本文關(guān)鍵詞：調(diào)節(jié)對(duì)散光的影響研究，，由筆耕文化傳播整理發(fā)布。

        目的通過(guò)研究不同水平調(diào)節(jié)刺激下散光的可能改變,探討調(diào)節(jié)是否存在非球性成分以及伴隨著調(diào)節(jié)的改變這種非球性成分的變化趨勢(shì)；通過(guò)研究調(diào)節(jié)對(duì)不同類型、不同程度散光的不同影響,分析調(diào)節(jié)非球性可能的形式；通過(guò)對(duì)比調(diào)節(jié)下散光修正后近視力與遠(yuǎn)矯正下近視力,探討調(diào)節(jié)下散光的改變對(duì)近距離工作的影響；通過(guò)分析對(duì)比不同屈光檢查方法,尋找簡(jiǎn)便可行的近距散光檢查方法。方法序貫選取散光受試者166例(右眼),年齡18-21歲,平均(19.8±1.2)歲,平均球鏡度(-3.33±2.21)D,散光度(0.61±0.47)D。按兩種角度分組研究：①按散光類型分為：順規(guī)散光組(強(qiáng)主子午線方向?yàn)?0°±20°)、逆規(guī)散光組(強(qiáng)主子午線方向?yàn)?80°±20°)及斜軸散光組(45°±25°,130°±25°)。②按散光度分為：組一(散光度≤0.50D)、組二(0.50D<散光度≤1.00D)、組三(散光度>1.00D)。序貫選取雙眼屈光不正狀態(tài)具有同質(zhì)性的受試者43例(兩眼球鏡度相差<1.00D,散光度相差≤0.50DC),研究?jī)裳坶g的調(diào)節(jié)是否存在差異。平均球鏡度(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.角膜曲率計(jì)(Topcon OM-4)檢查各受試者角膜曲率；2.綜合驗(yàn)光儀(TopconVT-10)主觀驗(yàn)光法檢查各受試者調(diào)節(jié)靜止?fàn)顟B(tài)下(視遠(yuǎn),眼前5m)屈光不正度；3.推進(jìn)法(石原式近點(diǎn)計(jì))檢查單眼調(diào)節(jié)幅度,±2.00D反轉(zhuǎn)拍(配合40cm標(biāo)準(zhǔn)對(duì)數(shù)視力表)檢查單眼調(diào)節(jié)靈敏度,FCC(配合十字視標(biāo))檢查單眼調(diào)節(jié)滯后；4.通過(guò)注視眼前40cm處近視力表(TopconVT-10綜合驗(yàn)光儀配套近距卡NC-1)刺激調(diào)節(jié),檢查40cm處遠(yuǎn)矯正下近視力(DCNVA1);5.綜合驗(yàn)光儀檢查各受試者視近40cm調(diào)節(jié)刺激下屈光度：調(diào)節(jié)狀態(tài)下的散光在視遠(yuǎn)單眼全矯基礎(chǔ)上用采交叉柱鏡修正,受試者為單眼注視狀態(tài)(另一眼關(guān)閉),受檢眼水平向前注視近視力表中其最佳視力的視標(biāo)；6.檢查視近40cm調(diào)節(jié)刺激下散光修正后近視力(ACNVA1);7.以4-6步同樣的方法檢查視近20cm調(diào)節(jié)刺激下的遠(yuǎn)矯正下近視力(DCNVA2)、散光度及散光修正后近視力(ACNVA2);8.采用單樣本K-S檢驗(yàn)法對(duì)數(shù)據(jù)進(jìn)行正態(tài)性檢驗(yàn)；對(duì)三種不同調(diào)節(jié)刺激下兩兩之間散光的差異采用兩兩配對(duì)檢驗(yàn),若數(shù)據(jù)服從正態(tài)分布采用配對(duì)t檢驗(yàn),若不服從則采用配對(duì)符號(hào)秩和檢驗(yàn),檢驗(yàn)水準(zhǔn)取α’=0.05/3=0.0167; DCNVA1與ACNVA1、DCNVA2與ACNVA2的差異采用配對(duì)t/符號(hào)秩和檢驗(yàn),檢驗(yàn)水準(zhǔn)取a取0.05；對(duì)雙眼研究對(duì)象43例受試者兩眼間調(diào)節(jié)下散光改變、DCNVA與ACNVA的差值進(jìn)行配對(duì)分析,檢驗(yàn)水準(zhǔn)取α取0.05；調(diào)節(jié)下散光改變與角膜散光度、殘余散光度、調(diào)節(jié)滯后量、調(diào)節(jié)幅度、調(diào)節(jié)靈敏度之間進(jìn)行相關(guān)性分析,若數(shù)據(jù)服從正態(tài)分布采用Pearson積矩相關(guān)分析,若不服從則采用Spearman秩相關(guān)進(jìn)行分析。結(jié)果1.三個(gè)不同調(diào)節(jié)刺激下,兩兩間散光度的差異均具有統(tǒng)計(jì)學(xué)意義(視近40cm與視遠(yuǎn)5m：Z=-5.316,P<0.0167；視近20cm與視遠(yuǎn)5m：Z=-5.672,P<0.0167；視近20cm與視近40cm：Z=-2.463,P<0.0167),且視近20cm調(diào)節(jié)刺激下散光度>視近40cm調(diào)節(jié)刺激下散光度>視遠(yuǎn)5m調(diào)節(jié)靜止下散光度；2.三個(gè)不同調(diào)節(jié)刺激下,兩兩間散光軸位的差異均不具有統(tǒng)計(jì)學(xué)意義(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與ACNVA1、DCNVA2與ACNVA2的差異具有統(tǒng)計(jì)學(xué)意義,且散光修正后視力呈提高的趨勢(shì)(Z=-5.741,P=<0.01；Z=-6.848,P<0.01)；4.順規(guī)散光組和斜軸散光組與總體資料變化趨勢(shì)一致：三個(gè)不同調(diào)節(jié)刺激下,兩兩間散光度數(shù)的差異均具有統(tǒng)計(jì)學(xué)意義(視近40cm與視遠(yuǎn)5m：Z=-4.252,P<0.0167(順規(guī)),Z=-2.685,P<0.0167(斜軸)；視近20cm與視遠(yuǎn)5m：Z=-3.983,P<0.0167(順規(guī)),Z=-2.869,P<0.0167(斜軸)；視近20cm與視近40cm：Z=-2.586,P<0.0167(順規(guī)),Z=-2.568,P<0.0167(斜軸)),且視近20cm調(diào)節(jié)刺激下散光度>視近40cm調(diào)節(jié)刺激下散光度>視遠(yuǎn)5m調(diào)節(jié)靜止下散光度；DCNVA1與ACNVA1的差異具有統(tǒng)計(jì)學(xué)意義,且散光修正后視力呈提高的趨勢(shì)(Z=-3.575,P<0.01(順規(guī)),Z=-3.571,P<0.01(斜軸)),DCNVA2與ACNVA2的差異具有統(tǒng)計(jì)學(xué)意義,且散光修正后視力呈提高的趨勢(shì)(Z=-5.432,P<0.01(順規(guī)),Z=-2.954,P<0.01(斜軸))；而逆規(guī)散光組兩兩間散光度數(shù)的差異均不具有統(tǒng)計(jì)學(xué)意義(t=-0.224,P>0.05),且DCNVA1與ACNVA1、DCNVA2與ACNVA2的差異不具有統(tǒng)計(jì)學(xué)意義(t=2.016,P>0.05；t=-2.37,P>0.05)；5.散光度≤1.00D的受試者與總體資料變化趨勢(shì)一致：三個(gè)不同調(diào)節(jié)刺激下,兩兩間散光度數(shù)的差異均具有統(tǒng)計(jì)學(xué)意義(視近40cm與視遠(yuǎn)5m:Z=-3.437,P<0.0167(≤0.50DC),Z=-2.690,P<0.0167(0.50～1.00DC)；視近20cm與視遠(yuǎn)5m:Z=-5.416,P<0.0167(≤0.50DC),Z=-2.737,P<0.0167(0.50～1.00DC)；視近20cm與視近40cm:Z=-2.553,P<0.0167(≤0.50DC),Z=-2.450,P<0.0167(0.50～1.00DC),且視近20cm調(diào)節(jié)刺激下散光度>視近40cm調(diào)節(jié)刺激下散光度>視遠(yuǎn)5m調(diào)節(jié)靜止下散光度；DCNVA1與ACNVA1的差異具有統(tǒng)計(jì)學(xué)意義,且散光修正后視力呈提高的趨勢(shì)(Z=-3.198,P<0.01(≤0.50DC),Z=-3.510, P<0.01(0.50～1.00DC),DCNVA2與ACNVA2的差異具有統(tǒng)計(jì)學(xué)意義,且散光修正后視力呈提高的趨勢(shì)(Z=-5.150,P<0.01(≤0.50DC),Z=-4.656,P<0.01(0.50～1.00DC));而散光度>1.00D的受試者兩兩間散光度數(shù)的差異均不具有統(tǒng)計(jì)學(xué)意義(Z=-1.848,P>0.05),且DCNVA1與ACNVA1、DCNVA2與ACNVA2的差異不具有統(tǒng)計(jì)學(xué)意義(t-1.406,P>0.05；Z=-1.717,P>0.05)；6.43名受試者兩眼間的調(diào)節(jié)對(duì)散光的影響之差異情況不具有統(tǒng)計(jì)學(xué)意義(Z=-1.024,P>0.05(40cm-5m):Z=-0.198,P>0.05(20cm-5m)；Z=-0.728, P>0.05(20cm-40cm)).結(jié)論1.人眼的調(diào)節(jié)存在非球性成分,各子午線的調(diào)節(jié)具有一定的不均衡性;2.調(diào)節(jié)刺激增加,散光變化總體趨勢(shì)表現(xiàn)為散光度增加,這于順規(guī)散光、斜軸散光及散光度≤1.00D的患者更為明顯：但調(diào)節(jié)過(guò)程中調(diào)節(jié)非球性的形式可能會(huì)發(fā)生變化,且是隨機(jī)的、個(gè)性化的,并未表現(xiàn)出一致的規(guī)律性；3.調(diào)節(jié)下散光的改變不同程度地影響著近視力從而影響近距離工作；4.于正常人群,兩眼調(diào)節(jié)等量、非球性形式一致；5.在視遠(yuǎn)全矯基礎(chǔ)上采用交叉柱鏡修正近用散光,視標(biāo)為被檢者最佳視力的視標(biāo),這可能是檢查視近散光的有效方法,且可直接嵌入到常規(guī)屈光檢查工作中。

    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.

          調(diào)節(jié)對(duì)散光的影響研究

中文摘要4-7Abstract7-9縮略語(yǔ)/符號(hào)說(shuō)明12-13前言13-15    研究現(xiàn)狀、成果13    研究目的、方法13-15對(duì)象和方法15-20    1.1 研究對(duì)象15        1.1.1 入選條件15        1.1.2 分組情況15    1.2 實(shí)驗(yàn)裝置及條件15-16    1.3 實(shí)驗(yàn)過(guò)程16-19        1.3.1 基本資料采集16-17        1.3.2 病例篩選17        1.3.3 角膜散光的檢查17        1.3.4 不同調(diào)節(jié)刺激下屈光狀態(tài)的檢查17-18        1.3.5 調(diào)節(jié)功能的檢查18-19    1.4 數(shù)據(jù)分析19-20結(jié)果20-32    2.1 不同調(diào)節(jié)刺激下散光度的變化情況20-24    2.2 不同調(diào)節(jié)刺激下散光軸位的變化情況24-27    2.3 調(diào)節(jié)性散光對(duì)近視力的影響情況27-29    2.4 雙眼間調(diào)節(jié)性散光的差異情況29-31        2.4.1 雙眼間調(diào)節(jié)性散光的差異情況29-31        2.4.2 雙眼間調(diào)節(jié)功能的差異情況31    2.5 調(diào)節(jié)性散光與角膜散光及調(diào)節(jié)功能參數(shù)的相關(guān)情況31-32分析和討論32-43    3.1 不同調(diào)節(jié)刺激下散光度的變化情況32-37    3.2 不同調(diào)節(jié)刺激下散光軸位的變化情況37-38    3.3 調(diào)節(jié)性散光對(duì)近視力的影響情況38-40    3.4 雙眼間調(diào)節(jié)性散光的差異情況40    3.5 調(diào)節(jié)性散光與角膜散光及調(diào)節(jié)功能參數(shù)的相關(guān)情況40-41    3.6 檢查近用散光方法的可行性41-43結(jié)論43-44參考文獻(xiàn)44-48發(fā)表論文和參加科研情況說(shuō)明48-49綜述49-68    綜述參考文獻(xiàn)62-68致謝68

  本文關(guān)鍵詞：調(diào)節(jié)對(duì)散光的影響研究，由筆耕文化傳播整理發(fā)布。