年龄相关性白内障早期视觉功能的临床评价

Early clinical evaluation of visual function in patients with age-related cataract

目的探讨对比敏感度和眩光对比敏感度对白内障患者视觉功能评价的意义。方法使用自动眩光对比敏感度检查仪对最佳矫正视力≥0.5的年龄相关性白内障患者66例(115只眼)和健康人34例(34只眼)进行对比敏感度和眩光对比敏感度的检测。白内障患者中皮质性白内障31例(50只眼),核性白内障17例(32只眼),后囊膜下白内障18例(33只眼)。结果不同视力的白内障患者对比敏感度和眩光对比敏感度在低频段和中频段差异均有统计学意义(P<0.01),在高频段差异无统计学意义(P>0.05)。皮质性白内障眼在对比敏感度的低和中频段,在眩光对比敏感度的低、中和高频段均低于健康眼,差异有统计学意义(P<0.01);核性白内障眼的对比敏感度和眩光对比敏感度在低频段低于健康眼,差异有统计学意义(P<0.01),眩光对比敏感度在中和高频段低于健康眼,差异有统计学意义(P<0.05);后囊膜下白内障眼的对比敏感度和眩光对比敏感度在低、中和高频段均低于健康眼,差异有统计学意义(P<0.01)。最佳矫正视力≥0.8的57只白内障眼对比敏感度和眩光对比敏感度在各个频段均低于健康眼,对比敏感度在低频段,眩光对比敏感度在高频段差异有统计学意义(P<0.05);眩光对比敏感度在低频段差异有统计学意义(P<0.01);余频段的对比敏感度和眩光对比敏感度的差异无统计学意义(P>0.05)。白内障眼的眩光对比敏感度比对比敏感度下降明显,在6.3°、4.0°、2.5°、1.6°、1.0°视角两者之间差异有统计学意义(P<0.01),在0.7°视角差异无统计学意义(P>0.05)。结论对比敏感度和眩光对比敏感度的测定可以为早期年龄相关性白内障患者的视觉功能评价提供灵敏、全面的客观依据。(中华眼科杂志,2006,42:236-240)

Objective To investigate the characteristics of visual acuity, contrast sensitivity and glare contrast sensitivity in age-related cataract patients. Methods In this study, 115 eyes of 66 age-related cataract patients with a best corrected visual acuity of 0. 5 or better, who had been classified into cortical cataract group （50 eyes of 31 subjects）, nuclear sclerosis group （32 eyes of 17 subjects）, posterior subcapsular cataract group （33 eyes of 18 subjects）; and control group （34 eyes of 34 subjects） were examined with a contrast glare tester to assess contrast sensitivity and glare contrast sensitivity. Results There were statistically significant differences among contrast sensitivity and glare contrast sensitivity in the cataract patients with different visual acuity at low, medium spatial frequency （P 〈 0. 01 ）; there were no statistically significant differences among those at high spatial frequency （ P 〉 0. 05 ）. Cortical cataract was associated with the contrast sensitivity at low, medium spatial frequency, where the glare contrast sensitivity fell into at low, medium and high spatial frequency; in the patients with cataract of nuclear sclerosis was associated with the contrast sensitivity at low spatial frequency, where the glare contrast sensitivity was at low, medium and high spatial frequency; in contrast to posterior subcapsular cataract both the contrast sensitivity and glare contrast sensitivity （ at low, medium, high spatial frequency） were lower than normal eyes （P 〈 0. 05）. Each spatial frequency of contrast sensitivity and glare contrast sensitivity in 57 cataract eyes with a best corrected visual acuity of 0. 8 or better were lower than normal eyes. In those eyes the contrast sensitivity at low spatial frequency and glare contrast sensitivity at low and high spatial frequency had statistically siglnificant difference compared with control （ P 〈 0. 05 ） ; other spatial frequency had no statistically significant difference among groups （ P 〉 0. 05 ）. The glare contrast sensitivity in cataract eyes was lower than contrast sensitivity at visual angle of 6. 3°, 4. 0°, 2. 5°, 1.6°, 1.0°, the difference was statistically significant （P 〈 0. 01 ）. Conclusion Contrast sensitivity and glare contrast sensitivity are reliable in evaluating visual function in the patients with early age-related cataract.