儿童远视合并弱视眼的高阶像差与视觉质量的关系

Relationship between the higher order aberrations and the diopter as well as contrast sensitivity in children with hyperopic amblyopia

目的:探索儿童远视弱视眼的高阶像差与屈光度及对比敏感度的关系。方法:66例远视弱视患儿经10g/L阿托品散瞳7d后进行检影并使用Allegretto波前像差仪进行像差测定;20d待瞳孔完全恢复后在完全矫正屈光不正情况下用CSV-1000对比敏感度灯测试其暗室对比敏感度。结果:带状检影球镜度为+2.60±1.76D,柱镜度为+1.15±0.98D,散光轴为82.83±27.93。而波前像差测得的值分别为+2.76±1.69D,+1.35±1.02D,85.37±30.72D。随着球镜值增大,各阶像差值亦增大。中、低度弱视组两两比较,RMS1,RMS5,RMSh差异有显著性(P<0.01),中低度远视组两两比较RMS2,RMSg及C12差异有显著性(P<0.01)。弱视患儿全频段对比敏感度均下降,尤其高频区下降显著,高阶像差中C8及C12与高频段对比敏感度有相关性。结论:波前像差检查及对比敏感度检查均能较正确,全面地反映弱视儿童眼的屈光度及视觉质量,可作为远视、弱视儿童屈光检查的一种客观手段。有助于了解儿童弱视的原因及追踪观察其治疗的转归。

AIM： To investigate the relationship between the higher order aberrations and the diopter as well as contrast sensitivity in children with hyperopic amblyopia. METHODS： Sixty-six cases of children with hyperopic amblyopia were dilated the pupils with atropine for seven days and a retinoscopy was executed for everyone. The wavefront analyzer was also used in the study; When the pupils regained the normal diameter 20 days later, the contrast sensitivity was measured by the CSV-1000 in a dark room. RESULTS： The mean refractive states of the children were ＋2.60±1.76D（hyperopic diopter） and ＋1.15±098D（astigmatic diopter） with an axis of 82.83±27.93 by barred retinoscopy. While recorded by the wavefront aberrations they were ＋2.76±1.69D and ＋1.35±1.02D respectively with an axis of 85.37±30.72D.With the increase of the hyperopic diopter, the aberrations at all levels increased. The differences of RMS1,RMS5 and RMSh in the middle and low amblyopic group was as significant as the differences of RMS2,RMSg and C12 in the middle and low hyperopic group （P〈0.01）. The contrast sensitivity of the children decreased at all frequencies, especially at high frequency. The C8 and C12 at higher order aberrations had significant correlation with the contrast sensitivity at higher frequency. CONCLUSION：The wavefront aberrations and contrast sensitivity can correctly evaluate refractive degree and visual quality in children with hyperopia and could be used as an objective measure. At the same time , they are useful in investigating the cause of amblyopia and effect of the therapy. 