隐斜对成年人近视眼双眼调节反应与聚散适应的影响
发布时间：2018-08-20 17:26
【摘要】：目的本实验通过测量不同类型的隐斜对双眼与单眼调节反应,以及阅读前后隐斜方向与大小的改变规律,研究不同类型的隐斜对双眼调节反应与聚散适应的影响及其规律,推测内隐斜对近视发展的影响因素;推测不同类型的隐斜对单眼与双眼调节反应的规律,为测量调节反应评估双眼视异常的临床意义提供参考依据。同时对阅读后视疲劳进行评估,探究不同类型的隐斜对阅读视屏显示终端(VDT)引起的视疲劳差异是否具有统计学意义,以及阅读VDT与纸质版文本引起的视疲劳差异是否具有统计学意义。方法于2013年9月至11月选择天津医科大学在读本科与研究生为受试者,共116例,年龄在(20.58±2.96)岁,最低18岁,最高29岁。其中男性52例,女性64例。入选标准:等效球镜度-6.00D;散光-1.00D;屈光参差1.00D;最佳矫正视力≥1.0;无显斜;未服用过影响调节反应与眼外肌的系统性疾病相关药。根据近距隐斜量(NP),将受试者分入三组:正位组(N组):48例,(-6Δ≤NP≤0),年龄(20.96±2.45)岁,等效球镜度数(-3.63±1.66)D;外隐斜组(EXO组):42例,(NP-6Δ),年龄在(21.29±2.10)岁,等效球镜度数(-3.99±1.94)D;内隐斜组(ESO组):26例,(NP0),年龄在(19.77±1.61)岁,等效球镜度数(-3.69±1.24)D。按照标准验光流程进行屈光检查与双眼视功能检查。步骤如下:1.屈光检查:用综合验光仪进行规范主觉验光。2.双眼视功能检查:用Von Graefe方法测量远、近水平隐性斜视度,在测量隐斜的基础上得出计算性AC/A(调节性集合/调节)值。测量正、负相对调节(PRA,NRA),单眼调节幅度(M-AMP),双眼调节幅度(B-AMP)。3.调节反应的测量:受试者佩戴全矫眼镜,用开放视野红外线电脑自动验光仪(Shin-Nippon WR-5100K,Japan)测量单眼调节反应(MA)和双眼调节反应(BA)。4.阅读:阅读40cm处的VDT无序文本20min。5.立刻填写视疲劳评估表。6.阅读后复行双眼视功能检查以及单眼与双眼调节反应的测量。7.随机抽取一半受试者,24h后再次戴全矫眼镜,阅读40cm处的印刷无序文本(与VDT阅读文本中字体,大小,内容一致)20min。8.立刻填写视疲劳评估表。采用SPSS 17.0软件进行统计分析。如果计量资料符合正态分布,选择多组方差分析,t检验;如果不符合正态分布,选非参数秩和检验。以P0.05为差异具有统计学意义。结果1.阅读前三组单眼与双眼调节反应差值均有统计学意义(P0.05)。EXO组:BAMA(t=9.264,P0.05);N组:BAMA(t=4.840,P0.05);ESO组:MABA(t=-6.064,P0.05)。对三组BA进行多重比较,结果具有统计学意义(P0.05)。BA:EXO组ESO组(P0.05);EXON组(P0.05);N组ESO组(P0.05)。对三组MA进行LSD多重比较,差异不具有统计学意义(P0.05)。2.三组的MA与BA阅读前后的变化差异无统计学意义(单眼:χ~2=0.011,P0.05;双眼:χ~2=1.190,P0.05)。EXO组与N组表现为:BAMA。ESO组表现为:MABA。而且阅读后MA与BA均较阅读前有所增加,但差异无统计学意义。23.阅读前后三组远距隐斜量的差异不具有统计学意义(χ~2=5.220,P0.05)。4.阅读前后PRA、NRA、M-AMP和B-AMP的差异不具有统计学意义(P0.05)。5.三组近距隐斜量的改变量(χ~2=44.026,P0.05),AC/A值的改变量(χ~2=6.986,P0.05)具有统计学意义。ESO组内隐斜量变小;EXO组外隐斜量变小;N组隐斜量变大。ESO组AC/A值变小;EXO组AC/A值变大;N组AC/A值没有变化。6.阅读VDT前后三组视疲劳评估差异不具有统计学意义(χ~2=5.281,P0.05)。7.阅读VDT的一半受试者与阅读印刷文本的一半受试者视疲劳评估差异有统计学意义(U=1320.5,P0.05)。结论1.不同类型的隐斜对双眼调节反应有影响,外隐斜与正常眼位的双眼调节反应高于单眼调节反应,内隐斜单眼调节反应高于双眼调节反应;2.不同类型的隐斜对单眼调节反应无明显影响;3.阅读前后,不同类型的隐斜在融像性聚散需求方向的作用下表现为不同方向的聚散适应,外隐斜变现为集合性聚散适应,内隐斜与正位(低度外隐斜)变现为开散性聚散适应;4.AC/A值可能对不同类型的隐斜的聚散适应有影响;5.内隐斜双眼调节滞后量较高,可能是近视的发展速度较快的影响因素;6.不同类型的隐斜阅读VDT文本后视疲劳程度无差异。7.阅读VDT比印刷文本更易引起视疲劳症状。
[Abstract]:Objective To study the effects of different types of cryptocline on binocular accommodation and aggregation-dispersion adaptation, and to speculate the influencing factors of different types of cryptocline on the development of myopia, and to speculate the different types of cryptocline on monocular accommodation. The regulation of eye and binocular accommodation response provides a reference for evaluating the clinical significance of binocular vision abnormality by measuring accommodation response. At the same time, the visual fatigue after reading was assessed, and the difference of visual fatigue caused by different types of cryptocline on reading video display terminal (VDT) was investigated. Methods 116 undergraduates and postgraduates of Tianjin Medical University were selected from September to November, 2013, aged (20.58 (+ 2.96) years, the lowest 18 years and the highest 29 years. Among them, 52 were males and 64 were females. Good corrected visual acuity (> 1.0); no obliquity; no drugs related to systemic diseases affecting accommodation response and extraocular muscles were taken. According to the amount of nearsighted recession (NP), subjects were divided into three groups: orthotopic group (N group): 48 cases, (- 6_ < NP < 0), age (20.96 (- 2.45) years, equivalent spherical degree (- 3.63 (- 1.66) D); Exotropic group (EXO group): 42 cases, (NP - 6), age (21.29). Equivalent spherical diopter (-3.99 (-1.94) D; Implicit oblique group (ESO group): 26 cases (NP0), aged (19.77 (-1.61) years, Equivalent spherical diopter (-3.69 (-1.24) D). Refractive examination and binocular visual function examination were performed according to the standard refraction procedure. The steps were as follows: 1. Refractive examination: Standardized subjective refraction was performed with a comprehensive refractometer.2. Binocular visual function examination. Von Graefe method was used to measure distant and near-horizontal recessive strabismus, and the calculated AC/A (accommodative set/accommodation) values were obtained on the basis of the measurement of recessive strabismus. Positive, negative relative accommodation (PRA, NRA), monocular accommodation amplitude (M-AMP), and binocular accommodation amplitude (B-AMP) were measured. 3. accommodation response: subjects wore full-corrected glasses, and used an open-field infrared computer. Reading: Read the disordered text of VDT at 40 cm for 20 min.5. Fill in the eyestrain assessment form immediately. 6. Recurrent binocular visual function tests and measurement of monocular and binocular accommodation responses. 7. Half of the subjects were randomly selected, and again 24 hours later. Write the visual fatigue assessment form immediately. SPSS 17.0 software was used for statistical analysis. Results 1. The difference between monocular and binocular accommodation responses in the first three groups was statistically significant (P 0.05). In EXO group, BAMA (t = 9.264, P 0.05); in N group, BAMA (t = 4.840, P 0.05); in ESO group, MABA (t = - 6.064, P 0.05). There was no significant difference between the three groups of MA before and after reading (single eye: _~2 = 0.011, P 0.05; binocular: _~2 = 1.190, P 0.05). The performance of EXO group and N group was: MABA. There was no significant difference between the three groups before and after reading (_~2 = 5.220, P 0.05). 4. Before and after reading, there was no significant difference between PRA, NRA, M-AMP and B-AMP (P 0.05). 5. The changes of short-range cryptography (_~2 = 44.026, P 0.05), AC / A (_~2 = 6.986, P 0.05). There was no significant difference in visual fatigue assessment between the three groups before and after VDT reading (_~2=5.281,P 0.05). 7. Half of the subjects who read VDT had no significant difference with those who read printed text. Conclusion 1. Different types of cryptocline have influence on binocular accommodative response. The binocular accommodative response in exotropia and normal eye position is higher than that in monocular accommodative response, and the monocular accommodative response in cryptocline is higher than that in binocular accommodative response. 3. Before and after reading, different types of cryptoclines exhibited convergence and dispersion adaptation in different directions under the effect of the demand direction of convergence and dispersion, while the external cryptocline became convergence and dispersion adaptation, and the implicit and positive (low-degree cryptocline) became divergent convergence and dispersion adaptation; 4. AC/A value may have a shadow on the convergence and dispersion adaptation of different types of cryptoclines. Implicit strabismus has a higher lag of accommodation, which may be the influencing factor for the rapid development of myopia. 6. There is no difference in the degree of visual fatigue between different types of recessive reading VDT text. 7. Reading VDT is more likely to cause visual fatigue symptoms than printed text.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R778.11
，
本文编号：2194421
[Abstract]:Objective To study the effects of different types of cryptocline on binocular accommodation and aggregation-dispersion adaptation, and to speculate the influencing factors of different types of cryptocline on the development of myopia, and to speculate the different types of cryptocline on monocular accommodation. The regulation of eye and binocular accommodation response provides a reference for evaluating the clinical significance of binocular vision abnormality by measuring accommodation response. At the same time, the visual fatigue after reading was assessed, and the difference of visual fatigue caused by different types of cryptocline on reading video display terminal (VDT) was investigated. Methods 116 undergraduates and postgraduates of Tianjin Medical University were selected from September to November, 2013, aged (20.58 (+ 2.96) years, the lowest 18 years and the highest 29 years. Among them, 52 were males and 64 were females. Good corrected visual acuity (> 1.0); no obliquity; no drugs related to systemic diseases affecting accommodation response and extraocular muscles were taken. According to the amount of nearsighted recession (NP), subjects were divided into three groups: orthotopic group (N group): 48 cases, (- 6_ < NP < 0), age (20.96 (- 2.45) years, equivalent spherical degree (- 3.63 (- 1.66) D); Exotropic group (EXO group): 42 cases, (NP - 6), age (21.29). Equivalent spherical diopter (-3.99 (-1.94) D; Implicit oblique group (ESO group): 26 cases (NP0), aged (19.77 (-1.61) years, Equivalent spherical diopter (-3.69 (-1.24) D). Refractive examination and binocular visual function examination were performed according to the standard refraction procedure. The steps were as follows: 1. Refractive examination: Standardized subjective refraction was performed with a comprehensive refractometer.2. Binocular visual function examination. Von Graefe method was used to measure distant and near-horizontal recessive strabismus, and the calculated AC/A (accommodative set/accommodation) values were obtained on the basis of the measurement of recessive strabismus. Positive, negative relative accommodation (PRA, NRA), monocular accommodation amplitude (M-AMP), and binocular accommodation amplitude (B-AMP) were measured. 3. accommodation response: subjects wore full-corrected glasses, and used an open-field infrared computer. Reading: Read the disordered text of VDT at 40 cm for 20 min.5. Fill in the eyestrain assessment form immediately. 6. Recurrent binocular visual function tests and measurement of monocular and binocular accommodation responses. 7. Half of the subjects were randomly selected, and again 24 hours later. Write the visual fatigue assessment form immediately. SPSS 17.0 software was used for statistical analysis. Results 1. The difference between monocular and binocular accommodation responses in the first three groups was statistically significant (P 0.05). In EXO group, BAMA (t = 9.264, P 0.05); in N group, BAMA (t = 4.840, P 0.05); in ESO group, MABA (t = - 6.064, P 0.05). There was no significant difference between the three groups of MA before and after reading (single eye: _~2 = 0.011, P 0.05; binocular: _~2 = 1.190, P 0.05). The performance of EXO group and N group was: MABA. There was no significant difference between the three groups before and after reading (_~2 = 5.220, P 0.05). 4. Before and after reading, there was no significant difference between PRA, NRA, M-AMP and B-AMP (P 0.05). 5. The changes of short-range cryptography (_~2 = 44.026, P 0.05), AC / A (_~2 = 6.986, P 0.05). There was no significant difference in visual fatigue assessment between the three groups before and after VDT reading (_~2=5.281,P 0.05). 7. Half of the subjects who read VDT had no significant difference with those who read printed text. Conclusion 1. Different types of cryptocline have influence on binocular accommodative response. The binocular accommodative response in exotropia and normal eye position is higher than that in monocular accommodative response, and the monocular accommodative response in cryptocline is higher than that in binocular accommodative response. 3. Before and after reading, different types of cryptoclines exhibited convergence and dispersion adaptation in different directions under the effect of the demand direction of convergence and dispersion, while the external cryptocline became convergence and dispersion adaptation, and the implicit and positive (low-degree cryptocline) became divergent convergence and dispersion adaptation; 4. AC/A value may have a shadow on the convergence and dispersion adaptation of different types of cryptoclines. Implicit strabismus has a higher lag of accommodation, which may be the influencing factor for the rapid development of myopia. 6. There is no difference in the degree of visual fatigue between different types of recessive reading VDT text. 7. Reading VDT is more likely to cause visual fatigue symptoms than printed text.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R778.11
，
本文编号：2194421
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