CAJ | 학술논문

背景近距离工作时,视网膜的成像质量受调节、瞳孔和像差的共同影响;而近距离工作时视网膜成像的清晰度又被认为是青少年近视发生发展的可能诱因.因此,研究近视及正视青少年在阅读状态下的眼动参数和像差的差异性显得尤为重要.目的研究有初发性近视和进展性近视的青少年在阅读状态下的调节反应、瞳孔直径和像差的差异,从视网膜离焦诱导近视和像差诱导近视这两个假说探讨调节反应和像差与近视发生发展的相关机制.方法 57例年龄12～16岁青少年受试者分为正视组16眼、初发性近视组20眼和进展性近视组21眼.嘱受试者阅读左眼前25 cm处电脑显示屏上由快速序列视觉呈现方式软件所呈现的一篇中文短文,用SEIKO-WV500型自动验光仪测量调节反应,实时录像记录瞳孔直径,并用WASCA波前像差仪测量像差,对3组间的结果进行比较.结果各组受试者的调节反应和像差的个体差异均较大,在4 D的调节刺激下,初发性近视组和进展性近视组的调节滞后值为(1.72±0.53)D,(1.74±0.44)D,高于正视组的(0.96±0.55)D,差异有统计学意义(t=4.25、t=4.47,P<0.01).初发性近视组和进展性近视组的调节滞后差异无统计学意义(t=0.18,P>0.05).调节刺激在0～4 D时,所有受试者的瞳孔直径、全眼像差、高阶像差、球差和彗差均随着调节力的增加而显著减小(P<0.01),但在同一调节刺激下,不同屈光组之间受试者的瞳孔直径、全眼像差、高阶像差、球差和彗差的差异均无统计学意义(P>0.05).结论初发性近视和近视进展过程中在近距离阅读状态下存在较高的调节滞后,近距离阅读状态下对离焦的低模糊敏感性、较高的调节滞后及远视性离焦可能是近视发生、发展的促进因素.
배경 근거리공작시,시망막적성상질량수조절、동공화상차적공동영향;이근거리공작시시망막성상적청석도우피인위시청소년근시발생발전적가능유인.인차,연구근시급정시청소년재열독상태하적안동삼수화상차적차이성현득우위중요.목적 연구유초발성근시화진전성근시적청소년재열독상태하적조절반응、동공직경화상차적차이,종시망막리초유도근시화상차유도근시저량개가설탐토조절반응화상차여근시발생발전적상관궤제.방법 57례년령12～16세청소년수시자분위정시조16안、초발성근시조20안화진전성근시조21안.촉수시자열독좌안전25 cm처전뇌현시병상유쾌속서렬시각정현방식연건소정현적일편중문단문,용SEIKO-WV500형자동험광의측량조절반응,실시록상기록동공직경,병용WASCA파전상차의측량상차,대3조간적결과진행비교.결과각조수시자적조절반응화상차적개체차이균교대,재4 D적조절자격하,초발성근시조화진전성근시조적조절체후치위(1.72±0.53)D,(1.74±0.44)D,고우정시조적(0.96±0.55)D,차이유통계학의의(t=4.25、t=4.47,P<0.01).초발성근시조화진전성근시조적조절체후차이무통계학의의(t=0.18,P>0.05).조절자격재0～4 D시,소유수시자적동공직경、전안상차、고계상차、구차화혜차균수착조절력적증가이현저감소(P<0.01),단재동일조절자격하,불동굴광조지간수시자적동공직경、전안상차、고계상차、구차화혜차적차이균무통계학의의(P>0.05).결론초발성근시화근시진전과정중재근거리열독상태하존재교고적조절체후,근거리열독상태하대리초적저모호민감성、교고적조절체후급원시성리초가능시근시발생、발전적촉진인소.
Background Image clarity during near work is influenced by several factors,such as accommodative lag,pupil size and monochromatic aberrations.Since image clarity during extended reading at near distance has been cited as a possible inducement of myopia in childhood and a possible difference between myopic and emmetropic people throughout life,it is important to examine these factors in myopic and emmetropic myopic juvenile during reading at near distance. Objective The aim of this study was to investigate the relationships among wavefront aberrations,accommodative response and pupil size in early onset and progressive myopes eyes under the different reading status and explore the possible mechanism of the development of myopia as well. Methods Fiflyseven subjects aged from 12 to 16 years were enrolled and grouped as emmetropes,the onset of myopes and progressive myopes.Reading material were Chinese novels presented by rapid serial visual presentation at a distance of 25 cm. Accommodative response and pupil size were recorded by a Grand Seiko WV-500 autorefractor.The Image J software was used to calculate the pupil diameter.Wavefront aberrations were then measured with a WASCA wavefront analyzer. Results Aberrations and accommodative response showed large inter-subjeet variability.With accommodative stimulus of 4 diopter,the accommodative lag in the early-onset of myopes group and progressive myopes group were ( 1.72 ±0. 53) D and ( 1.74 ±0. 44) D, showing larger value in comparison with ( 0. 96 ±0. 55) D of emmetropes group( t＝4.25 ,t=4.47 ,P<0. 001). However,there were no significant differences in accommodative lag between the early-onset of myopes group and progressive myopes group( t = 0. 18, P>0. 05). The mean value of pupil diameter, total RMS value, high-order RMS value, spherical aberration and coma were all significantly reduced with the stimulus varied from 0 D to 4 D( P<0. 01). However,none of the pupil sizs,total RMS value,high-order RMS value,spherical aberration and coma had significant difference among different refractive groups( P>0. 05). Conclusion The early-onset of myopes and progressive myopes had larger accommodative lag. The lower sensitivity to defocus at near reading distance,inducing the larger accommodative lag and hyperopic defocus may be linked to the developing myopia.