐斜均值:正常学生为1.97△;低、中、高度近视全体学生分别为1.76△,1.33△,-0.68△;矫正足度组分别为2.11△,1.75△,0△;不矫正组(低、中度近视)分别为1.29△,-0.78△。近隐斜均值:正常学生为-0.67△;低、中、高度近视全体学生分别为-2.43△,-3.02△,-5.71△;矫正足度组分别为-1.20△,-2.28△,-4.06△;不矫正组(低、中度近视)分别为-3.28△,-5.06△。近隐斜度产生显著差异的屈光度界线有两处:(1)-0.75～-2.00D,(2)-6.00D;矫正足度后仅有一处:-3.00～-6.00D。远隐斜度产生显著差异的屈光度界线有一处:-3.00～-6.00D;矫正足度后消失。结论:近视学生比正常学生外隐斜显著增多。学生近视如不矫正或矫正不足,对近隐斜度的影响在低度近视就已非常显著,对远隐斜度的影响是近视程度越高影响越大。     

配戴多焦点硬性角膜接触镜对近视患者双眼视功能的影响

目的：探讨多焦点设计的硬性角膜接触镜对近视患者双眼视功能的影响。

方法：自身前后对照研究。于2020-07/08在川北医学院招募近视学生15人作为试验者,试验者首先配戴框架眼镜行双眼视功能检查,然后分别配戴单焦点与多焦点硬性角膜接触镜(间隔1wk),每种镜片配戴2wk后行双眼视功能检查。采用单因素方差分析比较多焦点硬性角膜接触镜(MFRGP)、单焦点硬性角膜接触镜(SVRGP)和框架眼镜双眼视功能的差异。

结果：三种镜片立体视、远距水平隐斜、远距正融像性聚散、远距负融像性聚散、近距正融像性聚散、聚散灵活度、集合近点、调节幅度、调节灵活度、负相对调节比较均无差异(P>0.05)。与框架眼镜相比,配戴MFRGP近距水平隐斜、近距负融像性聚散、调节滞后、正相对调节增大,AC/A降低(P=0.023、0.048、0.001、0.013、0.046); 与SVRGP相比,MFRGP近距水平隐斜、调节滞后、正相对调节增大,AC/A降低(P=0.014、<0.001、0.001、0.009)。

结论：配戴MFRGP会引起近距水平隐斜、调节滞后、正相对调节增大和AC/A降低,这些变化可能对配戴者近距离用眼产生一定影响,在临床应用中要考虑这些预期的变化,以便正确评估和管理患者。     

有晶状体眼后房型人工晶状体植入术后水平隐斜及融合功能的变化

目的评价有晶状体眼后房型人工晶状体（PPC-ICL）植入治疗高度近视术后患者水平隐斜及融合功能的变化。方法自身对照研究。被检者为行PPC-ICL植入术治疗高度近视的患者42例（84眼）,分别于术前、术后1个月和术后6个月行远、近水平隐斜及远、近内外融合的测定。采用重复测量的方差分析对术前、术后1个月及6个月以上各参数进行统计分析。结果术后1个月时看远、看近水平隐斜分别为（-2.24±3.33）△和（-4.95±5.45）△,术后6个月时分别为（-2.02±2.93）△和（-3.55±5.10）△,均低于术前[（-4.33±4.62）△和（-8.88±6.74）△],差异有统计学意义（F=5.00、9.53,P＜0.01）。术后1个月时看远、看近内融合分别为（12.74±3.52）△和（14.36±3.96）△,术后6个月时分别为（13.95±4.01）△和（16.79±3.90）△,均高于术前[（9.83±2.68）△和（10.95±3.28）△],差异有统计学意义（F=15.83、25.96,P＜0.01）。术后1个月时看远、看近外融合分别为（8.05±2.15）△和（15.29±3.52）△,术后6个月时分别为（7.74±1.86）△和（14.64±3.11）△,均高于术前[（7.36±2.66）△和（13.43±3.11）△]。术后看近外融合较术前差异有统计学意义（F=3.53,P＜0.05）,看远外融合差异无统计学意义（F=0.99,P＞0.05）。结论PPC-ICL植入术后患者水平隐斜和融合范围较术前改善,视觉舒适度提高。     

川东北地区基于某视光门诊的非斜视性双眼视觉异常患病情况及相关因素研究

目的：:调查川东北地区某眼视光门诊12～35岁患者的非斜视性双眼视觉异常（NSBVD）患病情况及相关因素。方法：:系列病例研究。招募于川北医学院附属医院眼视光门诊寻求常规视力检查的12～35岁志愿者172例。检查内容包括主觉验光、立体视觉、水平隐斜、正融像性聚散（PFV）和负融像性聚散（NFV）、聚散灵活度（VF）、集...     

角膜屈光手术对近视患者双眼视功能的影响

目的：:探究角膜屈光手术对近视患者双眼视功能的影响及临床意义。方法：:回顾性研究。选取2018年1月至2020年4月于长春爱尔眼科医院屈光手术中心行角膜屈光手术的患者82例（164眼）,年龄18~32（23.5±4.2）岁。术前等效球镜度（SE）为-8.38~-0.88（-4.75±1.69）D。根据双眼SE差值将患者...     

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...     

Contact lenses vs spectacles in myopes: is there any difference in accommodative and binocular function?

Background  

Theoretically, the accommodative and vergence demands are different between single-vision contact lenses and spectacle lenses. The aim of the present study was to determine whether these differences exist when these two correction methods are used in clinical practice. For this, different visual parameters that characterize the accommodative (accommodation amplitude, accommodative facility, and accommodative response) and binocular function (near and distance horizontal and vertical dissociated phorias, near and vertical associated phorias, near and distance negative and positive fusional vergence, vergence facility, near point of convergence, negative and positive relative accommodation, stimulus AC:A ratio and stereoacuity) were evaluated in a student population when their myopia was corrected with either spectacles or soft contact lenses (SCL).     

Evaluation of a new criterion of binocularity

The purpose of this study was to assess a new criterion for binocular comfort analogous to the classical Sheard's criterion. Instead of equating the fusional demand with the monocular phoria as is done when Sheard's criterion is applied, the new criterion uses a calculated binocular fusional demand. The binocular demand was derived using a clinical measurement of the convergence accommodation per convergence (CA/C) ratio. Sheard's criterion was also evaluated. Other commonly used indicators of binocularity (heterophoria, vergences, accommodative amplitude, facility and response, fixation disparity, and the associated phoria) were measured. One hundred subjects (52 males, 48 females; mean age 26 years) were classified as either symptomatic or asymptomatic by an interviewing clinician. The examining clinician was intentionally masked as to the classification of the subjects. We hypothesized that the new criterion would best discriminate between the two groups of patients inasmuch as it is based on currently accepted dual-interaction models of accommodation and vergence. Our analysis confirmed that the CA/C ratio corresponded closely to those published previously (mean = 0.06 D/delta). Significant differences (p less than 0.05) were determined between the symptomatic and asymptomatic groups for gender, near phoria through a +2.00 D add, accommodative amplitude, positive vergences at near, and both the classical Sheard's and the new criterion. The new criterion was the best discriminator between the groups, identifying 72% correctly, an improvement of 6% over the classical Sheard's. However, various stepwise discriminant analysis procedures consistently failed to demonstrate that the calculated binocular fusional demand or the new criterion was superior to the near phoria or the classical Sheard's value. These results suggest potential clinical utility for new procedures based on recently described models of accommodation and vergence, but further development appears necessary.     

Comparison of Binocular Vision Parameters Pre- and Post-EPILASIK Laser Vision Correction Surgery for Myopia in a Pilot Study – Can Vision Therapy Augment Refractive Results?

Purpose:To analyze the changes in the binocular vision parameters after bilateral Epilasik laser vision correction surgery (LVCS).Setting:Medical Research Foundation, Tamil Nadu, India.Study design:Prospective cohort study.Methods:Subjects with a best corrected visual acuity of ≤ 0.0 Log MAR scale and refractive error: < 6.00DS of myopia, < 0.75D of astigmatism, and < 1D of anisometropia were included in the study. All subjects underwent a comprehensive eye examination, LVCS workup which included corneal topography, tomography, aberrometry, and dry eye assessment prior to binocular vision assessment. Complete Binocular vision assessment which included stereopsis, fusion for distance and near, near point of convergence, phoria measurement, vergence amplitudes and facility, accommodative amplitudes, response, and facility was performed with the best corrected vision prior to LVCS, one month and six months after the surgery.Results:Twenty-five subjects of age 23.8 ± 2.9 years were included. Age ranged from 20 to 32 years. Ten were female and 15 were male. The median spherical power was –2.00DS with an inter quartile range (IQR) of –1.50DS to –3.00DS for both eyes. The median cylindrical power was plano with IQR –0.50DC to –1.00DC for both eyes. There was a statistically significant decrease in monocular and binocular accommodative amplitudes (accounting for age-related changes) as well as positive fusional vergence recovery for near between baseline and one month after surgery (p < 0.05).Conclusion:Though subjects were asymptomatic post LVCS, still there is an indication that myopic LVCS could precipitate or aggravate an existing non-strabismic binocular vision anomaly. Comprehensive binocular vision assessment and appropriate management is recommended before and after LVCS.     

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.