外斜視兒童的近視研究

 Comparing myopic error in patients with basic and convergence insufficiency intermittent exotropia in China - PubMed (nih.gov)

比較外斜視兒童的慣用眼與非慣用眼的近視程度，非慣用眼的近視程度較高。

199位間歇性外斜視兒童，根據遠與近的斜視程度分為兩組，基本型(遠近斜視程度接近)與內聚不足型(近斜視明顯大於遠)。再進一步分類為屈光參差與非屈光參差。

結果

-內聚不足型之慣用眼等值球面度- 2.09 ± 1.45D，非慣用眼 - 2.53 ± 1.44D。

-基本型慣用眼等值球面度 - 2.46 ± 1.56D，非慣用眼 - 2.89 ± 1.37D 。

-兩組相同，慣用眼的近視程度顯著小於非慣用眼

其中屈光參差(雙眼屈光度差異大於等於1.00D)有43位，非屈光參差有156位。

-屈光參差組的近外斜量45.26 ± 24.41 PD，遠外斜量33.53 ± 23.31 PD

-非屈光參差組的近外斜量 43.42 ± 20.69 PD，遠外斜量 29.07 ± 16.84 PD

-兩組之間無顯著差異

散瞳劑與角膜塑型術(OK鏡片)的使用與兒童雙眼視覺相關研究

 Accommodation and vergence function in children using atropine combined with orthokeratology - PubMed (nih.gov)

62位8-12歲兒童分為四組，第一組結合使用0.01% atropine與OK鏡片，第二組使用安慰劑與OK鏡片，第三組使用0.01% atropine與鏡框眼鏡，第四組控制組使用安慰劑與鏡框眼鏡。

研究開始與三個月後，評估雙眼視覺功能，包括horizontal phoria, fusional vergence, the accommodative convergence/accommodation (AC/A) ratio, accommodative lag, and accommodative amplitude (AA)。

結果

1.調節遲緩僅OK鏡片組有顯著改進，其他三組未改變

Accommodative lag significantly decreased in the OK group (P = 0.002), but remained unchanged in the other three groups (all P > 0.05).

2.雙眼調節靈巧度與正相對調節在結合組與OK鏡片組有進步，其他兩組未改變

Binocular accommodative facilities and positive relative accommodations increased in the combination and OK groups (both P < 0.05) , but remained unchanged in the atropine and control groups (both P > 0.05). 

3.僅OK鏡片組的內斜位有顯著降低。

Only the participants with esophoria in the OK group had a significant decrease in esophoria (P = 0.008).

4.融像性聚散與AC/A在四組間無顯著差異

Changes in fusional vergence and AC/A did not significantly differ between the four groups (all P > 0.05).

HUMPHRISS IMMEDIATE CONTRAST (HIC，一種雙眼同時打開的驗光方式)

     在單眼驗光之後需要進行雙眼調節平衡，方式有很多種，其中一種較特別的方式為HUMPHRISS IMMEDIATE CONTRAST (HIC)。概念是先霧視非檢查眼，接著在檢查眼之前輪流以+/-0.25DS鏡片比較清晰度。

    此種方式的好處是兩眼皆處於開放狀態，有雙眼融像更接近真實視覺狀態，調節也能有較好控制。

    當比較兩片鏡片時。會有三種可能的結果，+0.25DS比較清楚、-0.25DS比較清楚、兩者相同。    

    但不同教科書上對於步驟及終點卻有不同的描述，又因為最原始的版本無法獲得，所以我試著比較手上三本有比較完整步驟的教科書，看看不同作者的作法。

1. Clinical Procedures for Ocular Examination 4th

/NANCY B. CARLSON,  DANIEL KURTZ

這本是大部分視光學校的屈光實驗教科書，書上對於終點是這麼描述的

• a. If the patient reports that the -0.25 D sphere is clearer, add-0.25 D to the correction (or take away + 0.25 D) and continue step 5 until the two views appear equal.
• b. If the +0.25 is preferred, add a +0.25 to the correction and continue step 5.
• If on the next comparison the patient prefers the -0.25, add the -0.25 and proceed to step 6.
• c. If the two views appear equal, leave the correction as is and proceed to step 6

...終點為直到兩片鏡片看起來相同．而正或負清楚則加入相對應鏡片之後到反向出現．

2. OPTOMETRY : Science, Techniques and Clinical Management

/Mark Rosenfield, Nicola Logan

• lf the patient is not accommodating, then they should immediately respond that the target is clearer with the minus lens.
• lf the patient gives one of three responses , either that
• (1) the plus lens is clearer
• (2) that there is no difference between the two lenses or
• (3) that the minus lens is clearer, but it makes the letters smaller or blacker,
• then it can be assumed that the patient is accommodating.
• With any of these three answers, additional plus sphere should be added and the test repeated until the patient has no hesitation in responding that the-0.25 DS is preferred.

...終點為負鏡片清楚．兩者相同或正鏡片清楚或負鏡片影像縮小則繼續加正鏡片

3. Clinical Procedures in Primary Eye Care

/David B. Elliott

• 6. If the patient immediately reports that the-0.25 DS is definitely clearer, repeat the demonstration of the lenses and ask if the-0.25 DS ‘is definitely clearer or just smaller and blacker’.
• Only add -0.25 DS if the patient immediately reports that the lens is definitely clearer.
• 8 .If the patient reports that the +0.25 DS is clearer or that there is no difference, add +0.25 DS to the refractive correction
• 10.Continue to compare the -0.25 DS and +0.25 DS until the +0.25 DS is immediately rejected.

...終點為正鏡片被立即拒絕．正鏡片清楚或兩者相同繼續加正鏡片