对症视觉训练对双眼视功能参数的影响

A study of oculomotor parameters before and after vision therapy

目的观察视觉训练对调节、集合等双眼视功能参数的影响，评估视觉训练对缓减视疲劳，改善异常双眼视功能的作用。方法回顾性系列病例研究。收集在天津市眼科医院视光学中心视光门诊就诊的有视疲劳症状、双眼视功能异常患者121例，男62例，女59例，年龄8～27岁．平均（15．5±5．2）岁。排除眼部疾病后进行屈光和双眼视功能检查。按照诊断结果，进行9周的视觉功能训练，训练前后进行调节、集合等双眼视功能相关检查和评估。采用配对t检验。结果通过视觉功能训练后，调节幅度（t=-9．015，P〈0．01）、正相对调节（t=9．569，P〈0．01）、负相对调节（t=-6．719，P〈0．01）、调节辐辏／调节（AC／A）（t=-3．244，P〈0．01）均显著改善。近外隐斜明显改善，差异有统计学意义（t=-3．716，P〈0．01）。调节滞后和远隐斜无明显变化，差异无统计学意义。结论通过合理的视觉功能训练可以改善双眼视功能，其中调节幅度、正相对调节、负相对调节、近隐斜、AC／A都有明显的变化．患者的双眼视症状、视疲劳症状明显缓解，但调节滞后、远隐斜没有明显的改善。

Objective To observe the changes in oculomotor parameters after vision therapy and assess the vision therapy effect on relieving the symptoms of asthenopia and improving binocular vision function. Methods In a retrospective ease series study, 121 asthenopic patients aged 8 to 27 years （average 15.5±5.2 years） were recruited from the Optical Center of Tianjin Eye Hospital. Sixty-two of them were males and 59 were females. All patients had routine eye examinations to exclude eye disease. Personalized vision therapy was performed based on the results of binocular vision examination and refraction with a phoropter. The oculomotor parameters were assessed after 9 weeks＇ vision therapy. All data were statistically analyzed by a paired samples t test. Results The accommodative amplitude （t=-9.015, P〈0.01）, positive relative accommodation （PRA, t=9.569, P〈0.01）, negative relative accommodation （NRA, t=-6.719, P〈0.01） and accommodative convergence/accommodation （AC/A ratio, t=-3.716, P〈0.01） were significantly improved. There was no difference in far exophoria before and after therapy, while near exophoria was significandy reduced （t=-3.716, P〈0.01）. There was no difference in accommodative lag after therapy. Conclusion The oculomotor parameters accommodative amplitude, NRA, PRA, near phoria and AC/A ratio improved after reasonable vision therapy. Visual fatigue symptoms were relieved remarkably.