非弱视性视力低下儿童调节训练效果的临床观察

Clinical observation on accommodative training in children with non-amblyopic low vision

目的观察调节训练对非弱视性视力低下儿童视功能的疗效。方法前瞻性病例系列研究。纳入2020年1月至2021年12月在濮阳市眼科医院的眼视光门诊就诊的47例非弱视性视力低下儿童的临床资料。其中男25例,女22例;年龄(8.96±2.02)岁,范围5~13岁,主觉验光结果低于同年龄儿童的正常视力,屈光度范围为-1.00~+2.00 D。调节训练前在屈光度完全矫正的基础上进行视功能检查,包括裸眼视力(UCVA,logMAR)、最佳矫正视力(BCVA,logMAR)、立体视、远近水平隐斜、负相对调节(NRA)、调节反应、正相对调节(PRA)、调节幅度及调节灵敏度(AF)等。每名患儿接受5次调节训练治疗,每周1次。结果UCVA和BCVA训练前分别为0.30(0.15,0.56),0.22(0.09,0.39),训练5次后分别为0.04(0.00,0.09),0.00(0.00,0.09),训练后比训练前明显提升,差异均有统计学意义(Z=-5.13,P<0.001;Z=-4.47,P<0.001);立体视锐度从(130.11±123.51)″改善至(73.92±56.50)″(t=3.42,P=0.020);调节幅度在训练后比训练前有改善(t=-6.40,P=0.001);远隐斜视和近隐斜视在训练前分别为-1.00(-3.00,0.00),-4.00(-5.50,-2.00)△,训练后分别为-2.00(-3.00,0.00),-3.00(-5.00,-1.00)△,差异均无统计学意义(Z=-0.15,P=0.988;Z=-2.34,P=0.190);NRA和PRA在训练后分别为(2.02±0.61)、(-3.06±1.59)D,比训练前(1.34±0.79)、(-1.39±1.28)D增强(t=-5.77,P=0.001;t=6.24,P=0.001);调节反应在训练前后差异无统计学意义(P>0.05);AF在训练后[9.00(6.00,13.25)cpm]比训练前[0.50(0.00,5.00)cpm]有改善(t=-4.99,P<0.001)。结论调节训练能改善非弱视性视力低下患儿的UCVA、BCVA、立体视、调节幅度、AF、NRA及PRA。

Objective To observe the efficacy of accommodative training in improving visual function in children with non-amblyopic low vision.Methods This was a prospective case series study.The clinical data of 47 children with non-amblyopic low vision who visited the optometry clinic of Puyang Eye Hospital from Jan.2020 to Dec.2021 were included.There were 25 males and 22 females.The age was(8.96±2.02)years old,ranged from 5 to 13 years old.The results of subjective optometry of these children were lower than the average visual acuity of the corresponding age,and the diopter ranged from-1.00 D to+2.00 D.Visual function tests were performed on the basis of complete refractive correction before visual training,included uncorrected visual acuity(UCVA,logMAR),best corrected visual acuity(BCVA,logMAR),stereopsis,distance heterophoria,near heterophoria,negative relative accommodation(NRA),accommodative response,positive relative accommodation(PRA),accommodative amplitude and accommodation flexibility(AF).All children received accommodation training 5 times in total,once a week.Results UCVA and BCVA significantly improved after training.UCVA and BCVA were 0.30(0.15,0.56)and 0.22(0.09,0.39)before training,and 0.04(0.00,0.09)and 0.00(0.00,0.09)after 5 times training,respectively.The differences were statistically significant(Z=-5.13,P<0.001;Z=-4.47,P<0.001).Stereopsis ameliorated from(130.11±123.51)″to(73.92±56.50)″(t=3.42,P=0.020).Accommodative amplitude significantly improved after training(t=-6.40,P=0.001).The distance and near heterophoria were-1.00(-3.00,0.00)△and-4.00(-5.50,-2.00)△before training,and-2.00(-3.00,0.00)△and-3.00(-5.00,-1.00)△after training,respectively.There was no statistically significant difference(Z=-0.15,P=0.988;Z=-2.34,P=0.190).NRA and PRA after training were(2.02±0.61)D and(-3.06±1.59)D,respectively,which increased by(1.34±0.79)D and(-1.39±1.28)D compared with those before training(t=-5.77,P=0.001;t=6.24,P=0.001).There was no significant difference in accommodative response before and after training(P>0.05).AF improved from 0.50(0.00,5.00)cpm to 9.00(6.00,13.25)cpm after training(t=-4.99,P<0.001).Conclusion Accommodative training can enhance some visual functions of children with non-amblyopic low vision,including UCVA,BCVA,stereopsis,accommodative amplitude,AF,NRA and PRA.