目的探讨低、高阶像差与人眼客观焦深的关联性及影响客观焦深的因素。
方法采用横断面研究，选取2022年2—4月在天津市眼科医院屈光手术中心就诊的近视及散光患者76例152眼，其中男41例，女35例。采用iTrace视功能分析仪手动选择3、4、5和6 mm 4个扫描直径，对患者的全眼低阶像差和高阶像差进行测量，同时直接测得患者在该瞳孔直径下的客观焦深。采用Spearman秩相关性分析评估不同瞳孔直径下客观焦深与低、高阶像差之间的相关性；对不同程度近视和散光人群及不同瞳孔直径、眼别、性别间的客观焦深进行比较。
结果客观焦深与总低阶像差在3、4、5、6 mm瞳孔直径下均呈正相关( r s ＝0.380、0.317、0.385、0.519，均 P<0.01)。客观焦深与离焦(近视度)在3、4、5、6 mm瞳孔直径下均呈正相关( r s ＝0.377、0.323、0.403、0.512，均 P<0.01)，与像散(散光度)仅在瞳孔直径为6 mm时呈正相关( r s ＝0.255， P<0.05)。3、4、5、6 mm瞳孔直径下不同近视程度组客观焦深总体比较差异均有统计学意义( H＝6.440、7.370、9.990、16.930，均 P<0.05)，其中不同瞳孔直径下高度近视组客观焦深均明显高于低度近视组，6 mm瞳孔直径下高度近视组客观焦深高于中度近视组，差异均有统计学意义(均 P<0.05)。客观焦深与总高阶像差在3、4、5、6 mm瞳孔直径下均呈正相关( r s ＝0.911、0.807、0.733、0.677，均 P<0.001)。在各项高阶像差中，客观焦深与总彗差在3、4、5、6 mm瞳孔直径下均呈正相关( r s ＝0.727、0.557、0.620、0.487，均 P<0.001)；与垂直彗差在3、4、5、6 mm瞳孔直径下均呈正相关( r s ＝0.439、0.405、0.553、0.400，均 P<0.001)；与水平彗差在瞳孔直径为5 mm和6 mm时均呈正相关( r s ＝0.308、0.308，均 P<0.01)；与三叶草像差在3、4、5、6 mm瞳孔直径下均呈正相关( r s ＝0.344、0.443、0.316、0.330，均 P<0.01)；与球差在瞳孔直径为4、5和6 mm时均呈正相关( r s ＝0.321、0.310、0.428，均 P<0.01)。3 mm与4 mm、5 mm与6 mm瞳孔直径下客观焦深比较，差异均有统计学意义( P＝0.011、0.004)。不同散光程度之间及不同性别、不同眼别之间客观焦深比较差异均无统计学意义(均 P>0.05)。
结论人眼客观焦深大小主要与高阶像差中垂直彗差和三叶草像差以及低阶像差中离焦量具有较强关联性，水平彗差和球差仅在瞳孔直径较大时与客观焦深相关性较强；此外，瞳孔直径较小(3 mm)或较大时(6 mm)明显影响客观焦深。
ObjectiveTo investigate the correlation between low-order and high-order aberrations and objective depth of focus in the human eye, and the factors that influence objective depth of focus.
MethodsA cross-sectional study was performed.Seventy-six patients (152 eyes) with myopia and astigmatism patients who were treated at the Refractive Surgery Center of Tianjin Eye Hospital from February to April 2022 were selected, including 41 males and 35 females.The patients' whole-eye low-order and high-order aberrations and objective depth of focus were measured at 3, 4, 5, and 6 mm manually selected pupil diameters using the iTrace visual function analyzer.The correlation between objective depth of focus and low-order and high-order aberrations at different pupil diameters was analyzed by Spearman rank correlation analysis.Objective depth of focus was compared between individuals with different degrees of myopia and astigmatism, individuals with different pupil diameters, right and left eyes, and different sexes.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Tianjin Eye Hospital (No.2022039).
ResultsObjective depth of focus was positively correlated with total low-order aberrations at 3, 4, 5, and 6 mm pupil diameter ( r s =0.380, 0.317, 0.385, 0.519, all at P<0.01). Objective depth of focus was positively correlated with defocus at 3, 4, 5, and 6 mm pupil diameter ( r s =0.377, 0.323, 0.403, 0.512, all at P<0.01), and with astigmatism at 6 mm pupil diameter ( r s =0.255, P<0.05). There were statistically significant overall differences in objective depth of focus between groups with different degrees of myopia at 3, 4, 5, and 6 mm pupil diameter ( H=6.440, 7.370, 9.990, 16.930; all at P<0.05). Among them, the objective depth of focus of high myopia was significantly higher than that of low myopia at different pupil diameters, and the objective depth of focus of high myopia was higher than that of moderate myopia at 6 mm pupil diameter, with statistically significant differences (all at P<0.05). Objective depth of focus was positively correlated with total high-order aberration at pupil diameters of 3, 4, 5, and 6 mm ( r s =0.911, 0.807, 0.733, 0.677; all at P<0.001). Among various high-order aberrations, objective depth of focus was positively correlated with total coma at 3, 4, 5, and 6 mm pupil diameter ( r s =0.727, 0.557, 0.620, 0.487; all at P<0.001), positively correlated with vertical coma at 3, 4, 5, and 6 mm pupil diameter ( r s =0.439, 0.405, 0.553, 0.400; all at P<0.001), positively correlated with horizontal coma at 5 and 6 mm pupil diameter ( r s =0.308, 0.308; both at P<0.01), positively correlated with trefoil aberration at 3, 4, 5, and 6 mm pupil diameter ( r s =0.344, 0.443, 0.316, 0.330; all at P<0.01), positively correlated with spherical aberration at 4, 5, and 6 mm pupil diameter ( r s =0.321, 0.310, 0.428; all at P<0.01). There was a significant difference in objective depth of focus between 3 and 4 mm, 5 and 6 mm pupil diameters ( P=0.011, 0.004). There was no statistically significant difference in objective depth of focus between different degrees of astigmatism, between males and females, or between left and right eyes (all at P>0.05).
ConclusionsThe objective depth of focus of the human eye is mainly strongly correlated with vertical coma, trefoil aberration in high-order aberrations, as well as defocus in low-order aberrations.Horizontal coma and spherical aberration are strongly correlated with objective depth of focus only when the pupil diameter is large.In addition, if the pupil diameter is too small (3 mm) or too large (6 mm), it has a significant effect on the objective depth of focus.
张明栋,王雁,赵新恒. 近视眼像差与人眼客观焦深的关联性分析[J]. 中华实验眼科杂志,2024,42(04)：347-353.
DOI:10.3760/cma.j.cn115989-20221123-00545版权归中华医学会所有。
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张明栋：参与选题、酝酿和设计试验、实施研究、采集数据、分析/解释数据、起草文章；王雁：参与选题、解释数据、对文章知识性内容的审阅和智力性内容的修改及定稿；赵新恒：参与选题、酝酿和设计试验、分析/解释数据、起草文章
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