自适应光学视觉模拟仪验光与传统验光的一致性研究

Agreement evaluation between adaptive optics visual simulator and conventional refraction methods

目的评价睫状肌麻痹状态下自适应光学视觉模拟仪(VAO)与传统主客观验光的差异性及一致性。方法采用诊断性试验研究方法,于2019年11月在川北医学院附属医院纳入健康受试者31例31眼,其中男15例15眼,女16例16眼;平均年龄(20.1±1.0)岁;均取右眼为受检眼。睫状肌麻痹状态下分别采用VAO和传统主客观验光方法对受试者进行验光,记录球镜度、柱镜度以及矢量散光度J_(0)和J_(45)。采用配对t检验比较不同验光方法验光值差异,采用组内相关系数(ICC)和Bland-Altman图评价2种验光方法的一致性。结果VAO主觉验光和综合验光仪主觉验光测得的球镜度、柱镜度、J_(0)和J_(45)的ICC分别为0.97、0.75、0.84和0.09。VAO和电脑验光仪客观验光测得的球镜度、柱镜度、J_(0)和J_(45)的ICC分别为0.98、0.70、0.74和0.61。VAO主觉验光与综合验光仪主觉验光方法测得的球镜度、柱镜度、J_(0)和J_(45)差值分别为(0.05±0.32)、(-0.23±0.28)、(-0.10±0.14)和(-0.04±0.16)D,其中2种主觉验光方法测量的柱镜度和J_(0)比较,差异均有统计学意义(均P<0.01),球镜度和J_(45)比较,差异均无统计学意义(P=0.41、0.18);VAO与电脑验光仪客观验光测得的球镜度、柱镜度、J_(0)和J_(45)的差值分别为(-0.70±0.26)、(-0.07±0.46)、(-0.03±0.27)和(0.01±0.12)D,其中VAO客观验光测量的球镜度较电脑验光仪明显偏负,差异有统计学意义(t=15.09,P<0.01),2种客观验光方法测量的柱镜度、J_(0)和J_(45)比较差异均无统计学意义(P=0.39、0.59、0.63)。2种客观验光方法测量的球镜度、柱镜度、J_(0)和J_(45)与综合验光仪主觉验光相应值的差值比较差异均无统计学意义(均P>0.05)。结论睫状肌麻痹状态下,VAO客观验光测量的球镜度与电脑验光仪相比更偏负;但VAO与综合验光仪主觉验光测得的球镜度和散光矢量值均具有较好的一致性,且测量差值临床可以接受。

Objective To evaluate the difference and agreement of cycloplegic refraction between adaptive optics visual simulator(VAO)and conventional refraction methods.Methods A diagnostic test study was conducted.Thirty-one eyes of 31 healthy subjects including 15 males and 16 females were enrolled in November,2019 in Affiliated Hospital of North Sichuan Medical College.Mean age of the subjects was(20.1±1.0)years,and the right eye was taken for data analysis.Cycloplegic refraction was measured by VAO and conventional refraction methods,respectively.Spherical power,cylindrical power,Jackson cross-cylinder power at axis 90°and 180°(J_(0))and Jackson cross-cylinder power at axis 45°and 135°(J_(45))vector powers were recorded.Paired t-test was used to compare the refractive parameters between different refraction methods,and the intraclass correlation coefficient(ICC)and Bland-Altman plots were used to evaluate the agreement between VAO and conventional refraction methods.This study adhered to the Declaration of Helsinki,and the research protocal was approved by an Ethics Committee of Affiliated Hospital of North Sichuan Medical College(No.2020ER[A]018).Written informed consent was obtained from each subject prior to any medical examination.Results For subjective refraction,the ICC for spherical power,cylindrical power,J_(0)and J_(45)between VAO and phoropter were 0.97,0.75,0.84 and 0.09,respectively.For objective refraction,the ICC for spherical power,cylindrical power,J_(0)and J_(45)between VAO and autorefractor were 0.98,0.70,0.74 and 0.61,respectively.The mean differences in spherical power,cylindrical power,J_(0)and J_(45)between VAO and phoropter were(0.05±0.32),(-0.23±0.28),(-0.10±0.14)and(-0.04±0.16)D,respectively,and the differences in cylindrical power and J_(0)were statistically significant(both at P<0.01),whereas no significant differences in spherical power and J_(45)were found(P=0.41,0.18).The mean differences in spherical power,cylindrical power,J_(0)and J_(45)measured by VAO and autorefractor were(-0.70±0.26),(-0.07±0.46),(-0.03±0.27)and(0.01±0.12)D,respectively,and the spherical power measurement by VAO was significantly more negative than the autorefractor(t=15.09,P<0.01),while no significant differences in cylindrical power,J_(0)and J_(45)were found(P=0.39,0.59,0.63).No significant difference values in spherical power,cylindrical power,J_(0)and J_(45)were found between the two objective refraction methods and phoropter subjective refraction(all at P>0.05).Conclusions With cycloplegia,spherical power obtained by VAO objective refraction is more negative compared with autorefractor.There is a good agreement of spherical power and astigmatism vector values measured by VAO and phoropter subjective refraction,and the measurement differences are clinically acceptable.