青少年近视患者夜戴角膜塑形镜后的视觉质量评估
청소년근시환자야대각막소형경후적시각질량평고
Evaluation of visual quality after overnight orthokeratology in pre-adolescent myopes
  • 万方数据
    中华实验眼科杂志 중화실험안과잡지
    CHINESE JOURNAL OF EXPERIMENTAL OPHTHALMOLOGY
    2012年 12期 1104-1109 ,共6页

    马薇%廖孟%金宏智%刘陇黔

    마미%료맹%금굉지%류롱검

    角膜塑形镜%近视/青少年%视觉质量 角膜塑形鏡%近視/青少年%視覺質量
    각막소형경%근시/청소년%시각질량
    Orthokeratology%Myopia/pre-adolescent%Quality of vision
    背景 角膜塑形镜配戴可暂时改变眼的近视度数,但其对配戴者视觉质量的影响值得关注.目的 观察青少年近视患者使用夜戴型角膜塑形镜后视觉质量的改变. 方法 采用描述性系列病例观察研究设计.每个受试者纳入研究前均签署知情同意书.收集2010年1月1日至12月30日的近视患者76例150眼,年龄(14.90±1.24)岁；平均等效球镜度(SE)为(-2.79±0.82)D.所有患者均在四川大学华西医院眼科配戴夜用型角膜塑形镜,每日戴镜至少8h,分别于配戴前及配戴后第1周、第3个月时接受主觉验光、裸眼视力(UCVA)、对比敏感度、角膜地形图、像差检查,并由同一验配医师询问患者配戴前后的视觉质量及相关症状.视觉质量的评价标准参照美国国家眼科研究院屈光不正生活质量量表(NEI-RQL-42TM),采用SPSS13.0统计学软件对相关数据进行重复测试单因素方差分析. 结果 配戴角膜塑形镜1周、3个月后SE分别为(-0.33±1.02)D和(-0.26±0.60)D,较配戴前的(-2.79±0.82)D显著下降,差异均有统计学意义(P＜0.01),而配戴后1周和3个月间SE差异无统计学意义(P=0.161).配戴角膜塑形镜后1周和3个月各空间频率下对比敏感度均低于配戴前,差异均有统计学意义(1周:3 cpd时P=0.001,6 cpd时P=0.001,12 cpd时P＜0.05,18 cpd时P＜0.05；3个月:3 cpd时P=0.001,6 cpd时P=0.001,12 cpd时P＜0.05,18 cpd时P＜0.05),而配戴后1周和3个月之间患眼对比敏感度的差异均无统计学意义(P＞0.05).配戴角膜塑形镜1周、3个月后角膜平坦K值、陡峭K值、e值均较配戴前明显降低,差异均有统计学意义(均P=0.000),而角膜表面非对称指数(SAI)、角膜表面规则指数(SRI)较配戴镜前均明显增加,差异均有统计学意义(均P=0.001).配戴角膜塑形镜前后的像差研究显示,总高阶像差、3阶像差和4阶像差在戴镜后1周和3个月均明显增加,与戴镜前比较差异有统计学意义(P＜0.05),戴镜后1周和3个月间差异均无统计学意义(P＞0.05),总像差及2阶像差在戴镜1周后与3个月均显示降低,与戴镜前比较差异均有统计学意义(P＜0.05),但戴镜后1周和3个月间差异均无统计学意义(P＞0.05).配戴角膜塑形镜前后5项视觉质量项目(从明处到暗处适应容易程度、夜间骑车容易程度、夜间是否常看到灯光晕环光圈、视力波动出现的频率、眩光程度)评分的差异均有统计学意义(P＜0.05),而视力波动出现的频率在配戴后1个月和3个月间差异均有统计学意义(P＜0.05).结论 配戴夜戴型角膜塑形镜戴后1周可使近视度数降低,配戴3个月近视度数趋于稳定.配戴角膜塑形镜可使角膜形状趋向不规则,对比敏感度下降,3阶像差和4阶像差增加.主观视觉质量较框架眼镜矫正时降低,尤其是夜间视觉质量.
    배경 각막소형경배대가잠시개변안적근시도수,단기대배대자시각질량적영향치득관주.목적 관찰청소년근시환자사용야대형각막소형경후시각질량적개변. 방법 채용묘술성계렬병례관찰연구설계.매개수시자납입연구전균첨서지정동의서.수집2010년1월1일지12월30일적근시환자76례150안,년령(14.90±1.24)세；평균등효구경도(SE)위(-2.79±0.82)D.소유환자균재사천대학화서의원안과배대야용형각막소형경,매일대경지소8h,분별우배대전급배대후제1주、제3개월시접수주각험광、라안시력(UCVA)、대비민감도、각막지형도、상차검사,병유동일험배의사순문환자배대전후적시각질량급상관증상.시각질량적평개표준삼조미국국가안과연구원굴광불정생활질량량표(NEI-RQL-42TM),채용SPSS13.0통계학연건대상관수거진행중복측시단인소방차분석. 결과 배대각막소형경1주、3개월후SE분별위(-0.33±1.02)D화(-0.26±0.60)D,교배대전적(-2.79±0.82)D현저하강,차이균유통계학의의(P＜0.01),이배대후1주화3개월간SE차이무통계학의의(P=0.161).배대각막소형경후1주화3개월각공간빈솔하대비민감도균저우배대전,차이균유통계학의의(1주:3 cpd시P=0.001,6 cpd시P=0.001,12 cpd시P＜0.05,18 cpd시P＜0.05；3개월:3 cpd시P=0.001,6 cpd시P=0.001,12 cpd시P＜0.05,18 cpd시P＜0.05),이배대후1주화3개월지간환안대비민감도적차이균무통계학의의(P＞0.05).배대각막소형경1주、3개월후각막평탄K치、두초K치、e치균교배대전명현강저,차이균유통계학의의(균P=0.000),이각막표면비대칭지수(SAI)、각막표면규칙지수(SRI)교배대경전균명현증가,차이균유통계학의의(균P=0.001).배대각막소형경전후적상차연구현시,총고계상차、3계상차화4계상차재대경후1주화3개월균명현증가,여대경전비교차이유통계학의의(P＜0.05),대경후1주화3개월간차이균무통계학의의(P＞0.05),총상차급2계상차재대경1주후여3개월균현시강저,여대경전비교차이균유통계학의의(P＜0.05),단대경후1주화3개월간차이균무통계학의의(P＞0.05).배대각막소형경전후5항시각질량항목(종명처도암처괄응용역정도、야간기차용역정도、야간시부상간도등광훈배광권、시력파동출현적빈솔、현광정도)평분적차이균유통계학의의(P＜0.05),이시력파동출현적빈솔재배대후1개월화3개월간차이균유통계학의의(P＜0.05).결론 배대야대형각막소형경대후1주가사근시도수강저,배대3개월근시도수추우은정.배대각막소형경가사각막형상추향불규칙,대비민감도하강,3계상차화4계상차증가.주관시각질량교광가안경교정시강저,우기시야간시각질량.
    Background Orthokeratology has been proved to temporarily alter the equivalent sphere,but its effects on visual quality deserve attention.Objective The present study was to investigate the visual quality after overnight orthokeratology in pre-adolescent myopes.Methods Written informed consent was obtained form each subject prior to entering into this series.A descriptive study design was used.One hundred and fifty eyes of 76 teenagers aged (14.90± 1.24)years with low and moderate myopia (-2.79 ± 0.82)D were included in the study.Fitted with Ortho-K contact lens,the lens was wore every night for over 8 hours.Subjective refraction,uncorrected visual acuity (UCVA),contrast sensitivity function,corneal-topography,and aberrometry were examined before,1 week and 3 months after the initiation of orthokeratology.Visual quality was generally evaluated by comparing before wearing,1 week and 3 months after wearing using the National Eye Institute refractive error quality of life instrument (NEI-RQL-42TM).All the procedures were performed by the same clinician.Results Spherical equivalent refractions were (-0.33± 1.02) D and (-0.26 ± 0.60) D 1 week and 3 months after orthokeratology,showing significant decline in comparison with (-2.79±0.82) D of before orthokeratology (P =0.001,0.001).However,no considerable difference was seen between 1 week and 3 months after orthokeratology (P=0.161).Contrast sensitivity function was significantly different in all spatial frequencies before wearing,1 week and 3 months after wearing,and those of 1 week and 3 months after wearing were significantly lower than those of before wearing (1 week:3 cpd P =0.001,6 cpd P=0.001,12 cpd P＜0.05,18 epd P＜0.05 ;3 months:3 cpd P=0.001,6 cpd P=0.001,12 cpd P＜0.05,18 cpd P＜0.05).There was no significant change in contrast sensitivity function between 1 week and 3 months of orthokeratology (P＞0.05).Flat K,steep K and corneal eccentricity (e) were significantly reduced (P =0.000),and surface asymmetry index (SAI) and surface regularity index (SRI) were significantly improved after orthokeratology in comparison with before orthokeratology (both P =0.001).Root mean square (RMS) of total higher-order,third-order and fourth-order aberrations were significantly increased (P＜0.05),but RMS of whole aberration and second-order aberrations significantly decreased after orthokeratology (P＜ 0.05).There were no significant changes in the fifth-order,sixth-order and seventh-order aberration among pre-wear,1 week and 3 months after orthokeratology.Scales of dark to bright,nocturnal driving,glare,visual fluctuate and halo were lower than those before orthokeratology (P＜0.05).The scales of visual fluctuate between 1 month and 3 months after orthokeratology had significant differences (P＜0.01),while the rest of the scales had no significant differences (P＞0.05).Conclusions Orthokeratology can reduce myopic diopter 1 week after orthokeratology.The overnight wearing of fitted orthokeratology can decrease contrast sensitivity and increase corneal surface irregularity and RMS of third-order and fourth-order.Compared with spectacles,orthokeratology reduces subjective visual quality,especially nocturnal quality.
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