融像性聚散功能障碍者观看3D影像后视疲劳和动眼参数的变化

Change of ocular motor parameters and visual fatigue of subjects with fusional vergence dysfunction after viewing 3D images

目的观察融像性聚散功能障碍者在观看3D影像后动眼参数的变化情况,并探讨其与视疲劳的相关性。方法本研究为病例对照研究,选取37名青年受试者,按其融像性聚散能力分为2组:视功能正常(normal visual function,NVF)组21人,融像性聚散功能障碍(fusional vergence dysfunction FVD)组16例。两组受试者观看40 cm处3D影像前和观影1 h后分别行动眼参数的测量,包括单眼调节幅度、梯度性调节性集合/调节(accommodation convergence/accommodation,AC/A)值、观看距离所对应的近距隐斜量、融像幅度以及视疲劳的主观问卷。结果两组人观看3D影像后均出现视疲劳,FVD组视疲劳问卷得分高于NVF组(P=0.012)。NVF组观影前后的单眼调节幅度分别为(12.49±1.37)D、(12.07±1.31)D;近距隐斜量分别为-3.02△±1.70△、-4.71△±1.51△,差异均有统计学意义(均为P<0.001);融像幅度分别为51.81△±6.93△、50.90△±7.57△,差异无统计学意义(P=0.059)。FVD组观影前后的单眼调节幅度分别为(12.33±1.70)D、(11.66±1.81)D;近距隐斜量分别为-3.13△±2.31△、-4.41△±2.59△,差异均有统计学意义(均为P<0.001);融像幅度分别为37.75△±6.72△、34.25△±7.37△,差异有统计学意义(P<0.001)。NVF组与FVD组观影前后AC/A均未发生显著性变化(P=0.631,P=0.245)。观影前后单眼调节幅度改变量、近距隐斜量改变量、AC/A改变量在NVF组和FVD组间差异均无统计学意义(均为P>0.05),且所有受试者观影前后近距隐斜量改变量与视疲劳程度无相关性(rs=0.021,P=0.904)。而观影前后融像幅度的改变量在NVF组-1.00△(-2.50△~1.50△)和FVD组-3.50△(-5.00△^-2.25△)间差异有统计学意义(P=0.001)。结论观看3D影像会导致视疲劳及单眼调节幅度、近距隐斜量和融像幅度的变化;融像性聚散障碍者较视功能正常者观影后融像幅度下降更明显,视疲劳更严重。融像幅度可作为预测和评估观影像后视疲劳程度的一项指标。

Objective To investigate the changes of ocular motor parameters and visual fatigue in fusional vergence dysfunction after viewing 3D images and its cor- relation with visual fatigue. Methods A case control study. A total of 37 young adults were enrolled. According to fusional vergence ability, they were divided into normal vis- ual function （NVF） group （ n = 21 ） and fusional vergence dysfunction （ FVD ） group （ n = 16）. Before and after viewing 3D images at 40 cm for 1 hour,monocular accommodation amplitudes, near heterophoria, AC/A ratio, fusional amplitude and subjective symptoms were examined,respectively. Results Viewing 3D images causes subjective visual fa- tigue in both groups and the score of visual fatigue was significantly higher in FVD group than NVF group （P = 0.012 ）. In NVF group, the monocular accommodation ampli- tudes before and after viewing 3 D images were （ 12.49 ± 1.37 ） D and （ 12.07 ± 1.31 ） D, near heterophoria were （ - 3.02 ± 1.70） A and （ - 4.71 ± I. 51 ） △ （ all P 〈 0.001 ）, fusion- al amplitude were （ 51.81 ± 6.93 ） A and （ 50.90 ± 7.57 ） A （ p = 0.059 ）. In FVD group, the monocular accommodation amplitudes before and after viewing 3D images were （ 12.33±1.70 ） D and （ 11.66 ± 1.81 ） D, near heterophoria were （ - 3.13 ± 2.31 ） △ and （ - 4.41 ± 2.59 ）△, fusional amplitude were （ 37.75 ± 6.72 ） A and （ 34.25 ± 7.37 ） △ （ all P 〈 0. 001 ）, while the AC/A didn＇ t show significant difference in both groups. Compa- ring with FVD group, the change of monocular accommodative magnitude, near hetero- phoria and AC/A in NVF group didn＇ t show statistically significant difference （ all P 〉 0. 05 ） and there was no correlation between the change near heterophoria and score of visual fatigue for all subjects（ rs =0.021 ,P =0.904 ）. While the change of fusional ampli- tude in NVF group - 1.00△ （ - 2.50△ to 1.50△ ） and FVD group - 3.50△（ - 5.00△ to - 2.25 △ ） were significantly different （ P = 0. 001 ）. fonclusion Viewing 3D imagescan cause subjective visual fatigue and leads to the changes or monocular accommooation amputuues, near heterophoria and fusional amplitude. The more significant decrease of fusional amplitude and visual fatigue occurre in fusional vergence dys- function subjects. It is shown that fusional amplitude can be utilized as one of objective indexes to predict and evaluate visu- al fatigue.