功能性视力下降临床特点及治疗分析

Clinical features and treatment of functional vision loss

目的探讨功能性视力下降临床特点及各类型患眼的视功能训练效果。方法回顾门诊接诊的功能性视力下降患儿临床资料,按照是否接受训练分为接受双眼视功能训练(包括调节及集合训练)的观察组,和仅予以屈光矫正的对照组,随访两组视力及双眼视功能。结果4周后观察组36眼矫正视力均达到1.0,对照组31眼中有16眼(51.6%)达到1.0,差异具有统计学意义(P<0.001)。两组患者治疗后调节功能各项指标均较治疗前改善,且观察组较对照组更为明显(P<0.05)。观察组中单纯调节异常者视力提升快于合并集合不足或集合过度者。停止训练后1个月,合并集合过度者4眼视力均有下降,其余32眼可维持1.0。结论功能性视力下降以单纯调节异常所致最常见;视功能训练可有效提高患眼视力,单纯调节异常治疗效果最佳;合并集合过度者需更长的训练时间,且停止训练后容易复发。

Objective To investigate the clinical features of functional vision loss and evaluate the efficacy of different types of visual function training.Methods Clinical data of children with functional vision loss admitted to Outpatient Department were retrospectively analyzed.All children were divided into the observation and control groups according to whether they received visual function training.In the observation group,patients received binocular function training(including accommodative and convergence training)and those in the control group received refractive correction alone.Visual acuity and binocular function were assessed during follow-up.Results Four weeks later,the best corrected visual acuity(BCVA)of all 36 eyes(100%)was improved to 1.0 in the observation group,while 16 eyes(51.6%)in the control group,and the difference was statistically significant(P<0.001).After visual function training,all parameters of accommodation were significantly improved compared with those before corresponding training in both observation and control groups,and the efficacy in the observation group were better than that in control group(all P<0.05).In the observation group,patients with abnormal accommodation alone achieved better improvement in BCVA compared with their counterparts complicated with convergence insufficiency or convergence excess.One month after the cessation of training,the BCVA of 4 eyes of patients with abnormal accommodation complicated with convergence excess was declined,and that of the remaining 32 eyes was maintained at 1.0.Conclusions Functional vision loss is mainly caused by abnormal accommodation alone.Visual function training can effectively improve the visual acuity,especially for patients with abnormal accommodation alone.Patients with abnormal accommodation complicated with convergence excess require longer training time.Relevant symptoms are prone to recurrence after the cessation of training.