双面复合设计渐进多焦点镜片配戴的视觉功能分析

Investigate visual function with double- mulriple progressive addition lens

目的 通过与单面设计渐进多焦点镜片的比较,研究老视患者配戴双面复合设计渐变多焦点镜片的视觉功能.方法 老视患者16例,年龄（57.9±7.66）岁,屈光状态为（-1.06±3.33）D,近附加（＋1.97±0.34）D.单盲随机给予全天配戴两种设计的渐进多焦点镜片（单面渐变设计和双面复合渐变设计）各4周,于每幅镜片配戴的第4周末进行戴镜状态下的双眼4m和40cm高低对比度视力（100%、10%）,双眼64cm（中距离）和40cm（近距离）清晰阅读范围、64cm（中距离）阅读速度的检测;问卷评分主观舒适度.对相关数据采用两阶段交叉的方差分析.结果 配戴双面复合设计渐进多焦点镜片后中近距离的视功能参数较单面设计有明显不同：（1）清晰阅读范围：64cm双面复合设计组（26.838±3.538）cm,较单面设计组范围大（F=12.305P=0.003）;40cm双面复合设计组（21.009±3.584）cm,较单面设计组范围大（F=42.817P=0.000）.（2）问卷评分：视野宽度评分中距离双面复合设计组（2.813±0.834）分较单面设计组高（F=7.298P=0.017）;近距离双面复合设计组（2.875±0.885）分较单面设计组高（F=10.205P=0.006）;中距离移动舒适度评分水平方向双面复合设计组（2.875±0.719）分较单面设计组高（F=9.000P=0.010）;垂直方向双面复合设计组（2.813±0.655）分较单面设计组高（F=7.226 P=0.018）;伏案工作舒适度评分双面设计组（2.938±0.772）分较单面设计组高（F=7.609P=0.015）.远近高低对比度视力、64cm阅读速度及其他问卷评分结果不同设计组间均差异无统计学意义（P＞0.05）.结论 双面复合设计渐进多焦点镜片较单面设计在不影响远近对比度视力和远用视野宽度的情况下,提供更宽的中近距离清晰阅读范围和更好的中近距离用眼舒适度,更加符合老视配戴者的视觉需求.

Objective To investigate visual function with double-multiple progressive addition lens （or PAL） by comparing with monofocal progressive addition lens. Methods Sixteen presbyopia with age of 57.9± 7.66, ametropia-1.06± 3.33D, addition＋1.97± 0.34D were included. With mono-blind participants were randomly fitted with monofocal PAL and double- multiple PAL for whole day respectively for 4 weeks. Binocular high （100%）- and low （10%）-contrast visual acuity at 4m and 40cm; Binocular clear width of reading materials at 64cm （intermediate） and 40cm （near） and reading rate at 64cm （intermediate） were checked. Patients＇comfort was measured by questionnaire. All of the measurements were taken at the end of the fourth week after every PAL. Cross-over measurement of variance analysis was used in analyzing related data. Results The data of visual function at intermediate and near showed significantly with double- mulriple progressive addition lens （1） The clear width of reading materials： At 64cm double-multiple PAL provided 26.838± 3.538cm,which was more wide than monofocal PAL （F =12.305, P =0.003）. At 40cm double- multiple PAL provided 21.009± 3.584cm, which was more wide than monofocal PAL （F=42.817, P =0.000）. （2） Qu estionnaire scale：The scale of visual filed at intermediate with double- multiple PAL was 2.813± 0.834, which was higher than monofocal PAL （F=7.298, P=0.017）. The scale of visual filed at near with double- multiple PAL was 2.875±0.885 which was higher than monofocal PAL （F =10.205, P =0.006）. The scale of visual shift horizontally at intermediate with double- multiple PAL was 2.875± 0.719, which was higher than monofocal PAL （F=9.000, P =0.010）. The scale of visual shift vertically at intermediate with double- multiple PAL was 2.813 ± 0.655,which was higher than monofocal PAL （F =7.226, P =0.018）. The scale of comfort for reading at desk with double- multiple PAL was 2.938± 0.772, which was higher than monofocal PAL （F =7.609, P =0.015）. The contrast visual acuity and reading rate at 64cm and the other subjective score did not show a significant difference between the two PALs （P 〉0.05）. Conclusions Double- multiple PAL provided more wide clear width of reading materials and better comfortability for intermediate and near visual task than monofocal PAL, but it dose not destroy the contrast acuity and visual field at distance. Double- multiple PAL do match the visual needs of patients with presbyopia.