主导眼评估及主导眼与非主导眼调节功能比较

发布时间：2018-03-11 13:31

本文选题：注视性主导眼　切入点：运动性主导眼　出处：《天津医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的1.研究用不同方法测量的主导眼结果的一致性,并分析双眼屈光不正度差异与不同测量方法结果的一致性是否具有相关性。2.分析测量结果出现差异的原因及理论基础,评价不同主导眼测量方法的优缺点。提出全面评估主导眼的思路。3.分别对三种类型的主导眼与非主导眼进行单眼调节功能测量,探究三种类型主导眼的调节功能与非主导眼的调节功能之间是否存在差异并分析其原因。研究主导眼的类型及单眼调节功能评估的意义。方法于2015年9月至2016年1月,随机选取天津医科大学学生及教师共80人,年龄最低18岁,最高37岁,平均(23.03±4.92)岁,其中男性33人,女性47人。入选条件为:单眼矫正视力达40/50及以上,双眼之间的视力差异小于两行;无显性斜视及弱视;无调节与集合功能异常;无眼部器质性疾病及影响眼屈光的全身性疾病;一年内无影响眼部调节功能及眼肌运动相关药物使用史;无手术史。按照标准验光流程进行屈光检查后,分别用不同方法测量注视性主导眼,运动性主导眼,知觉性主导眼,最后分别测量单眼调节幅度,单眼调节反应、单眼调节灵敏度。检查思路如下:1.标准验光:客观验光使用电脑验光仪,然后由同一验光师使用综合验光仪主观验光,最后提供所得屈光不正度数。2.主导眼检查:屈光不正完全矫正后,分别利用手指法、卡洞法、集合近点法、worth四点灯法、PEDIG法、附加镜片法及Dunlop法测量受试者主导眼。3.单眼调节功能测量:利用改良的移近法测量单眼调节近点,利用±2.00D反转拍及20/30的snellen近字母表测量单眼调节灵敏度(AF),利用开放视野型电脑验光仪(Grand Seiko WAM-5500,Japan)测量单眼调节滞后。运用SPSS19.0软件分别对全部被检者主导眼与非主导眼的调节幅度,滞后量及其灵敏度差异进行比较,使用配对样本t检验。分别对注视性,运动性、知觉性主导眼测量数据进行Kappa检验。差异具有统计学意义为P0.05,差异具有显著意义为P0.01。将Kappa结果类型分为以下几种:完全一致,k=1;高度一致,k=0.81-1.0;中高度一致,k=0.61-0.80;中度一致,k=0.41-0.60;低度一致,k=0.21-0.40;超低度一致,k=0.00-0.20。结果1.手指法测量主导眼成功率占97.5%,卡洞法测量主导眼成功率占100%,集合近点测量主导眼成功率占100%,worth四点灯测量主导眼成功率占21.25%,PEDIG测量主导眼成功率占91.25%,附加镜片法测量主导眼成功率占100%,Dunlop法测量主导眼成功率占88.75%。2.右眼为注视性主导眼有46人,占57.5%;左眼为注视性主导眼有34人,占42.5%。注视性主导眼等效球面镜(-3.19±2.81)D,注视性非主导眼等效球面镜(-3.63±2.48)D,差值(0.43±2.29)D。右眼为运动性主导眼的有32人,占40.00%;左眼为运动性主导眼48人,占60.00%。运动性主导眼等效球面镜(-3.32±2.69)D,运动性非主导眼等效球面镜(-3.50±2.63)D,差值(0.18±2.32)D。右眼为知觉性主导眼的有40人,占50%;左眼为知觉性主导眼40人,占50%。知觉性主导眼等效球面镜(-3.27±2.82)D,知觉性非眼等效球面镜(-3.56±2.49)D,差(值0.29±2.31)D。3.三种类型主导眼与对侧眼的等效球面镜的差异均无统计学意义(P0.05)。4.注视性与运动性主导眼结果一致性k=0.48呈中度一致;注视性与知觉性主导眼结果一致性k=0.32,呈中低度一致;运动性与知觉性主导眼检查结果一致性k=0.37,呈中低度一致。5.运动性主导眼与注视性主导眼的一致性与双眼屈光度差异具有正相关性(r=0.732,P0.05)。6.注视性主导眼组:主导眼与对侧非主导眼的AMP差异无统计学意义(t=-1.627,P0.05),主导眼与非主导眼的调节滞后无明显差异(t=-1.676,P0.05),主导眼与非主导眼的调节灵敏度无明显差异(t=-0.274,P0.05)。运动性主导眼组:主导眼与非主导眼的AMP差异无统计学意义(t=0.55,P0.05),主导眼与非主导眼的调节滞后具有显著差异(t=-4.034,P0.01),主导眼与非主导眼的调节灵敏度差异有统计学意义(t=-3.253 P0.05).知觉性主导眼组:主导眼与非主导眼的AMP差异无统计学意义(t=-0.757,P0.05),主导眼与对侧非主导眼的调节滞后量无明显差异(t=1.256,P0.05),主导眼与对侧眼的调节灵敏度无明显差异(t=-0.091,P0.05)。7.运动性主导眼与非主导眼调节滞后量具有高度相关性(r=0.442,P0.01)且运动性主导眼调节滞后量更小。运动性主导眼与非主导眼调节灵敏度具有相关性(r=0.864,P0.05),运动性主导眼调节灵敏度更差。结论1.主导眼的眼别不是恒定不变的,不同双眼视条件下主导眼可能会发生变化2.主导眼应结合注视,运动,知觉进行全面的评估。3.运动性主导眼与单眼调节功能联系更为密切。运动性主导眼具有更小的调节滞后量和更差的调节灵敏度。4.主导眼与非主导眼屈光不正度无统计学差异,但双眼屈光参差度越大,双眼视功能差异越大,注视性与运动性主导眼一致性越强越不利于不同双眼视情况下主导眼的转换,越容易产生疲劳。
[Abstract]:Objective to study the consistency of 1. dominant eye results measured by different methods, whether the consistency and difference analysis of isoametropic with different measurement results with.2. correlation analysis of measurement results of reason and theoretical basis of the differences, advantages and disadvantages of different evaluation methods for measuring ocular dominance. Put forward a comprehensive assessment method of.3. dominant eye respectively. On the three types of dominant eye and non dominant eye monocular accommodation function measurement, explore the regulatory function between the regulating function of three types of dominant eye and non dominant eye differences and analyze the reasons. The research led type and monocular eye adjustment function evaluation value. Methods from September 2015 to January 2016, randomly selected Medical University Of Tianjin students and teachers a total of 80 people, the minimum age of 18 years old, maximum 37 years old, the average (23.03 + 4.92) years old, male 33, female 47 people selected a: Monocular visual acuity reached above 40/50 and the visual acuity differences between the eyes for no less than two; the dominant strabismus and amblyopia; no regulating function and set no abnormalities; ocular disease and refractive effects of systemic disease; within one year without affecting the eye adjustment function and ocular movement related to drug use history; without operation history refraction was performed according to the standard of optometry. After the process, different approaches were used to measure gaze of the dominant eye, dominant eye movement, dominant eye perception, finally measured the amplitude of monocular accommodation, monocular accommodative sensitivity adjustment monocular. Check ideas as follows: 1. standard objective optometry optometry: computer optometry instrument, and by the same an optometrist using phoropter subjective optometry, finally provide income refractive error.2. dominant eye examination: refractive error was completely corrected, using finger method and card hole method, near point of convergence of worth method. Four lighting method, PEDIG method, additional lens method and Dunlop method to measure subjects' dominant eye adjustment function: the use of.3. monocular measurement monocular motion measurement method in near point accommodation improvement, the use of 2.00D + and 20/30 Snellen in reverse shot alphabet measurement (AF), monocular sensitivity adjustment using open field computer optometry instrument (Grand Seiko WAM-5500, Japan) measurement of monocular accommodation lag. SPSS19.0 is used for all tested were the dominant eye and adjusting range of the non dominant eye, compare the hysteresis and sensitivity differences, using paired samples t test respectively. The gaze, movement, perception of the dominant eye measurement data were analyzed by Kappa test. Differences with statistical significance for P0.05, a significant difference was P0.01. Kappa data type is divided into the following categories: completely consistent, highly consistent, k=1; k=0.81-1.0; k= 0.61-0.80; highly consistent, moderate agreement, k=0.41 -0.60; k=0.21-0.40; ultra low consistency, low consistency, k=0.00-0.20. measurement results of 1. fingers of the dominant eye success rate accounted for 97.5%, the dominant eye hole in the card test success rate accounted for 100%, near point of convergence measurement of the dominant eye success rate accounted for 100%, four worth light measuring ocular dominance in the success rate of 21.25%, the success rate for PEDIG measurement of the dominant eye 91.25%, additional lens measurement of ocular dominance in the success rate of 100%, Dunlop method to measure the success rate of the dominant eye right eye gaze 88.75%.2. dominant eye has 46 people, accounting for 57.5%; the left eye gaze of the dominant eye has 34 people, accounting for 42.5%. of the dominant eye gaze equivalent spherical mirror (-3.19 + 2.81) D fixation the non dominant eye spherical equivalent (-3.63 + 2.48) D, difference (0.43 + 2.29) D. for the right eye movement of the dominant eye has 32 people, accounting for 40%; the left eye movement of dominant eye 48, dominant eye movement 60.00%. spherical equivalent (-3.32 + 2.69) D, the non dominant eye movement equivalent The spherical mirror (-3.50 + 2.63) D, difference (0.18 + 2.32) D. for the right consciousness of the dominant eye has 40 people, accounting for 50%; the left eye perception of the dominant eye of 40 people, accounting for 50%. of the perception of the dominant eye spherical equivalent (-3.27 + 2.82) D, perceived non ocular spherical equivalent (-3.56 D (+ 2.49), the difference value of 0.29 + 2.31) D.3. three types of dominant and the contralateral eyes of the equivalent spherical mirror showed no significant difference (P0.05) and.4. on the leading sports eye consistent result k=0.48 showed moderate consistency; and perception of the dominant eye gaze consistent result was k=0.32 low consistency; motion and perception of the dominant eye examination results consistent k=0.37, is dominant in low.5. sports eye and watching of the dominant eye and binocular diopter differences consistent with a positive correlation (r=0.732, P0.05).6. on dominant eye group: there was no significant difference in the dominant eye and on the side of the main non the guide hole of AMP difference (t= -1.627, P0.05), the dominant eye and non dominant eye accommodative lag had no significant difference (t=-1.676, P0.05), no significant difference between the dominant eye and adjust the sensitivity of the non dominant eye (t=-0.274, P0.05). The dominant eye movement group: AMP between dominant eye and non dominant eye was statistically significant (t=0.55, P0.05), adjust the dominant eye and non dominant eye lag with significant difference (t=-4.034, P0.01), statistically significant dominant eye and non dominant eye regulation (t=-3.253 P0.05). The sensitivity difference of perception of the dominant eye group: there was no significant difference of AMP dominant eye and non dominant eye (t=-0.757, P0.05), dominant eye on the opposite side of the non dominant eye accommodative lag was no significant difference (t=1.256, P0.05), no significant difference between the dominant eye and adjust the sensitivity of the contralateral eye (t=-0.091, P0.05).7. dominant and non dominant eye movement eye accommodative lag is highly correlated (r=0.442, P0.01) and sports The dominant eye accommodative lag was smaller. The dominant and non dominant eye movement eye sensitivity adjustment has correlation (r=0.864, P0.05), the leading sports eye sensitivity adjustment worse. Conclusion the 1. dominant eye is not constant, under the condition of different binocular ocular dominance may occur 2. changes should be combined with the dominant eye gaze that movement, perception of a comprehensive assessment of the dominant eye movement and.3. monocular accommodation function more closely linked. The dominant eye movement has less accommodative lag and worse sensitivity adjustment.4. dominant eye and non dominant eye refraction, no significant difference, but the greater the degree of anisometropia and binocular visual function difference large, gaze and movement dominant eye consistency is stronger leading the eye more is not conducive to different binocular conditions, more prone to fatigue.

【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R778.11

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