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在进行或结束常规弱视治疗的青少年弱视患者中的可察觉视物变形

Piano ME, Bex PJ, Simmers AJ

期刊名称:Investigative ophthalmology & visual science

卷期:2016年第57卷第10期

蓝方方 副主任医师,广西视光中心副主任,国际角膜塑形镜学会资深会员,广西低视力康复指导委员会副秘书长。

对于儿童的弱视,很多临床医生往往只关注儿童的单眼视功能,而忽略了弱视儿童的双眼视知觉的扭曲,这也是儿童弱视双眼视功能下降的表现之一。该研究检测了弱视的双眼视知觉的扭曲(PVDs)情况,发现一半以上的儿童在弱视治疗结束后仍有不同程度的双眼视功能异常。本研究为弱视儿童双眼视功能的缺失提供了一定的依据,强调恢复和改善弱视儿童双眼视功能的重要性。

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摘要

目的:证实弱视儿童中可察觉的视物变形(PVDs),PVDs的严重程度与弱视的临床参数间的联系,以及PVDs与弱视治疗结果间的关系。

方法:使用16点双眼比对测试对148名视觉正常儿童(年龄, 9.18 ± 2.51 岁)及82名正在接受或结束了弱视治疗儿童(年龄, 6.33 ± 1.48 岁)测量可察觉视物变形。总体偏差(GD,物理与感知的靶位置之间均值中心的个人分析误差的综合向量)及总体不确定度(GU,进行了两个实验以上的标准差除以总体差)与年龄相匹配的对照组数据以及相关的针对性的弱视的临床参数(类型,单眼视力,治疗前的眼间视敏度差,屈光不正,诊断时的年龄,运动融合,立体视觉,近似的斜视角)与弱视治疗效果(屈光适应时间,治疗持续时间,封闭药量,治疗后眼间视敏度差,线条数目提高)相比较。

结果:PVDs患病率的数据点是56.1%。与屈光不正及微斜视的弱视患者相比,有斜视的弱视患者会感受到更加严重的视物变形(GD Kruskal Wallis H = 16.89, P < 0.001; GU Kruskal Wallis H = 15.31, P < 0.001)。可察觉的视物变形与双目功能的强度呈中等相关(e.g., log 立体视力 [GD rho = 0.419, P < 0.001; GU rho = 0.384, P < 0.001)],但与近似偏差角呈强相关(GD rho = 0.578, P < 0.001; GU rho = 0.384, P < 0.001)。PVDs的严重程度与弱视治疗效果或者弱视视力损伤之间没有关系。可察觉的视物变形持续存在于超过1/2的接受力弱视治疗并且效果被认为是成功的病例中。

结论:可察觉的视物变形是弱视的常见症状,并且与双目的临床结果(立体视力,偏差角)有关,而与单眼临床结果(视力)有关。这将会为证明去相关双目单视觉在弱视的许多方面的作用提供证据,并且表明正在恢复及改善的双目单视觉对弱视个体的重要性。

PURPOSE:To establish the point prevalence of perceived visual distortions (PVDs) in amblyopic children; the association between severity of PVDs and clinical parameters of amblyopia; and the relationship between PVDs and amblyopia treatment outcomes.METHODS:Perceived visual distortions were measured using a 16-point dichoptic alignment paradigm in 148 visually normal children (aged, 9.18 ± 2.51 years), and 82 amblyopic children (aged, 6.33 ± 1.48 years) receiving or following amblyopia treatment. Global distortion (GD; vector sum of mean-centered individual alignment error between physical and perceived target location) and Global uncertainty (GU; SD of GD over two experiment runs) were compared to age-matched control data, and correlated against clinical parameters of amblyopia (type, monocular visual acuity, pretreatment interocular acuity difference, refractive error, age at diagnosis, motor fusion, stereopsis, near angle of deviation) and amblyopia treatment outcomes (refractive adaption duration, treatment duration, occlusion dosage, posttreatment interocular acuity difference, number of lines improvement).RESULTS:Point prevalence of PVDs in amblyopes was 56.1%. Strabismic amblyopes experienced more severe distortions than anisometropic or microtropic amblyopes (GD Kruskal Wallis H = 16.89, P < 0.001; GU Kruskal Wallis H = 15.31, P < 0.001). Perceived visual distortions severity moderately correlated with the strength of binocular function, (e.g., log stereoacuity [GD rho = 0.419, P < 0.001; GU rho = 0.384, P < 0.001)], and strongly with near angle of deviation (GD rho = 0.578, P < 0.001; GU rho = 0.384, P < 0.001). There was no relationship between severity of PVDs and amblyopia treatment outcomes, or the amblyopic visual acuity deficit. Perceived visual distortions persisted in more than one-half of treated amblyopic cases whose treatment was deemed successful.CONCLUSIONS:Perceived visual distortions are common symptoms of amblyopia and are correlated with binocular (stereoacuity, angle of deviation), but not monocular (visual acuity) clinical outcomes. This adds to evidence demonstrating the role of decorrelated binocular single vision in many aspects of amblyopia, and emphasizes the importance of restoring and improving binocular single vision in amblyopic individuals.


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