短时间平板电脑游戏对青少年近视患者调节反应和调节微波动的影响

背景 近距离使用电子平板设备是造成近视发生和进展的危险因素之一,研究此类设备对人眼调节系统的影响可能为近视防控提供新的思路. 目的 观察短时间进行平板电脑游戏前后青少年近视患者的调节反应值、调节微波动以及瞳孔直径的变化. 方法 采用前瞻性系列病例观察研究方法,纳入2014年8月至2015年4月于北京大学人民医院就诊的60例青少年近视患者,患者平均年龄(11.6±2.6)岁,平均等效球镜屈光度(SER)为(-2.38±1.08)D.采用随机数字表法将60例受试者随机分成不同游戏时间组,分别进行3、5和10 min iPAD电脑平板游戏,采用开放视野红外验光仪记录受试者游戏前后的瞳孔直径和调节数据,将采集的调节数据减去理论调节反应值计算为实际调节反应值,以实际调节反应值的均方根(RMS)作为调节微波动幅度,采用一维离散傅里叶变换法分析调节反应曲线的频谱特征.采用配对t检验对各组游戏前后的调节反应值、调节微波动幅度以及瞳孔直径进行比较.采用Wilcoxon符号秩检验对各组游戏前后调节反应曲线的高频信号占总信号功率百分比进行分析.结果 10 min组受试者游戏后的调节反应值为(0.74±0.27)D,明显低于游戏前的(0.81±0.29)D,差异有统计学意义(t=2.263,P=0.036),而3 min组和5 min组受试者游戏前后的调节反应值差异均无统计学意义(均P＞0.05).10 min组受试者游戏后调节微波动幅度(RMS)为(0.31±0.08)D,较游戏前的(0.27±0.09)D明显增加,差异有统计学意义(t=-2.259,P=0.036),而3 min组和5 min组受试者游戏前后的调节微波动幅度差异无统计学意义(均P＞0.05).3个组受试者游戏后调节微波动高频信号均高于游戏前,其中5 min组和10 min组受试者游戏前后高频信号比较差异均有统计学意义(Z=-2.213、-2.016,均P＜0.05).3个组受试者游戏后瞳孔直径较游戏前均缩小,其中5 min组和10 min组受试者游戏前后瞳孔直径的差异均有统计学意义(t=2.428,P=0.026;t=2.515,P=0.021). 结论 青少年近视患者进行短时间平板电脑游戏并不加重调节滞后,但是调节微波动幅度增加及调节反应曲线高频信号成分的增加均可能导致图像模糊,对控制近视进展不利.

Influences of short-term iPAD game on accommodative response and microfluctuation in adolescent myopia patients

Background Using tablet computer at a short distance is one of the risk factors resulting to pathogenesis and progression of myopia.Studying the effect of such device on accommodative system of human eyes can provide further insights into myopia control.Objective This study was to explore the influences of playing iPAD game for a short duration on accommodative response,accommodative microfluctuation and pupil diameter in adolescent myopia patients.Methods Sixty adolescent myopic patients were included in Peking University People 's Hospital from August 2014 to April 2015,with the mean age (11.6±2.6) years and mean spherical equivalent refraction (SER) (-2.38±1.08)D.The patients were randomly divided into 3 groups according to different playing duration of iPAD game,including 3-minute group,5-minute group and 10-minute group.An open-field infrared refractometer was used to record pupil diameter and accommodation-associated data before and after playing iPAD game.Accommodative response was defined as the difference between the recorded value and theoretical accommodative response,and root mean square (RMS) was used to describe the amplitude of accommodative microfluctuation.One-dimension discrete Fourier transformation was used to analyze spectral characteristic of accommodative response curve.Paired t tests were used to compare these accommodative parameters before and after playing game,while Wilcoxon signed-rank tests were applied for analyzing high frequency component of accommodative microfluctuation.This research conforms to the declaration of Helsinki,and was approved by Peking University People's Hospital Ethics Committee,all the subjects and their guardian signed informed consent.Results The accommodative response values before and after playing iPAD game in 10-minute group were (0.81 ±0.29)D and (0.74 ± 0.27) D,respectively,with significant difference between them (t =2.263,P =0.036),and no significant differences were found in the accommodative response values before and after playing iPAD game in the 3-minute group and 5-minute group (both at P＞0.05).The RMS after playing iPAD game was (0.31 ±0.08) D in the 10-minute group,which was significantly higher than (0.27 ± 0.09) D before playing iPAD game (t =-2.259,P =0.036).The high-frequency spectral power of accommodative response curves in all the three groups were increased after playing iPAD game in comparison with before playing iPAD game,with significant differences in the 5-minute group and 10-minute group (Z =-2.213,-2.016;both at P ＜ 0.05),and the pupil diameters were significantly decreased after playing iPAD game in comparison with before playing iPAD game,with significant differences in the 5-minute group and 10-minute group (t =2.428,P =0.026;t =2.515,P =0.021).Conclusions Short-term exposure to iPAD does not deteriorate accommodative lag in adolescent myopic patients.However,the increase of amplitude and high-frequency spectral power of accommodative microfluctuation,together with accommodation lag will result in blurred images and may bring adverse effects on myopic eyes.