初发近视儿童调节反应与近视屈光度的关系

目的 探讨初发近视儿童调节反应与近视屈光度的关系。设计 回顾性病例系列。研究对象 北京同仁验光配镜中心视力下降在6个月内的8～10岁儿童96例,复方托吡卡胺散瞳测双眼近视低于-1.00 D。方法 散瞳前采用综合验光仪进行调节反应、调节灵活度以及正、负相对调节检查。选取双眼中较低度数眼的参数进行统计学分析。主要指标 屈光度、调节反应、调节灵活度、正负相对调节。结果 受试者屈光度为（-0.66±0.25）D,调节反应为（0.25±0.36）D;调节灵活度为（6.31±2.54）cpm;负相对调节为（2.20±0.40）D;正相对调节为（-1.96±1.32）D。调节反应与近视屈光度呈负相关（r=-0.34,P=0.001）;调节反应与调节灵活度、负相对调节无相关性（r=0.027,P=0.798,r=-0.140,P=0.174）;调节反应与正相对调节呈正相关（r=0.231,P=0.023）。结论 初发近视儿童已存在调节反应滞后,调节反应滞后和正相对调节的降低,可能是近视发生发展的原因。（眼科, 2014, 23: 319-322）     

学龄期近视进展儿童调节功能的客观检查和分析

目的　对学龄期近视进展儿童进行调节功能的客观检查与分析，观察调节功能与近视进展之间的相关性。方法　选取2017年至2018年在首都医科大学附属北京同仁医院视光学门诊定期就诊的71名学龄期儿童为研究对象，根据受试者近年的屈光度进展速度，按≤0.50 D·a^-1、>0.50~1.00 D·a^-1、>1.00~1.50 D·a^-1、>1.50 D·a^-1分为4组，使用人眼调节分析仪对受试者进行调节功能的客观测量与分析，记录不同调节刺激视标下4组的客观调节反应值和客观调节微波动值，并作对比。结果　在所有调节视标上，各组随着调节刺激幅度增加，客观调节反应值也逐渐增加，4组在不同调节刺激视标下的客观调节反应值及平均的客观调节反应值差异均无统计学意义（均为P＞0.05）。≤0.50 D·a^-1、>0.50~1.00 D·a^-1、>1.00~1.50 D·a^-1、>1.50 D·a^-1近视进展速度组调节微波动值分别为（62.2±5.6）D、（62.5±5.3）D、（66.5±6.0）D和（58.0±6.5）D，4组间差异有统计学意义（F=6.424，P=0.001），在+0.50~-0.50 D、-2.00 D调节刺激视标下，4组的客观调节微波动值比较差异均有统计学意义（均为P＜0.05），在其余调节刺激视标下差异均无统计学意义（均为P＞0.05）。结论　对于学龄期儿童的近视进展速度，客观调节微波动值相对于客观调节反应值可能是一个更为敏感的相关指标。     

Validity and repeatability of the modified push-up method for measuring the amplitude of accommodation

Introduction : The modified push-up method is recommended for testing the amplitude of accommodation in young children. In this study, the modified push-up method was compared with the conventional push-up method for measuring the amplitude of accommodation. Methods : Three experiments were carried out in the validity study. The first experiment was set up to compare the measured amplitudes between the modified push-up method and the conventional push-up method. The second and third experiments were carried out to further investigate the possible contribution of the target choice or criterion choice, respectively, to the measured amplitude results. The repeatability study was then performed. Results : The modified push-up method produced lower measures of the amplitude of accommodation than the conventional push-up method. The average difference was 0.40 D monocularly and 1.30 D binocularly. The choices of both target and criterion significantly contributed to the difference. The modified push-up method was a highly repeatable method. Conclusion : We conclude that the modified push-up method is interchangeable with the conventional push-up method for clinical use, but lower amplitude readings by 0.40 D monocularly and 1.3 D binocularly would be expected.     

改良内斜视矫正术治疗部分调节性内斜视

目的探讨部分调节性内斜视手术的临床效果。方法对52例部分调节性内斜视以[(裸眼视近-裸眼视远)+(戴镜视近-戴镜视远)]×1/2之所得三棱镜度设计行内斜矫正术,术后平均观察2年。结果术后2年,斜视治愈率高达94.23%;术后矫正视力较术前均有不同程度提高,差异有统计学意义,P<0.05;双眼单视功能较术前均有明显改善,差异有显著性,P<0.05。结论以1/2×[(裸眼视近-裸眼视远)+(戴镜视近-戴镜视远)]的斜视角来设计手术,对矫正部分调节性内斜视效果较好,但要注意早诊断早治疗。     

Comparison of Visual Function after Multifocal and Accommodative IOL Implantation

Purpose： To compare early visual function between patients undergoing phacoemulsification combined with multifocal and accommodative intraocular lens implantation.
Methods： A total of 112 patients with age-related cataract undergoing phacoemulsification in our hospital were recruited for this study and randomly assigned into multifocal （56 eyes; ZAM00 group） and accommodative （56 eyes; FLEX group） intraocular lens groups. Visual acuity and contrast sensitivity were statistically compared between the two groups.
Results： No significant difference was found in uncorrected distant visual acuity between the ZMA00 and FLEX groups at 1 week, or 1, 3, and 6 months after operation （all P〉0.05）. At postoperative 6 months, no statistical significance was noted in distant and intermediate best-corrected visual acuity or in contrast sensitivity between the two groups （all P〉0.05）. Patients in the ZMA00 group were superior to their counterparts in the FLEX group regarding near best corrected visual acuity, reading speed, and spectacle independence （all P〈0.05）.
Conclusion： ZMA00 and FLEX IOL implantation can provide excellent distant and intermediate visual acuity for patients with age-related cataract. ZMA00 IOL is superior to FLEX in terms of near visual acuity.     

Evaluation of Accommodative Insufficiency with the Visual Analogue Scale (VAS)

Purpose: The purpose of this study was to evaluate whether asthenopic symptoms in schoolchildren diagnosed with accommodative insufficiency (AI) and graded with the Visual Analogue Scale (VAS) could be correlated with the degree of accommodative deficiency in these children, and to investigate if VAS grading of the asthenopic symptoms could be used as an instrument to indicate the level of improvement of AI. Methods: Forty-nine children (mean age 10.2 years ± 2.7) diagnosed with AI graded their degree of asthenopia on the VAS before and after a 12-week treatment period wearing individually dispensed reading glasses. Results: The improvement in accommodation after treatment was statistically significant (p < 0.001) and 83.7% of the children obtained normal accommodative amplitude in relation to age. The reduction in asthenopic symptoms as graded with the VAS was also statistically significant (p < 0.001) after treatment and 89.9% of the children obtained a normal VAS score. However, no correlation between the degree of accommodative deficiency and the VAS grading could be found, neither before nor after treatment. Discussion: Based on these results we conclude that the visual analogue scale (VAS) cannot be used as an instrument to indicate the degree of accommodative deficiency nor can it be used to indicate the level of improvement during the course of treatment. However, the VAS can be used as an instrument to verify and document whether or not asthenopic symptoms are present, and therefore also to indicate when symptoms have been relieved.     

双元件可调节人工晶状体设计

目的：设计一种新的双元件可调节人工晶状体,并对其成像质量进行评估。方法：通过光学设计软 件Zemax,建立新设计的双元件可调节人工晶状体和人眼模型,模拟仿真其在不同视距下（L=6 m、 L=70 cm、L=40 cm以及L=25 cm）的成像结果,得到空间频率为100 cycles/mm时的调制传递函数 （MTF）值。与Simonov等研究结果进行对比分析,同时分析仿真结果是否满足人工晶状体植入光学 特性和测试标准。结果：通过光学设计软件模拟仿真新设计的双元件可调节人工晶状体眼模型,其 结果显示无论α=0°还是α=5°,瞳孔大小为3 mm时,单色光（λ=0.546 μm）空间频率100 cycles/mm 对应的MTF值均大于0.43,满足人工晶状体植入光学特性和测试标准。在α=0°时,仿真结果相较 于Simonov等研究结果有较大提升;在α=5°时,无明显提升。结论：本研究设计的双元件可调节人 工晶状体仿真结果满足人工晶状体植入光学特性和测试标准要求,相较于Simonov的研究结果,其 整体性能有所提升。     

Visual acuity and the accuracy of the accommodative response

Previous investigators have observed that some subjects show large amounts of accommodative lag. We hypothesized that less accurate accommodation might be associated with poorer visual acuity and/or smaller pupil sizes. Sixty subjects (30 emmetropes and 30 myopes) aged 20-30 years, participated. All had best-corrected visual acuity of 6/6 or better [mean = -0.10 +/- 0.07 logarithm of the minimum angle of resolution (logMAR)]. Subjects monocularly viewed reduced Bailey-Lovie charts through a +6.50 D Badal lens on a Canon R1 auto-refractor. Visual acuity, accommodative response and pupil diameter were measured for 0, 2 and 4 D accommodative stimuli. For accommodation measurements (N= 10) subjects were instructed to fixate the smallest letters that they could read. The mean accommodative response was +0.22 +/- 0.28, +1.83 +/- 0.23 and +3.71 +/- 0.27 D for the 0, 2 and 4 D stimuli, respectively. The mean visual acuity was -0.06 +/- 0.10, -0.11 +/- 0.07 and -0.11 +/- 0.07 logMAR for the 0, 2 and 4 D stimuli, respectively. Visual acuity for the 0 D stimulus was significantly poorer than for other conditions (p < 0.001) and associated with increased accommodative lead (p < 0.01). There was also an association between visual acuity and accommodative response (or lag) for the 4 D stimulus (p=0.002). The emmetropes showed significantly better visual acuity than the myopes (p= 0.004). No significant difference was observed in the accommodative response between emmetropes and myopes. Pupil diameter was not associated with the accuracy of the accommodative response (p > 0.17). Increased accommodative lead (0 D stimulus) and accommodative lag (4 D stimulus) are associated with decreased visual acuity. Smaller pupil diameters are not associated with increased accommodative lag.     

Improving interactive facility with vision training

The measurement of accommodative facility has gained acceptance in optometric examinations because it can provide valuable information on the dynamics of accommodation. Accommodative infacility is usually treated by prescribing various orthoptic exercises. This study arose from a need to investigate the effects of specific vision training procedures on binocular accommodative facility (interactive facility). The results indicate that even relatively short periods of accommodative rock training can improve the level of interactive facility.