成人近视不同验光方法的差异和相关因素分析

The difference of detected optometrie results and related factors analysis in adult myopia

目的比较成人近视眼患者不同验光方法球镜屈光度、柱镜屈光度和散光轴位的差异及相关因素分析.方法首先分别对成人近视眼患者100例(200只眼)进行自然瞳孔电脑验光、散瞳电脑验光、视网膜检影及主观屈光的检查,其中男性36例(72只眼),女性64例(128只眼);年龄18～47岁,平均24.7岁;然后,分为三组:组Ⅰ(按视网膜检影屈光度):组Ⅰ a≤6.0D,144只眼,组Ⅰ b＞6.0D,56只眼;组Ⅱ(按年龄)组Ⅱa＜25岁,132只眼,组Ⅱb≥26岁,68只眼;组Ⅲ(按性别)组Ⅲa男性,72只眼,组Ⅲb女性,128只眼.最后,比较不同种验光方法球镜、柱镜和散光轴位的差别并进行相关因素分析.结果四种验光获得的球镜、柱镜屈光度和散光轴位均值分别为:自然瞳孔电脑验光(-6.29±2.57)D、(-1.12±0.76)D、(121.32±74.45)°;散瞳电脑验光(-5.78±2.54)D、(-1.15±0.79)D、(98.61±78.03)°;视网膜检影(-6.02±2.59)D、(-1.18±0.65)D、(123.81±72.78)°;主观屈光:(-6.18±2.57)D、(-1.06±0.64)D、(129.94±73.87)°.四种条件下球镜屈光度均存在显著性统计学差异(P＜0.05).自然瞳孔条件下的球镜屈光度高于散瞳的球镜屈光度,整体视网膜检影高于散瞳电脑验光.屈光度高近视组与屈光度低近视组,在年龄相同的条件下,小瞳的整体球镜明显高于散瞳后球镜;在年龄不同的条件下,年小组这种差异明显高于年长组;在对各干扰因素的分析中,瞳孔状态是影响球镜屈光度的主要因素,年龄越小、屈光度越高影响也越大.对柱镜屈光度比较,柱镜屈光度也受瞳孔的影响.在年龄高与年龄低组,球镜屈光度相同的条件下,前者的整体散光度散瞳条件下高于自然瞳孔,比较有显著性差异(P＜0.05);其余各组整体散光度比较无显著差异(P＞0.05).对于散光轴位的比较,视网膜检影与主观屈光检查、散瞳电脑验光与自然瞳孔电脑验光整体结果比较无显著性差异(P＞0.05);但视网膜检影与散瞳电脑验光、主观屈光检查与自然瞳孔电脑验光整体结果比较有显著性差异(P＜0.05),这种差异与年龄、性别和屈光度无关.结论不同验光方法所获得的整体球镜屈光度是有差异的.这种差异受瞳孔大小、年龄和屈光度的影响,自然瞳孔条件下的屈光度高于散瞳后屈光度,年龄小、屈光度高差异显著,而性别间验光比较并无差异;除年龄大的整体柱镜屈光度在散瞳条件下高于自然瞳孔,其余各组比较差异极小,这种差异与调节、晶状体和玻璃体等因素有关.散光轴位小的差异是验光方法的进位差异造成的.

Objective To compare the differences of results detected by the four optometries, and to analyze the related factors. Methods 100 adult myopes were each examined with four optometries： autorefraction without cycloplegis, autorefraction after cycloplegis, skiascopy and subjective refraction. The patients consisted of 36 males （72 eyes） and 64females （ 128 eyes）, ranging in age from 18 to 47 years （mean 24.7 years）. Then, the subjects were divided into several groups： Group I （according to the results of skiascopy）： Group I a ≤6.0D, 144 eyes, GroupIb 〉6.0D, 56 eyes; Group Ⅱ （according to ages）： Group Ⅱ a〈25 years, 132 eyes, Group Ⅱb ≥26 years, 68 eyes; Group Ⅲ （according to gender）： Group Ⅲ a, male, 72 eyes, Group Ⅲ b, female, 128 eyes. The results of the sphere changes, cylinder changes and cylinder axis changes of different optometries were compared and the related factors were analyzed. ResultsThe means of sphere changes, cylinder changes and cylinder axis changes of different optometries were： autorefraction without cycloplegis： - 6.29 ± 2.57D, - 1.12 ± 0.76, 121.32 ± 74.45; autorefraction after cycloplegis： -5.78±2.54D, - 1.15 ±0.79, 98.61 ± 78.03; skiascopy： - 6.02D± 2.59, - 1.18 ± 0.65, 123.81 ± 72.78; subjective refraction： - 6.18 ± 2.57D, - 1.06 ±0.64D, 129.94 ± 73.87. There was significant difference among the results of sphere changes （P 〈 0.05）. The sphere changes were greater in optometries without cycloplegis than that after cycloplegis and were greater in skiascopy than that in autorefraction after cycloplegis. In Group Ia and Grouplb, The sphere changes were significantly greater in optometries without cycloplegis than that after cycloplegis, and the differences were even greater in Group Ⅱ a. than in Group Ⅱ b. Analyzing the related factors, cycloplegis is of the greatest importance, especially for the younger subjects or subjects with higher sphere changes. The cylinder changes were also influenced by cycloplegis. When the sphere changes were same, there was significant difference in cylinder changes with optometries after cycloplegis in Group Ⅱ a and Group Ⅱ b, but not in other groups. There was no significant difference among the four optometries in terms of cylinder axis. But when comparing with the other there optometries, the difference was significant and was not related to age, gender or sphere changes. Conclusions There was difference among different optometries in terms of sphere changes. The difference was related to cycloplegis, age and sphere changes. The sphere changes were greater in optometries after cycloplegis than those without cycloplegis. The difference was more significant in younger subjects and subjects with higher sphere changes, but was not related to gender. The cylinder changes were greater in optometries after cycloplegis than those without cycloplegis only in older subjects, but not in other groups. The difference was related to accommodation, lens and vitreous. The small difference of cylinder axis was contributed to the different intervals among the optometries.