本文選題：注視性主導(dǎo)眼　切入點：運動性主導(dǎo)眼　出處：《天津醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的1.研究用不同方法測量的主導(dǎo)眼結(jié)果的一致性,并分析雙眼屈光不正度差異與不同測量方法結(jié)果的一致性是否具有相關(guān)性。2.分析測量結(jié)果出現(xiàn)差異的原因及理論基礎(chǔ),評價不同主導(dǎo)眼測量方法的優(yōu)缺點。提出全面評估主導(dǎo)眼的思路。3.分別對三種類型的主導(dǎo)眼與非主導(dǎo)眼進(jìn)行單眼調(diào)節(jié)功能測量,探究三種類型主導(dǎo)眼的調(diào)節(jié)功能與非主導(dǎo)眼的調(diào)節(jié)功能之間是否存在差異并分析其原因。研究主導(dǎo)眼的類型及單眼調(diào)節(jié)功能評估的意義。方法于2015年9月至2016年1月,隨機(jī)選取天津醫(yī)科大學(xué)學(xué)生及教師共80人,年齡最低18歲,最高37歲,平均(23.03±4.92)歲,其中男性33人,女性47人。入選條件為:單眼矯正視力達(dá)40/50及以上,雙眼之間的視力差異小于兩行;無顯性斜視及弱視;無調(diào)節(jié)與集合功能異常;無眼部器質(zhì)性疾病及影響眼屈光的全身性疾病;一年內(nèi)無影響眼部調(diào)節(jié)功能及眼肌運動相關(guān)藥物使用史;無手術(shù)史。按照標(biāo)準(zhǔn)驗光流程進(jìn)行屈光檢查后,分別用不同方法測量注視性主導(dǎo)眼,運動性主導(dǎo)眼,知覺性主導(dǎo)眼,最后分別測量單眼調(diào)節(jié)幅度,單眼調(diào)節(jié)反應(yīng)、單眼調(diào)節(jié)靈敏度。檢查思路如下:1.標(biāo)準(zhǔn)驗光:客觀驗光使用電腦驗光儀,然后由同一驗光師使用綜合驗光儀主觀驗光,最后提供所得屈光不正度數(shù)。2.主導(dǎo)眼檢查:屈光不正完全矯正后,分別利用手指法、卡洞法、集合近點法、worth四點燈法、PEDIG法、附加鏡片法及Dunlop法測量受試者主導(dǎo)眼。3.單眼調(diào)節(jié)功能測量:利用改良的移近法測量單眼調(diào)節(jié)近點,利用±2.00D反轉(zhuǎn)拍及20/30的snellen近字母表測量單眼調(diào)節(jié)靈敏度(AF),利用開放視野型電腦驗光儀(Grand Seiko WAM-5500,Japan)測量單眼調(diào)節(jié)滯后。運用SPSS19.0軟件分別對全部被檢者主導(dǎo)眼與非主導(dǎo)眼的調(diào)節(jié)幅度,滯后量及其靈敏度差異進(jìn)行比較,使用配對樣本t檢驗。分別對注視性,運動性、知覺性主導(dǎo)眼測量數(shù)據(jù)進(jìn)行Kappa檢驗。差異具有統(tǒng)計學(xué)意義為P0.05,差異具有顯著意義為P0.01。將Kappa結(jié)果類型分為以下幾種: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。結(jié)果1.手指法測量主導(dǎo)眼成功率占97.5%,卡洞法測量主導(dǎo)眼成功率占100%,集合近點測量主導(dǎo)眼成功率占100%,worth四點燈測量主導(dǎo)眼成功率占21.25%,PEDIG測量主導(dǎo)眼成功率占91.25%,附加鏡片法測量主導(dǎo)眼成功率占100%,Dunlop法測量主導(dǎo)眼成功率占88.75%。2.右眼為注視性主導(dǎo)眼有46人,占57.5%;左眼為注視性主導(dǎo)眼有34人,占42.5%。注視性主導(dǎo)眼等效球面鏡(-3.19±2.81)D,注視性非主導(dǎo)眼等效球面鏡(-3.63±2.48)D,差值(0.43±2.29)D。右眼為運動性主導(dǎo)眼的有32人,占40.00%;左眼為運動性主導(dǎo)眼48人,占60.00%。運動性主導(dǎo)眼等效球面鏡(-3.32±2.69)D,運動性非主導(dǎo)眼等效球面鏡(-3.50±2.63)D,差值(0.18±2.32)D。右眼為知覺性主導(dǎo)眼的有40人,占50%;左眼為知覺性主導(dǎo)眼40人,占50%。知覺性主導(dǎo)眼等效球面鏡(-3.27±2.82)D,知覺性非眼等效球面鏡(-3.56±2.49)D,差(值0.29±2.31)D。3.三種類型主導(dǎo)眼與對側(cè)眼的等效球面鏡的差異均無統(tǒng)計學(xué)意義(P0.05)。4.注視性與運動性主導(dǎo)眼結(jié)果一致性k=0.48呈中度一致;注視性與知覺性主導(dǎo)眼結(jié)果一致性k=0.32,呈中低度一致;運動性與知覺性主導(dǎo)眼檢查結(jié)果一致性k=0.37,呈中低度一致。5.運動性主導(dǎo)眼與注視性主導(dǎo)眼的一致性與雙眼屈光度差異具有正相關(guān)性(r=0.732,P0.05)。6.注視性主導(dǎo)眼組:主導(dǎo)眼與對側(cè)非主導(dǎo)眼的AMP差異無統(tǒng)計學(xué)意義(t=-1.627,P0.05),主導(dǎo)眼與非主導(dǎo)眼的調(diào)節(jié)滯后無明顯差異(t=-1.676,P0.05),主導(dǎo)眼與非主導(dǎo)眼的調(diào)節(jié)靈敏度無明顯差異(t=-0.274,P0.05)。運動性主導(dǎo)眼組:主導(dǎo)眼與非主導(dǎo)眼的AMP差異無統(tǒng)計學(xué)意義(t=0.55,P0.05),主導(dǎo)眼與非主導(dǎo)眼的調(diào)節(jié)滯后具有顯著差異(t=-4.034,P0.01),主導(dǎo)眼與非主導(dǎo)眼的調(diào)節(jié)靈敏度差異有統(tǒng)計學(xué)意義(t=-3.253 P0.05).知覺性主導(dǎo)眼組:主導(dǎo)眼與非主導(dǎo)眼的AMP差異無統(tǒng)計學(xué)意義(t=-0.757,P0.05),主導(dǎo)眼與對側(cè)非主導(dǎo)眼的調(diào)節(jié)滯后量無明顯差異(t=1.256,P0.05),主導(dǎo)眼與對側(cè)眼的調(diào)節(jié)靈敏度無明顯差異(t=-0.091,P0.05)。7.運動性主導(dǎo)眼與非主導(dǎo)眼調(diào)節(jié)滯后量具有高度相關(guān)性(r=0.442,P0.01)且運動性主導(dǎo)眼調(diào)節(jié)滯后量更小。運動性主導(dǎo)眼與非主導(dǎo)眼調(diào)節(jié)靈敏度具有相關(guān)性(r=0.864,P0.05),運動性主導(dǎo)眼調(diào)節(jié)靈敏度更差。結(jié)論1.主導(dǎo)眼的眼別不是恒定不變的,不同雙眼視條件下主導(dǎo)眼可能會發(fā)生變化2.主導(dǎo)眼應(yīng)結(jié)合注視,運動,知覺進(jìn)行全面的評估。3.運動性主導(dǎo)眼與單眼調(diào)節(jié)功能聯(lián)系更為密切。運動性主導(dǎo)眼具有更小的調(diào)節(jié)滯后量和更差的調(diào)節(jié)靈敏度。4.主導(dǎo)眼與非主導(dǎo)眼屈光不正度無統(tǒng)計學(xué)差異,但雙眼屈光參差度越大,雙眼視功能差異越大,注視性與運動性主導(dǎo)眼一致性越強(qiáng)越不利于不同雙眼視情況下主導(dǎo)眼的轉(zhuǎn)換,越容易產(chǎn)生疲勞。
[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.

【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R778.11

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