散光可以治吗_调节对散光的影响研究

  本文关键词：调节对散光的影响研究，，由笔耕文化传播整理发布。

        目的通过研究不同水平调节刺激下散光的可能改变,探讨调节是否存在非球性成分以及伴随着调节的改变这种非球性成分的变化趋势；通过研究调节对不同类型、不同程度散光的不同影响,分析调节非球性可能的形式；通过对比调节下散光修正后近视力与远矫正下近视力,探讨调节下散光的改变对近距离工作的影响；通过分析对比不同屈光检查方法,寻找简便可行的近距散光检查方法。方法序贯选取散光受试者166例(右眼),年龄18-21岁,平均(19.8±1.2)岁,平均球镜度(-3.33±2.21)D,散光度(0.61±0.47)D。按两种角度分组研究：①按散光类型分为：顺规散光组(强主子午线方向为90°±20°)、逆规散光组(强主子午线方向为180°±20°)及斜轴散光组(45°±25°,130°±25°)。②按散光度分为：组一(散光度≤0.50D)、组二(0.50D<散光度≤1.00D)、组三(散光度>1.00D)。序贯选取双眼屈光不正状态具有同质性的受试者43例(两眼球镜度相差<1.00D,散光度相差≤0.50DC),研究两眼间的调节是否存在差异。平均球镜度(3.77±2.14)D(右眼)、(3.64±2.19)D(左眼),平均散光度(0.63±0.33)DC(右眼)、(0.65±0.38)DC(左眼)。1.角膜曲率计(Topcon OM-4)检查各受试者角膜曲率；2.综合验光仪(TopconVT-10)主观验光法检查各受试者调节静止状态下(视远,眼前5m)屈光不正度；3.推进法(石原式近点计)检查单眼调节幅度,±2.00D反转拍(配合40cm标准对数视力表)检查单眼调节灵敏度,FCC(配合十字视标)检查单眼调节滞后；4.通过注视眼前40cm处近视力表(TopconVT-10综合验光仪配套近距卡NC-1)刺激调节,检查40cm处远矫正下近视力(DCNVA1);5.综合验光仪检查各受试者视近40cm调节刺激下屈光度：调节状态下的散光在视远单眼全矫基础上用采交叉柱镜修正,受试者为单眼注视状态(另一眼关闭),受检眼水平向前注视近视力表中其最佳视力的视标；6.检查视近40cm调节刺激下散光修正后近视力(ACNVA1);7.以4-6步同样的方法检查视近20cm调节刺激下的远矫正下近视力(DCNVA2)、散光度及散光修正后近视力(ACNVA2);8.采用单样本K-S检验法对数据进行正态性检验；对三种不同调节刺激下两两之间散光的差异采用两两配对检验,若数据服从正态分布采用配对t检验,若不服从则采用配对符号秩和检验,检验水准取α’=0.05/3=0.0167; DCNVA1与ACNVA1、DCNVA2与ACNVA2的差异采用配对t/符号秩和检验,检验水准取a取0.05；对双眼研究对象43例受试者两眼间调节下散光改变、DCNVA与ACNVA的差值进行配对分析,检验水准取α取0.05；调节下散光改变与角膜散光度、残余散光度、调节滞后量、调节幅度、调节灵敏度之间进行相关性分析,若数据服从正态分布采用Pearson积矩相关分析,若不服从则采用Spearman秩相关进行分析。结果1.三个不同调节刺激下,两两间散光度的差异均具有统计学意义(视近40cm与视远5m：Z=-5.316,P<0.0167；视近20cm与视远5m：Z=-5.672,P<0.0167；视近20cm与视近40cm：Z=-2.463,P<0.0167),且视近20cm调节刺激下散光度>视近40cm调节刺激下散光度>视远5m调节静止下散光度；2.三个不同调节刺激下,两两间散光轴位的差异均不具有统计学意义(t=0.905,P=0.367(5m-40cm); t=0.403, P=0.688(5m-20cm); t=0.485, P=0.629(20cm-40cm));3.DCNVA1与ACNVA1、DCNVA2与ACNVA2的差异具有统计学意义,且散光修正后视力呈提高的趋势(Z=-5.741,P=<0.01；Z=-6.848,P<0.01)；4.顺规散光组和斜轴散光组与总体资料变化趋势一致：三个不同调节刺激下,两两间散光度数的差异均具有统计学意义(视近40cm与视远5m：Z=-4.252,P<0.0167(顺规),Z=-2.685,P<0.0167(斜轴)；视近20cm与视远5m：Z=-3.983,P<0.0167(顺规),Z=-2.869,P<0.0167(斜轴)；视近20cm与视近40cm：Z=-2.586,P<0.0167(顺规),Z=-2.568,P<0.0167(斜轴)),且视近20cm调节刺激下散光度>视近40cm调节刺激下散光度>视远5m调节静止下散光度；DCNVA1与ACNVA1的差异具有统计学意义,且散光修正后视力呈提高的趋势(Z=-3.575,P<0.01(顺规),Z=-3.571,P<0.01(斜轴)),DCNVA2与ACNVA2的差异具有统计学意义,且散光修正后视力呈提高的趋势(Z=-5.432,P<0.01(顺规),Z=-2.954,P<0.01(斜轴))；而逆规散光组两两间散光度数的差异均不具有统计学意义(t=-0.224,P>0.05),且DCNVA1与ACNVA1、DCNVA2与ACNVA2的差异不具有统计学意义(t=2.016,P>0.05；t=-2.37,P>0.05)；5.散光度≤1.00D的受试者与总体资料变化趋势一致：三个不同调节刺激下,两两间散光度数的差异均具有统计学意义(视近40cm与视远5m:Z=-3.437,P<0.0167(≤0.50DC),Z=-2.690,P<0.0167(0.50～1.00DC)；视近20cm与视远5m:Z=-5.416,P<0.0167(≤0.50DC),Z=-2.737,P<0.0167(0.50～1.00DC)；视近20cm与视近40cm:Z=-2.553,P<0.0167(≤0.50DC),Z=-2.450,P<0.0167(0.50～1.00DC),且视近20cm调节刺激下散光度>视近40cm调节刺激下散光度>视远5m调节静止下散光度；DCNVA1与ACNVA1的差异具有统计学意义,且散光修正后视力呈提高的趋势(Z=-3.198,P<0.01(≤0.50DC),Z=-3.510, P<0.01(0.50～1.00DC),DCNVA2与ACNVA2的差异具有统计学意义,且散光修正后视力呈提高的趋势(Z=-5.150,P<0.01(≤0.50DC),Z=-4.656,P<0.01(0.50～1.00DC));而散光度>1.00D的受试者两两间散光度数的差异均不具有统计学意义(Z=-1.848,P>0.05),且DCNVA1与ACNVA1、DCNVA2与ACNVA2的差异不具有统计学意义(t-1.406,P>0.05；Z=-1.717,P>0.05)；6.43名受试者两眼间的调节对散光的影响之差异情况不具有统计学意义(Z=-1.024,P>0.05(40cm-5m):Z=-0.198,P>0.05(20cm-5m)；Z=-0.728, P>0.05(20cm-40cm)).结论1.人眼的调节存在非球性成分,各子午线的调节具有一定的不均衡性;2.调节刺激增加,散光变化总体趋势表现为散光度增加,这于顺规散光、斜轴散光及散光度≤1.00D的患者更为明显：但调节过程中调节非球性的形式可能会发生变化,且是随机的、个性化的,并未表现出一致的规律性；3.调节下散光的改变不同程度地影响着近视力从而影响近距离工作；4.于正常人群,两眼调节等量、非球性形式一致；5.在视远全矫基础上采用交叉柱镜修正近用散光,视标为被检者最佳视力的视标,这可能是检查视近散光的有效方法,且可直接嵌入到常规屈光检查工作中。

    ObjectiveTo analyze the existence of astigmatism with accommodation and its change tendency by comparing the astigmatism among different level of accommodation. To analyze the different effect on different kinds and different degree of astigmatism, to find out the possible mechanism of accommodative astigmatism. To study the possible effect of astigmatism with accommodation on near vision work by comparing the distance corrected vision acuity and accommodative astigmatism corrected near vision acuity. To find out a proper and easy handing way to measure the near astigmatism.Methods166university volunteer students,166astigmatic right eyes, aged18to21years old, were recruited in this study. They were divided in two different ways (1) according to the kinds of astigmatism, into with-the-rule, against-the-rule and oblique astigmatism, and (2) according to the degree of astigmatism, into less than0.50D, between0.50D and1.00D, and more than1.00D.43university volunteer students, with a difference of spherical refractive error less1.00D and astigmatism less than0.50D between two eyes, were recruited to analyze the difference of accommodation and accommodative astigmatism between two eyes.1.The corneal curvature radius and corneal diopter were measured by kerotometer.2.The refraction of166astigmatic eyes were measured at distance (at5m).3.The amplitude of accommodation and accommodative facility wear measured by push-up technique and±2.00D flipper respectively. The lag of accommodation was measured by FCC, with cross pattern chart.4.The distance corrected near vision acuity in40cm(DCNVA1)was measured with distance-corrected glasses.5.The astigmatism at near (at40cm) was measured under monocular condition with cross-cylinder lenses, with the tested eye looking straight ahead at the line of its best corrected vision acuity in near vision chart.6.The accommodative astigmatism corrected near vision acuity in40cm(ACNVA1) was measured with near-corrected glasses in40cm,using near vision chart. 7.The distance corrected near vision acuity in20cm(DCNVA2), the astigmatism at40cm and the accommodative astigmatism corrected near vision acuity in20cm (ACNVA2)were measured the same way as step4to6.8.The degree of astigmatism between each two of the three different distances, the axis of astigmatism between each two of the three different distances, DCNVA vs ACNVA at40cm and20cm, the accommodative astigmatism and the change of near vision acuity between two eyes of43subjects were compared by paired t-test respectively if the data is normal distribution, if not, compared by Wilcoxon matched-pairs signed-ranks test. Analyze the association between the accommodative astigmatism and corneal astigmatism, residual astigmatism, lag of accommodation, amplitude of accommodation and accommodative facility.Results1.The degree of astigmatism with accommodation was increased significantly as follow order:fixating at20cm,40cm and distance.(Z=-5.316, P<0.0167; Z=-5.672, P<0.0167; Z=-2.463;P<0.0167respectively);2.The axis of astigmatism showed no statistical significance among different level of accommodation(t=0.905;P=0.367(5m-40cm);r=0.403, P=0.688(5m-20cm);t=0.485, P=0.629(20cm-40cm));3.The near vision acuity when fixing at40cm and20cm were both increased significantly when accommodative astigmatism corrected(Z=-5.741,P<0.01; Z=-6.848,P<0.01,respectively);4.The with-the-rule and oblique astigmatism group have the same tendency as the all subjects. The degree of astigmatism with accommodation was significantly increased (Z=-4.252, P<0.0167; Z=-3.983, P<0.0167; Z=-2.586, P<0.0167respectively for with-the-rule astigmatism group; and Z=-2.685,P<0.0167;Z=-2.869,P<0.0167; Z=-2.568,P<0.0167respectively for oblique astigmatism group).The near vision acuity when fixing at40cm and20cm were both increased significantly when accommodative astigmatism corrected (Z=-3.575, P<0.01; Z=-5.432, P<0.01respectively with-the-rule astigmatism group;and Z=-3.571,P<0.01;Z=-2.954,P<0.01respectively for oblique astigmatism group).However, there is no significant difference in against-the-rule astigmatism group(t=-0.224,P>0.05; t=2.016,P>0.05; t=-2.37,P>0.05);5.Groups that the astigmatism less than1.00DC had the same tendency as the all subjects. The degree of astigmatism with accommodation was significantly increased (Z=-3.437,P<0.0167; Z=-5.416,P<0.0167; Z=-2.553,P<0.0167respectively for group with astigmatism less than0.50DC;and Z=-2.690,P<0.0167; Z=-2.737,P<0.0167; Z=-2.450,P<0.0167respectively for group with astigmatism between0.50DC and1.00DC). The near vision acuity when fixing at40cm and20cm were both increased significantly when accommodative astigmatism corrected (Z=-3.198, P<0.01; Z=-5.150,P<0.01respectively for group with astigmatism less than0.50DC;and Z=-3.510,P<0.01; Z=-4.656,P<0.01group with astigmatism between0.50DC and1.00DC).However, there is no significant difference in group with more than1.00DC astigmatism(Z=-1.848,P>0.05;t=-1.406,P>0.05;Z=-1.717,P>0.05);6.Astigmatism changes showed no significant difference between two eyes(Z=-1.024,P>0.05(40cm-5m);Z=-0.198,i>>0.05(20cm-5m);Z=-0.728,P>0.05(20c m-40cm)).Conclusion1.The power of accommodation are not the same in all meridians of the eyes;2.A change in astigmatism with accommodation does indeed exist, the degree of astigmatism has a tendency of increasing with accommodation., especially for those who had with-the-rule and oblique astigmatism and astigmatism less than1.00DC. But it may be various among individual;3.The changes of astigmatism with accommodation sometimes affects near vision work;4.The astigmatism with accommodation may be the same between two eyes in the same person;5.Using cross-cylinder lenses may be a good method to measure near astigmatism.

          调节对散光的影响研究

中文摘要4-7Abstract7-9缩略语/符号说明12-13前言13-15    研究现状、成果13    研究目的、方法13-15对象和方法15-20    1.1 研究对象15        1.1.1 入选条件15        1.1.2 分组情况15    1.2 实验装置及条件15-16    1.3 实验过程16-19        1.3.1 基本资料采集16-17        1.3.2 病例筛选17        1.3.3 角膜散光的检查17        1.3.4 不同调节刺激下屈光状态的检查17-18        1.3.5 调节功能的检查18-19    1.4 数据分析19-20结果20-32    2.1 不同调节刺激下散光度的变化情况20-24    2.2 不同调节刺激下散光轴位的变化情况24-27    2.3 调节性散光对近视力的影响情况27-29    2.4 双眼间调节性散光的差异情况29-31        2.4.1 双眼间调节性散光的差异情况29-31        2.4.2 双眼间调节功能的差异情况31    2.5 调节性散光与角膜散光及调节功能参数的相关情况31-32分析和讨论32-43    3.1 不同调节刺激下散光度的变化情况32-37    3.2 不同调节刺激下散光轴位的变化情况37-38    3.3 调节性散光对近视力的影响情况38-40    3.4 双眼间调节性散光的差异情况40    3.5 调节性散光与角膜散光及调节功能参数的相关情况40-41    3.6 检查近用散光方法的可行性41-43结论43-44参考文献44-48发表论文和参加科研情况说明48-49综述49-68    综述参考文献62-68致谢68

  本文关键词：调节对散光的影响研究，由笔耕文化传播整理发布。