间歇性外斜视青少年不同类型优势眼与注视眼的关系

The Association between Different Ocular Dominance and Fixation Preferences in Adolescents with Intermittent Exotropia

目的:探讨间歇性外斜视(IXT)青少年不同类型优势眼与注视眼(非偏斜眼)的关系。方法:系列病例研究。选取2018年7—12月于湖南爱尔眼视光研究所就诊的IXT青少年患者43例,屈光全矫后分别使用卡洞法测量注视性优势眼,使用集合近点法测量运动性优势眼,使用基于Gabor信号识别的连续闪烁抑制法测量知觉性优势眼,并采用眼位控制力评分观察受检者的远距离客观控制力来判定注视眼。采用Kappa一致性检验比较优势眼与注视眼的一致性,采用单因素Logistic回归分析双眼知觉性优势差异和优势眼与注视眼一致性程度的关系。结果:43例IXT患者中,注视性优势眼、运动性优势眼及知觉性优势眼均与注视眼呈现出中度一致性(Kappa值分别为0.46、0.43、0.68,均P<0.001)。30例有明确双眼知觉优势差异的患者,其知觉性优势眼与注视眼高度一致(Kappa值=0.86,P<0.001),而注视性优势眼、运动性优势眼与注视眼的一致性仍为中度一致性(Kappa值=0.57,P=0.002;Kappa值=0.44,P=0.006)。单因素Logistic回归分析显示IXT患者的双眼知觉性优势差异是知觉性优势眼与注视眼一致性程度的影响因素(B=0.53,OR=1.70,P<0.001),即双眼优势差异越大,知觉性优势眼与注视眼一致性的概率越高。结论:青少年IXT患者的注视性优势眼、运动性优势眼、知觉性优势眼均与注视眼有一致性,但知觉性优势眼与注视眼的一致性更为紧密,尤其当患者有明确知觉优势差异时,知觉性优势眼检查比注视性优势眼和运动性优势眼检查来确定注视眼更为可靠。

Objective: To investigate the association between different ocular dominance and fixation preferences in adolescents with intermittent exotropia (IXT). Methods: In this case serial study, a total of 43 patients with IXT from Aier Institute of Optometry and Vision Science from July to December 2018 participated. With full refractive error correction, the hole-in-the-card test was used to identify sighting dominance, the near point of convergence test was used to determine motor dominance, and a continuous flash technique based on a Gabor patch was used to determine ocular sensory dominance. The preferred eye for fixation was determined by Mayo's office control scale when observing a target at long distance. The degree of agreement between the dominant eye and the preferred eye for fixation was quanti?ed with Kappa statistics. And the association between the above-mentioned concordance and ocular dominance index (ODI) was analyzed by logistic regression. Results: For a total of 43 patients with IXT, sighting dominance, motor dominance, and sensory dominance showed moderate agreement with fixation preference (the Kappa values were 0.46, 0.43, and 0.68, respectively, P<0.001). When there was a clear sensory dominance, the agreement between the sensory dominant eye and the preferred fixation eye was fairly high (Kappa values was 0.86, P<0.001), while the agreements of the other two kinds of ocular dominance and fixation preference were still moderate (the Kappa values were 0.57 and 0.44, respectively, P<0.01). Logistic regression showed that the probability for the preferred fixation eye to agree with the sensory dominant eye increased with the value of ODI (B=0.53, OR=1.70, P<0.001), the greater the ODI value, the higher the probability for agreement between the sensory dominant eye and the preferred fixation eye. Conclusion: For IXT adolescents, there is a consistent relationship between ocular dominance and fixation preference. The results of sensory ocular dominance are more closely related to the preferred eye for fixation, especially when there is a clear sensory dominance, which is more reliable than a sighting dominance test or motor dominance test.