视知觉学习治疗大龄儿童屈光参差性弱视的疗效观察

Observation on the curative effect of perceptual learning for juvenile anisometropic amblyopia

目的观察应用基于互联网的视知觉学习系统治疗9～13岁屈光参差性儿童弱视的疗效,分析其视力的变化,为寻找儿童弱视快速、有效的治疗方法提供参考。方法选取我院收治的弱视患儿216例(216眼),分别应用基于互联网的视知觉学习系统(视觉组)和传统综合训练方法(综合组)对大龄弱视儿童进行治疗,具体训练方案由医师基于患儿视觉表现的初始状态、功能低下的严重程度以及训练治疗过程中的进步来设计。视知觉学习系统组给予提高视觉噪声和轮廓整合、位置噪声等视觉训练方案;传统综合训练组采取红光、精细目力训练等治疗。90d为1个疗程,共3～4个疗程。对比观察两种方法在弱视治疗后1、3、9、12个月的视力变化。结果视知觉学习系统组的疗效优于传统综合训练组(P=0.000),不同程度屈光参差性弱视视知觉学习系统组的疗效优于传统综合训练组(P<0.01)。视知觉学习系统组视力提升速率明显高于传统综合训练组,视知觉学习系统组在疗程第6个月已有50%的患儿进入基本治愈的平台期,而传统综合训练组50%的患儿在观察终点才进入基本治愈平台期。视知觉学习训练组治疗屈光参差性弱视平均训练13.75h可提高一行视力,其中中度弱视所需时间最短(10.78h),重度弱视次之(12h),轻度弱视所需时间最长(26.5h)。结论基于互联网的视知觉学习系统提供了强烈、活跃、有反馈的个性化视觉刺激,对超过视觉发育敏感期的9～13岁屈光参差性儿童弱视的疗效优于传统综合训练法,缩短了视功能障碍治疗的周期。此新方法能在较短时间达到最佳治疗效果,为弱视的临床治疗提供了新的可行途径。

Objective To evaluate the curative effect of perceptual learning based on internet for juvenile anisometropic amblyopia, analyze the change of visual acuity and provide the reference for quickly and effective treat- ment of amblyopia children. Methods Two hundred and sixteen juvenile patients （216 eyes） with anisometropic am- blyopia were chosen and treated with the perceptual learning based on internet and the traditional combined training. The specific training programs were designed by doctor, which according to the vision initial state, degree of severity in low vision and advancement during training process. The perceptual learning group received the visual trainings, such as improving visual noise, contour integration and position noise ; The traditional combined training group received red lights flashing and fine visual training. The total therapeutic effect of two groups were compared. Results The total therapeutic effect of perceptual leaming group was better than that of traditional combined training group （ P = 0. 000）, the total therapeutic effect of patients with different level anisometropic in perceptual learning group was also better than that in traditional combined training group ,there were significant differences （all P 〈 0.01 ）. The visual a- cuity of perceptual learning group was improved largely than traditional training group. The time when 50% patients have arrived curative plateau were different, perceptual learning group was 6m, however traditional group at the last follow-up. The eases in perceptual learning group needed 13.75 training hours to improve the visual acuity of one row sight, in which the shortest （10. 78 hours） was the midrange amblyopia, then the severe amblyopia（ 12. 00 hours） and the slight amblyopia （26.5 hours） in turn. Conclusion The perceptual learning based on internet can provide intensive, active ,feedback and individual visual stimulus, effective for juvenile aged 9 - 13 anisometropic amhlyopia who out of vision sensitive developmental period, and shorten the treatment cycle of vision dysfunction. The new treatment can achieve the best treatment effectiveness in a short time and provide a new feasible way for amblyopia clinical therapy.