知觉学习治疗大龄弱视患者的疗效观察

Clinical efficacy of perceptual learning training in treatment of amblyopia:a prospective study of 60 patients at 6 to 24 years old

目的观察知觉学习提高大龄弱视患者视力和对比敏感度(contrast sensitivity,CS)的临床疗效。方法选择60例弱视患者进行知觉学习,训练前分别测量健眼和弱视眼的最佳矫正logMAR视力和7组空间频率对比敏感度,然后遮盖健眼对弱视眼进行知觉训练,每天训练1次,每次约30 min。以10 d为一个疗程,一个疗程结束后再对健眼和弱视眼分别进行矫正后logMAR视力检查和对比敏感度测试。结果训练前健眼logMAR视力0.020 0±0.105 0,训练后健眼logMAR视力0.004 4±0.099 6,差异有统计学意义(P=0.023 0);训练前弱视眼logMAR视力0.532 7±0.381 8,训练后弱视眼logMAR视力0.443 9±0.304 4,差异有统计学意义(P=0.000 0)。健眼训练前后7组空间频率对比敏感度均无统计学差异,弱视眼训练前后0.5、1、2所对应的空间频率对比敏感度差异无统计学意义,4、8、12、16所在空间频率对比敏感度差异有统计学意义(P<0.05)。≤12岁的弱视患者,健眼和弱视眼7组空间频率对比敏感度训练前后差异均无统计学差异;>12岁弱视患者,健眼训练前后7组空间频率对比敏感度仅12、16所在空间频率对比敏感度差异有统计学意义(P<0.05),而弱视眼训练前后除空间频率2所在对比敏感度外,其他6组差异有统计学意义(P<0.05)。结论知觉学习能显著改善弱视患者的各空间频率对比敏感度和视力,显著提高弱视眼的对比敏感度辨别能力,尤其是高空间频率对比敏感度,同时对健眼也有一定程度的改善。但该学习更适用于配合较好的大龄弱视患者。

Objective To observe the clinical efficacy of perceptual learning training in the treatment of older patients with amblyopia. Methods Prospective case study was carried out in 60 amblyopic patients at an age from 6 to 24 years old subjected in our center. They all undertook the perceptual learning training. Before training, logarithm of the minimum angle of resolution （logMAR） visual acuities were taken for the non-amblyopic eye and the amblyopic eye with best correction. Seven sets of spatial frequency contrast sensitivity function measurements were also taken. With the non-amblyopic eye covered, perceptual learning training was performed on the amblyopic eye for 30 min once a day, for a treatment course of 10 d. At the end of the treatment period, IogMAR visual acuities and contrast sensitivity function measurements were measured for the non-amblyopic and amblyopic eye. Results Before treatment, the logMAR visual acuity of the non-amblyopic eye was O. 020 0 ±0. 105 0, while after treatment, the acuity was 0.004 4 ±0.099 6 （P =0.023 0）. Before training, the logMAR visual acuity of the amblyopic eye was 0. 532 7 ±0. 381 8 while after training, the acuity was O. 443 9 ± 0. 304 4 （ P = 0.000 0）. At all 7 groups of spatial frequencies, the changes in contrast sensitivity for the non-amblyopic eye were not statistically significant. For the amblyopic eye, no significant improvement was noted in the contrast for spatial frequencies patients ≤ 12 years old, contrast sensitivity before sensitivity of spatial frequencies of 0.5, 1 and 2 before and after training. However, 4, 8, 12 and 16, there was significant improvement （ P 〈 O. 05 ）. For amblyopic there was no statistical significance in both the non-amblyopic and amblyopic eye in and after training at all 7 spatial frequencies. For amblyopic patients 〉 12 years old,the difference in contrast sensitivity before and after training for the non-amblyopic eye was significant only at the spatial frequency of 12, 16 （P 〈0.05） and not for the other 5 groups. In comparison, the difference in contrast sensitivity before and after training for the amblyopic eye was statistically significant for the spatial frequencies of 0.5, 1, 4, 8, 12 and 16 （ P 〈 0.05 ）. Conclusion Perceptual learning can significantly improve contrast sensitivity, especially, in the high spatial frequency contrast sensitivity and visual acuity in amblyopic patients with some improvements in the non-amblyopic eye, and also can improve the visual acuity of the non-amblyopic eye. This type of training shows better results for the amblyopic eye in older subjects compared to younger subjects.