位置辨别训练对屈光不正性弱视患者视锐度的影响

Influence of position discrimination training on ametropic amblyopic visual acuity

背景：由于位置锐度代表了人眼所能识别的最小空间纹理，作者选择了位置辨别训练来观察对儿童弱视者某种视觉任务进行反复训练的治疗作用。目的：评价何置辨别训练改善弱视患者位置辨别功能进而提高视力的作用。设计、时间及地点：回顾性、自身对照试骀，于2006—07／2009—01在广西壮族自治区人民医院视光中心完成。对象：选择在广西视光中心就诊的屈光不正性弱视患者50例，其中男31例，女19例，年龄（7±1）岁。方法：采用位置噪声分类图像进行弱视治疗。位置辨别能力的训练每天进行2次，终止时间为受试者的位置辨别水平达5级且维持恒定状态。每位受试者在接受训练前通过标准对数视力表检测最佳戴镜矫正视力，训练4-6个月后再次检测最佳戴镜矫正视力，视力检测结果对照logMAR视力进行转换。主要观察指标：比较治疗前、后弱视患者最佳矫正视力以及位置辨别能力的差异。结果：在戴镜矫正屈光不正的前提下接受视知觉学习的时间为（9．5±2．1）个月。弱视患者在治疗前、后的最佳矫正视力分别为0.294±0．176logMAR，0．028±0．097logMAR，差异具有显著性意义（t=-18．943，P=0．000）；治疗前、后位置噪声分别为（2．7±16），（39±12）级，差异具有显著性意义（t=5．543，P=0．000）。结论：位置辨别训练可以改善弱视者的位置辨别功能，此改善可转化为最佳矫正视力的提高。

BACKGROUND： Position acuity represents the finest spatial grain, so we selected position discrimination training to investigate whether it has therapeutic effect for children amblyopia. OBJECTIVE： To explore whether repetitive position discrimination could improve position discrimination performance and amblyopic visual acuity. DESIGN, TIME AND SETTING： A randomized, self-controlled experiment was performed at the Visual Science and Optometry Center, People＇s Hospital of Guangxi Zhuang Autonomous Region from July 2006 to January 2009. PARTICIPANTS： A total of 50 ametropic amblyopes （31 males, 19 females） aged （7±1） years old, were selected from the Visua Science and Optometry Center. METHODS： All ametropic amblyopes underwent classification image learning Jn positional noise, twice a day until their identification of position had reached grade 5 and maintained stable. The best corrected visual acuity （BCVA） before and 4-6 months after training was measured, and the results were transformed according to LogMAR. MAIN OUTCOME MEASURES： Position discrimination and BCVA before and after their training. RESULTS： All subjects had been corrected with spectacles and undergone about （9.5±2.1） months＇ position discrimination training with positional noise. Position discrimination were improved from （2.7±1.6） to （3.9±1.2） noise levels （t=- 5.543, P=0.000） and BCVA were also improved from 0.294±0.176logMAR to 0.028±0.097logMAR （/=-18.943, P=0.000） with practice. CONCLUSION： Position discrimination training could imporve ametropic amblyopic position acuity, which could improve BCVA.