隱斜對成年人近視眼雙眼調節(jié)反應與聚散適應的影響
發(fā)布時間：2018-08-20 17:26
【摘要】：目的本實驗通過測量不同類型的隱斜對雙眼與單眼調節(jié)反應,以及閱讀前后隱斜方向與大小的改變規(guī)律,研究不同類型的隱斜對雙眼調節(jié)反應與聚散適應的影響及其規(guī)律,推測內隱斜對近視發(fā)展的影響因素;推測不同類型的隱斜對單眼與雙眼調節(jié)反應的規(guī)律,為測量調節(jié)反應評估雙眼視異常的臨床意義提供參考依據(jù)。同時對閱讀后視疲勞進行評估,探究不同類型的隱斜對閱讀視屏顯示終端(VDT)引起的視疲勞差異是否具有統(tǒng)計學意義,以及閱讀VDT與紙質版文本引起的視疲勞差異是否具有統(tǒng)計學意義。方法于2013年9月至11月選擇天津醫(yī)科大學在讀本科與研究生為受試者,共116例,年齡在(20.58±2.96)歲,最低18歲,最高29歲。其中男性52例,女性64例。入選標準:等效球鏡度-6.00D;散光-1.00D;屈光參差1.00D;最佳矯正視力≥1.0;無顯斜;未服用過影響調節(jié)反應與眼外肌的系統(tǒng)性疾病相關藥。根據(jù)近距隱斜量(NP),將受試者分入三組:正位組(N組):48例,(-6Δ≤NP≤0),年齡(20.96±2.45)歲,等效球鏡度數(shù)(-3.63±1.66)D;外隱斜組(EXO組):42例,(NP-6Δ),年齡在(21.29±2.10)歲,等效球鏡度數(shù)(-3.99±1.94)D;內隱斜組(ESO組):26例,(NP0),年齡在(19.77±1.61)歲,等效球鏡度數(shù)(-3.69±1.24)D。按照標準驗光流程進行屈光檢查與雙眼視功能檢查。步驟如下:1.屈光檢查:用綜合驗光儀進行規(guī)范主覺驗光。2.雙眼視功能檢查:用Von Graefe方法測量遠、近水平隱性斜視度,在測量隱斜的基礎上得出計算性AC/A(調節(jié)性集合/調節(jié))值。測量正、負相對調節(jié)(PRA,NRA),單眼調節(jié)幅度(M-AMP),雙眼調節(jié)幅度(B-AMP)。3.調節(jié)反應的測量:受試者佩戴全矯眼鏡,用開放視野紅外線電腦自動驗光儀(Shin-Nippon WR-5100K,Japan)測量單眼調節(jié)反應(MA)和雙眼調節(jié)反應(BA)。4.閱讀:閱讀40cm處的VDT無序文本20min。5.立刻填寫視疲勞評估表。6.閱讀后復行雙眼視功能檢查以及單眼與雙眼調節(jié)反應的測量。7.隨機抽取一半受試者,24h后再次戴全矯眼鏡,閱讀40cm處的印刷無序文本(與VDT閱讀文本中字體,大小,內容一致)20min。8.立刻填寫視疲勞評估表。采用SPSS 17.0軟件進行統(tǒng)計分析。如果計量資料符合正態(tài)分布,選擇多組方差分析,t檢驗;如果不符合正態(tài)分布,選非參數(shù)秩和檢驗。以P0.05為差異具有統(tǒng)計學意義。結果1.閱讀前三組單眼與雙眼調節(jié)反應差值均有統(tǒng)計學意義(P0.05)。EXO組:BAMA(t=9.264,P0.05);N組:BAMA(t=4.840,P0.05);ESO組:MABA(t=-6.064,P0.05)。對三組BA進行多重比較,結果具有統(tǒng)計學意義(P0.05)。BA:EXO組ESO組(P0.05);EXON組(P0.05);N組ESO組(P0.05)。對三組MA進行LSD多重比較,差異不具有統(tǒng)計學意義(P0.05)。2.三組的MA與BA閱讀前后的變化差異無統(tǒng)計學意義(單眼:χ~2=0.011,P0.05;雙眼:χ~2=1.190,P0.05)。EXO組與N組表現(xiàn)為:BAMA。ESO組表現(xiàn)為:MABA。而且閱讀后MA與BA均較閱讀前有所增加,但差異無統(tǒng)計學意義。23.閱讀前后三組遠距隱斜量的差異不具有統(tǒng)計學意義(χ~2=5.220,P0.05)。4.閱讀前后PRA、NRA、M-AMP和B-AMP的差異不具有統(tǒng)計學意義(P0.05)。5.三組近距隱斜量的改變量(χ~2=44.026,P0.05),AC/A值的改變量(χ~2=6.986,P0.05)具有統(tǒng)計學意義。ESO組內隱斜量變小;EXO組外隱斜量變小;N組隱斜量變大。ESO組AC/A值變小;EXO組AC/A值變大;N組AC/A值沒有變化。6.閱讀VDT前后三組視疲勞評估差異不具有統(tǒng)計學意義(χ~2=5.281,P0.05)。7.閱讀VDT的一半受試者與閱讀印刷文本的一半受試者視疲勞評估差異有統(tǒng)計學意義(U=1320.5,P0.05)。結論1.不同類型的隱斜對雙眼調節(jié)反應有影響,外隱斜與正常眼位的雙眼調節(jié)反應高于單眼調節(jié)反應,內隱斜單眼調節(jié)反應高于雙眼調節(jié)反應;2.不同類型的隱斜對單眼調節(jié)反應無明顯影響;3.閱讀前后,不同類型的隱斜在融像性聚散需求方向的作用下表現(xiàn)為不同方向的聚散適應,外隱斜變現(xiàn)為集合性聚散適應,內隱斜與正位(低度外隱斜)變現(xiàn)為開散性聚散適應;4.AC/A值可能對不同類型的隱斜的聚散適應有影響;5.內隱斜雙眼調節(jié)滯后量較高,可能是近視的發(fā)展速度較快的影響因素;6.不同類型的隱斜閱讀VDT文本后視疲勞程度無差異。7.閱讀VDT比印刷文本更易引起視疲勞癥狀。
[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.
【學位授予單位】：天津醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R778.11
，
本文編號：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.
【學位授予單位】：天津醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R778.11
，
本文編號：2194421
本文鏈接：http://sikaile.net/yixuelunwen/wuguanyixuelunwen/2194421.html
最近更新
教材專著
