调节对人眼周边视网膜球性离焦影响

Effect of accommodation on peripheral defocus

目的 研究调节状态下人眼周边视网膜球性离焦量的变化规律,探讨人眼周边视网膜球性离焦量与屈光力的相关性.方法 临床病系列研究.对2013年3～6月在温州医科大学眼视光学院共收集了33例（33只眼）自愿受试者的数据,平均年龄（25.03±1.33）岁.分为正视组、低度近视、中度近视组三组,分别为10例（10只眼）、10例（10只眼）、13例（13只眼）,等效球镜度分别为（-0.25±0.26）D、（-1.75±0.55）D、（-4.15±0.92）D.用试镜片全矫近视,采用WASCA波前像差仪测量0.3D和2.5D调节刺激下右眼中心及周边鼻颞30＆#176;像差,采用重复测量方差分析调节增加时周边球性离焦的变化趋势,及视远和视近时视网膜30＆#176;不同屈光组之间的差异.结果 三组离焦在所有视网膜位置随调节而增加,差异均有统计学意义（P＜0.01）.鼻侧30＆#176;视远时离焦量正视组（0.640±0.670） μm和低度近视组（0.298±0.462） μm,分别大于中度近视组（-0.599±0.833）μm,差异有统计学意义（P ＜0.01,P=0.004）.而视近时离焦量只有正视组（1.734±0.589） μm大于中度近视组（0.868±1.061） μm,差异有统计学意义P＜0.05 （P =0.019）.鼻侧30＆#176;视远和视近时球性离焦与屈光度之间呈线性相关,差异有统计学意义P ＜0.01（视远斜率为0.274 μm/D,r2=0.572,P=0.001;视近斜率为0.170 μm/D,r2=0.345,P=0.049）.结论 人眼周边视网膜球性离焦随调节增加趋向近视性漂移,周边视网膜30＆#176;远视离焦量随近视度数的增加而增加.

Objective To investigate the changes in the peripheral defocus of the human eye under accommodation and the correlation between defocus and refractive power and to investigate the possible mechanism of the development of myopia.Methods Thirty-three subjects were enrolled,ranging in age from 22 to 27 years with all average age of（25.03±l.33）years.Emmetropia,low myopia,moderate myopia group were 10,10,13,spherical equivalent was （-0.25 ±0.26）D,（-1.75±0.55）D,（-4.15±0.92）D.Trial lenses were used to correct myopia,Measurements at the fovea,and at eccentricities of 30＆#176; in the temporal and nasal hemispheres of the horizontal visual field at distances of 3m,40cm were obtained using Zemike aberration coefficients calculated with a WASCA wavefront analyzer.Only the right eye of each subject was tested.Repeated measures ANOVA were analysis of variance accommodation increases peripheral aberrations trends,as well as the distant and near vision,peripheral retina 30＆#176; different refractive aberration differences between groups.Results The defocus at all retinal positions increased with accommodation were statistically significant（P 〈0.001）.The significant differences were found at distance between refractive error groups at nasal 30°; with the defocus amount emmetropia（0.640±0.670μm）and low myopia group（0.298±0.462μm）were greater than moderate myopia group（-0.599±0.833μm）,（P 〈0.001,P =0.004）.As for near,defocus amount emmetropia（l.734±0.589μm）than moderate myopia group（0.868±l.061μm）,and was statistically significant（P=0.019）.At temporal 30°;,as far and near vision it was no difference among the three groups.The focus was correlated with diopter at nasal 30°; as far and near vision（as far slope of 0.274 μm/D,r2=0.572,P =0.001; as near slope 0.170 μm/D,r2=0.345,P =0.049）.Conclusions The defocus toward positive values with accommodation and that it is myopic shift with accommodation.Peripheral 30°; hyperopic defocus amount increased with the increase in myopia.