调节聚散系统交互作用的相关性

林惠玲; 李苗苗; Drobe Björn; 陈浩

doi:10.3760/cma.j.issn.1674-845X.2019.05.004

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中华眼视光学与视觉科学杂志

• 论著 •

ENGLISH ABSTRACT

调节聚散系统交互作用的相关性

作者及单位信息

出版日期： 2019 -05 -25 ·

DOI： 10.3760/cma.j.issn.1674-845X.2019.05.004

Correlation of the Interactions between Accommodation and Vergence in Different Refraction Groups

Authors Info & Affiliations

Lin Huiling

Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China

Li Miaomiao

Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China

Drobe Björn

R&D Optics Asia, Essilor International, Singapore 339346

Chen Hao

Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China

Published： 2019 -05 -25 ·

DOI： 10.3760/cma.j.issn.1674-845X.2019.05.004

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摘要

目的：探讨正视眼和早发性近视眼刺激性调节性集合/调节比值（AC/A值）、刺激性集合性调节/集合比值（CA/C值）、反应性AC/A以及反应性CA/C之间的差异及相互关系。

方法：病例对照研究。选取2016年10月至2017年1月在温州医科大学附属眼视光医院视光门诊就诊的9～14岁早发性近视患者27例为早发性近视组，另选取20例正视者作为正视组，在双眼视状态使用精工自动红外验光仪和改良式Thorington法分别测量25 cm处5个调节刺激水平和6个聚散刺激水平下的调节反应和隐斜量，计算2组的刺激性AC/A、刺激性CA/C、反应性AC/A以及反应性CA/C值。数据采用 t检验和Pearson相关性分析进行统计分析。

结果：正视组、早发性近视组的反应性AC/A分别为（4.07±1.47） ^Δ/D、（5.13±1.95） ^Δ/D，差异有统计学意义（ t=2.12， P=0.04）。正视组、早发性近视组的刺激性AC/A和反应性AC/A值之间均呈正相关（正视组： r=0.903， P<0.001；早发性近视组： r=0.880， P<0.001）。正视组的反应性AC/A和反应性CA/C呈负相关（ r=-0.450， P=0.04），早发性近视组这2个参数间无相关性（ r=-0.367， P=0.06）。

结论：早发性近视眼的反应性AC/A高于正视眼。AC/A和CA/C之间的负相关性只见于正视眼的反应性比率之间，提示单AC/A值不能全面评估调节系统和聚散系统之间的交互作用。

关键词：调节性集合/调节比值;集合性调节/集合比值;调节性聚散;聚散性调节

ABSTRACT

Objective:To investigate stimulus and response accommodative convergence to accommodation (AC/A) and stimulus and response convergence accommodation to convergence (CA/C ) ratios between different refractive groups and heterophoria groups. The correlations between the four parameters were also investigated.

Methods:In this case control study, 20 emmetropes (EMM) and 27 early-onset myopes (EOM) aged 9 to 14 years participated in this descriptive study from October 2016 to January 2017 at Eye Hospital, Wenzhou Medical University. The accommodative response and phoria through five accommodative stimuli and 6 convergence stimuli levels were measured at 25 cm under binocular viewing conditions with a Grand Seiko WAM-5500 autorefractor and a modified Thorington card. Data were analyzed using t-tests and Pearson correlation analysis.

Results:Response AC/A ratios of the EMM and the EOM groups were 4.07±1.47 ^Δ/D and 5.13±1.95 ^Δ/D, respectively; the difference between the two groups was significant ( t=2.12, P=0.04). A significant linear correlation was found between the stimulus and response AC/A ratios in both the EMM and EOM groups ( r=0.903, P<0.001; r=0.880, P<0.001). A negative correlation was found between the response AC/A and CA/C ratios in the EMM group ( r=-0.450, P=0.04), while no correlation was found between these two ratios in the EOM group ( r=-0.367, P=0.06).

Conclusions:EOM has a higher response AC/A ratio compared to EMM. The negative correlation between AC/A and CA/C was only found between the response ratios of EMM, indicating that the AC/A ratio cannot provide a true representation of both cross-link interactions.

KEYWORDS： accommodative convergence to accommodation ratio;convergence accommodation to convergence ratio;accommodative vergence;vergence accommodation

Corresponding author:Hao Chen, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China (Email: nc.defcaab.eye.liamoahnehc)

FUNDING:

The International S& T Cooperation Program of China（2014DFA30940）

Science and Technology Project of Wenzhou（2018Y1063）

COPYRIGHTS:

No content published by the journals of Chinese Medical Association may be reproduced or abridged without authorization. Please do not use or copy the layout and design of the journals without permission.

All articles published represent the opinions of the authors, and do not reflect the official policy of the Chinese Medical Association or the Editorial Board, unless this is clearly specified.

引用本文

林惠玲,李苗苗,Drobe Björn,等. 调节聚散系统交互作用的相关性[J]. 中华眼视光学与视觉科学杂志,2019,21(5)：339-344.

DOI:10.3760/cma.j.issn.1674-845X.2019.05.004

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调节和聚散是双眼近距离工作时不可分割的2个眼动参数。调节系统和聚散系统通过两者之间的交互作用分别产生调节性聚散和聚散性调节。2个系统之间的交互作用由调节性集合/调节比值（Accommodative convergence to accommodation ratio，AC/A，单位调节改变量引发的聚散改变量）和集合性调节/集合比值（Convergence accommodation to convergence ratio，CA/C，单位聚散改变量引发的调节改变量）来量化。早期有关近视的研究发现，近视眼由于调节滞后量较大而有较高的AC/A值 ^{[
1
]}，提示调节和聚散系统可能和近视的发生发展有一定的相关性。

AC/A分为刺激性AC/A和反应性AC/A，其中刺激性AC/A是每个调节刺激水平上的调节性聚散反应和调节刺激的比值；反应性AC/A是每个调节刺激水平上的调节性聚散反应和调节反应的比值。两者中，反应性AC/A是能够精确量化测量调节和聚散2个系统交互作用的重要参数，但由于方法学上对测量仪器的要求较高，测量过程耗时较长等原因，不适用于日常临床。一些研究显示刺激性和反应性AC/A之间具有相关性，刺激性AC/A可以用于临床上评估调节性聚散的交互作用 ^{[
2
,

3
]}，也有报道显示刺激性和反应性AC/A之间没有显著相关性 ^{[
4
,

5
]}。为进一步理清刺激性和反应性AC/A的关系，本研究以正视和早发性近视患者为研究对象，在不同调节刺激和聚散需求刺激情况下，探讨刺激性比率和反应性比率之间、AC/A和CA/C 2个比率之间的相互关系。

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摘要
参考文献

参考文献

[1]

Mutti DO , Mitchell GL , Jones-Jordan LA ,et al. The Response AC/A ratio before and after the onset of myopia. Invest Ophthalmol Vis Sci, 2017,58(3):1594-1602. DOI: 10.1167/iovs.16-19093 .