近视眼近距离用眼后的调节反应及波前像差变化研究

Accommodative response induced by near work and changes of wavefront aberration of myopic eyes

目的研究近视眼在近距离用眼诱发调节后的调节反应及波前像差变化规律。方法 145名研究对象分为正视眼组(n=46)和近视眼组(n=99)。分别测量调节幅度、调节反应量和波前像差(包括全眼、眼内和角膜高阶像差);观察近距离用眼诱发调节前后的全眼和角膜高阶像差变化;对近距离用眼诱发调节反应与像差变化量进行相关性分析。结果两组调节幅度比较差异无统计学意义(P>0.05);近视眼组调节反应量显著小于正视眼组(P<0.05)。与近距离诱发调节前比较,诱发调节后两组全眼像差均显著增大(P<0.05);近视眼组总高阶及其第3阶像差均显著增加(P<0.05)。相关分析显示,正视眼组的视网膜成像质量相关像差变化量与近距离用眼诱发调节反应存在一定的相关性(P<0.05),而近视眼组未发现类似规律性变化。结论近距离用眼后,近视眼同时存在调节反应不足、调节诱发高阶像差增加及像差增加缺乏规律性三种情况。提示对近视眼进行矫治时应兼顾调节和像差的针对性补偿,从而提高其视网膜成像质量。

Objective To investigate the effects of accommodative response induced by near work and changes of wavefront aberration of myopic eyes. Methods One hundred and forty-five study objectives were divided into emmetropic eye group（n=46） and myopic eye group（n=99）. The amplitude of accommodation, response magnitude of accommodation and wavefront aberration （including whole-eye high-order aberration, high-order aberration within eye and corneal high-order aberration） were measured, changes of whole-eye high-order aberration and corneal high-order aberration before and after accommodation induced by near work were observed, and correlation analysis was performed between accommodative response induced by near work and changes of aberration. Results There was no significant difference in the amplitude of accommodation between two groups（P〉0.05）, and the response magnitude of accommodation in myopic eye group was significantly lower than that in emmetropic eye group（P〈0.05）. Compared with that before accommodation induced by near work, the whole-eye aberration after accommodation induced by near work significantly increased in both groups （P〈0.05）, and the total high-order aberration and third-order aberration significantly increased in myopic eye group（P〈0.05）. Correlation analysis revealed that changes of aberration of image quality on retina in emmetropic eye group related to accommodative response induced by near work to some extent （P〈0.05）, while there were no such findings in myopic eye group. Conclusion After near work, insufficient accommodation, increase of high-order wavefront aberration and irregularity of changes of wavefront aberration can be observed simultaneously in myopia. It will substantially help to improve the retinal image quality by compensating the definite wavefront aberration when refractive error has been well corrected in myopia.