近距离计算机工作对不同类型近视眼波前像差的影响

Impact of near-distance computer work on wavefront aberration in different types of myopia

背景近视眼近距离工作时存在的调节异常及高阶像差均与视网膜图像模糊相关，因此研究稳定性和进展性近视眼近距离工作前后高阶像差的变化具有重要意义。目的观察进展性近视和稳定性近视在近距离工作，如计算机工作前后高阶像差的变化，同时评估不同类型近视眼高阶像差的变化。方法采用病例对照研究设计。60例受试者按年龄、性别匹配的原则进入进展性近视组及稳定性近视组，每组各30例。使用框架眼镜矫正屈光不正，然后持续使用计算机1h，阅读距离为40cm，暗环境、自然最大瞳孔状态下使用COAS波前像差仪测量右眼计算机工作前后的波前像差，分别导出3、4、5mm瞳孔直径下各阶像差的变化，分析计算机工作和近视类型对波前像差的影响，各阶高阶像差（3～6阶）以均方根（RMS）表示。结果直径3、4、5mm瞳孔下受试者使用计算机工作前后高阶像差的差异均无统计学意义（均P〉0．05）。直径3mm瞳孔时进展性近视和稳定性近视的高阶像差RMS差异均无统计意义（均P〉0．05）；直径4mm瞳孔下进展性近视3、5、6阶RMS和总高阶RMS显著高于稳定性近视，差异均有统计学意义（F=5．985，P=0．016；F=3．975，P=0．049；F=8．130，P=0．005；F=6．493，P=0．012）；直径5mm瞳孔下进展性近视3、5、6阶RMS和总高阶RMS显著高于稳定性近视，差异均有统计学意义（F=13．132，P=0．000；F=4．032，P=0．047；F=4．393，P=0．038；F=10．508，P=0．002）。各瞳孔直径下进展性近视组球差均大于稳定性近视组，但差异均无统计学意义（P〉0．05）。结论进展性近视眼高阶像差大于稳定性近视眼，但近距离工作，如从事计算机工作，不引起近视眼高阶像差的显著变化。

Background Both accommodative abnormality and higher order wavefront aberrations associated with near work are interrelated with blurry retinal image. It is very important to investigate the higher order wavefront aberrations in stable and progressive myopic eyes before and after near work. Objective The present study was to observe the high order aberration change of myopic eyes before and after computer work upon near work stimulation as well as the relationship of high order aberration changes to types of myopia. Methods The case-controlled design was used in this clinical study. Sixty right eyes of 60 subjects were enrolled, including 30 progressive myopias and 30 stable myopias with matched age and gender. Refractive errors of the subjects were completely corrected by the wearing of spectacles. The subjects remained the work for 1 hour in front of a computer monitor with 40 cm distance under the dark environment and nature pupil size, and the height of the eye and monitor center kept the same level. The changes of wavefront aberration in test eyes were measured with Complete Ophthalmic Analysis System before and after 1 hour of continuous computer work. The influences of computer-work and myopia types on wavefront aberration were analyzed in 3,4,5 mm pupil size. Root-mean-square （RMS） of aberrations was calculated as the index of higher order wavefront aberrations. Results There were no significant differences in the higher order wavefront aberrations before and after computer work for the two types of myopic eyes under the 3,4,5 mm pupil. The RMS of higher order wavefront aberrations were similar between progressive myopia and stable myopia under the 3 mm pupil condition. Total higher order RMS,6th-order,5th-order and 3rd-order RMS were significantly higher in progressive myopic group compared with stable myopic group under the 4 mm pupil size （ RMS3 ： F = 5. 985, P = 0. 016 ; RMS5 ： F = 3. 975, P=0. 049;RMS6：F=8. 130,P=O. OO5：RMST：F =6.493,P=0.012） and 5 mm pupil size（RMS3：F= 13. 132, P = 0. 000 ; RMS5 ： F = 4. 032, P = 0. 047 ; RMS6 ： F = 4. 393, P = 0. 038 ; RMST ： F = 10. 508, P = 0. 002 ）. The spherical aberrations were higher in progressive myopic group under the 3,4,5 mm pupil conditions in comparison with stable myopic group,but these alterations were insignificant between two types of myopias （P〉0. 05 ）. Conclusions Higher order wavefront aberrations of progressive myopic eyes is comparable higher than the stable myopic eyes. Computer reading task dose not significantly impact the higher order wavefront aberrations on myopic eyes.