内隐斜视青少年近视眼矫正时个体化下加的确立方法

The strategy of determining the customized near addition lens for juvenile esophoric myopes

目的探讨在青少年近视眼矫正时不同视近下加条件下，调节滞后及隐斜的变化，并构建下加与调节滞后、隐斜间关系的数学公式，以期得到使调节滞后与隐斜量同时最小的最适视近下加范围。方法招募110例单纯性近视眼的内隐斜视青少年患者，据MPMVA原则验光配镜后依次予以佩戴5种不同下加试镜片（0D、＋0．75D、＋1．50D、＋2．00D、＋2．50D）后测量双眼视近33cm的调节反应（Shin—Nippon，日本）以及遮盖试验＋排棱镜测量视近隐斜度；采用线性回归统计学分析视近下加与调节滞后、隐斜度间关系。结果随着下加度数增加，视近调节滞后量逐渐减少，而内隐斜量逐渐变小并向外隐斜方向变化；不同下加条件下调节滞后量[17（262．76，4），P〈0．01]以及隐斜度[F（223．45，4），P〈0．01]都存在统计学差异；内隐斜患者的最适下加与初始调节滞后存在线性相关性（r=0．526，P〈0．01），且最适下加与初始隐斜状态也存在线性相关性（r=0．523，P〈0．01）。结论根据青少年近视眼患者个体的初始近调节滞后量和近隐斜度，可获得适合该患者的视近下加范围，从而为青少年内隐斜近视眼确立个体化视近下加提供参考策略。

Objective To discuss accommodative lag and near phoria varying with the near addition lenses and establish the mathematic equations of near adds and accommodative lag,near phoria respectively in order to getting the optimal adds, which would create the least error in accommodative and convergence responses. Methods To measure accommodative lag by Shin-Nippon and near phoria by Cover Test in 33 cm after providing 0D, ＋0. 75D, ＋ 1. 509, ＋2. 00D, ＋2. 50D five near adds orderly to myopes after 110 simple myopes with esophoria have been corrected far vision wholly basing on MPMVA norm; to analyze the relation of near adds and accommodative lag, near phoria by linearity regression. Results While increasing dioptric value of the near adds, accommodative lag and esophoria decrease gradually. Both accommodative lag [ F（262.76, 4 ）, P 〈 0. 01 ] and near phoria [ F （ 223.45, 4 ）, P 〈 0. 01 ] show statistically significant difference among the five near adds. There is linearity correlation between the optimal adds and initial accommodative lag （r = 0. 526, P 〈 0. 01 ） and between the optimal adds and initial near phoria （r=0.523,P〈0.01）. Condusion The range of optimal near adds can be gotten basing on initial accommodative lag and near phoria of myopic individual, so that it can be provided referenced strategy of determining the customized near addition lens for juvenile esophoric myopes.