视觉训练治疗集合不足患者的有效性研究

Efficacy of visual training for insufficient convergence

目的探讨视觉训练对临床上集合不足(CI)患者的视疲劳是否有效,了解视觉训练对各项视功能参数的影响。方法研究共纳入23例诊断为CI的患者,其中19名患者接受为期8周的视觉训练。包括负镜片法训练调节幅度;hart crhart表训练调节灵活度;brock线、vectogram、lifesaver card和eccentric circles训练集合及融像范围。训练时间为每周4次,每次60min。另有4例患者未接受任何视觉训练治疗,仅接受临床观察8周,之后2例患者再接受为期8周的视觉训练。所有受试者在训练或临床观察前后均进行临床症状评分,并测量各项视功能参数,包括远近屈光度、矫正视力、调节幅度、调节灵活度、集合近点(NPC)、远近隐斜、远近聚散范围和调节性集合与调节的比值(AC/A)。结果 19例接受训练的患者临床症状评分由训练前25.8分下降为16.2分(P<0.01),治愈率及有效率分别为36.8%、73.6%。患者远近隐斜量,远距负融像能力,AC/A均无明显改变(均P>0.05),但远近正融像能力均提高(均P<0.01),近距负融像能力也有所提高(P<0.05),NPC明显减小(P<0.01)。通过临床症状和各项视功能参数相关性研究发现,训练前临床症状评分和NPC具有相关性(P<0.01),而训练后临床症状评分和远距正融像,近距负融像能力和近距正融像能力均相关(P<0.05或0.01)。相反,4例接受临床观察的患者无论是症状评分还是视觉参数均无改善,其中2例继续接受训练的患者,其临床症状和部分视功能有所改善。结论通过规范的视觉训练,多数CI患者的临床症状会得到缓解。NPC的缩小和近距正负融像能力的提高可能是减轻症状的主要原因。

Objective To assess the efficacy of visual training for insufficient convergence caused visual fatigue. Meth- ods Twenty-three patients with insufficient convergence were included in the study. Nineteen patients received 8 weeks of visual training, including negative lens for accommodation amplitude, Hart chart for accommodation flexibility, Brock string, Vectogram, Lifesaver card and Eccentric circles for convergence and fusion scope. Patients received 4 times of 60-min training per week. Four patients were just observed in clinic without any treatment for 8 weeks, and then 2 of them received 8 weeks of visual training in clinic. Clinical symptoms scores and visual function parameters were measured, including near-far dioptre, corrected visual acuity, accommodation amplitude, accommodation flexibility, near convergence point （NPC）, near-far phoria, near-far conver- gence and divergence scope, and accommodation convergence/convergence ratio （AC/A）. Results For 19 patients, the clinical symptom scores were reduced from 25.8 points to 16.2 points after training （t=7.15, P〈0,01） with a cure and effective rate of 36.8% and 73,6% respectively. There were no significant difference in near-near phoria, far negative fusion, AC/A （t =0.39, 0.72, 1.98, 0.34; P =0.70, 0.48, 0.06, 0.74） before and after training; while there was significant improvement in far and near positive fu- sion （t =4.78, 6.68 and P both〈：0.01）, near negative fusion（t=2.47, P=0.02）and NPC（t=5.23, P〈0.01）. And significant correlation was found between clinical symptom and NPC before training （r=0.97, P〈：0.01）; after training there were significant correlations between clinical symptom scores and far positive fusion （r=0.48, P〈0.05）, near negative ability （r=0.69, P〈0.01） and near posi- tive fusion ability （r=0.83, P〈0.01）. For 4 patients without any training, clinical symptom scores and visual ability had no improve- ment. But 2 of them who received visual training later the parameters were also improved. Conclusion The symptoms of most convergence insufficient patients will release after standard visual training, which may be related to the nearer NPC and the im- provement of negative and positive fusion ability.