自适应光学矫正高阶像差结合视知觉学习对难治性弱视的治疗效果

摘要

Objective To study the effect of higher order aberrations (HOA) correction combined with visual perceptual learning (PL) on residual amblyopia using adaptive optics visual simulator system (AOVS).Methods In this randomized controlled study,20 patients with residual amblyopia randomly divided into 2 groups,with 10 patients in each group.Patients in experimental group treated with visual PL based on low order aberrations (LOAs) and HOAs correction,and control group treated with visual PL based on LOAs correction only.All the patients underwent PL for 50 minutes everyday,last for 10 days.The visual acuity and contrast sensitivity (CS) were measured before and after the visual PL.All data was analyzed using paired t test,independent t test,and regression analysis.Results At last,16 paitents completed the study:9 patients in experimental group,and 7 patients in control group.In experimental group,the CS of low and medium spatial frequency (1,2,4 and 8 c/d) showed significant increase after the visual PL (t=-2.501,-2.504,-2.649,-2.511,P＜0.05).Compare to control group,the CS of 1 c/d and 4 c/d in experimental group was significantly higher (P＜0.05).Conclusion Higher order abberration correction combined with visual perceptual lerning could improve the CS of residual amblyopia,the longer effect should be confirmed by further studies.%目的 应用自适应光学矫正高阶像差结合视知觉学习方法治疗难治性弱视,评价矫正高阶像差与不矫正高阶像差对视知觉学习疗效的影响.方法 前瞻性随机对照研究.收集2013年9月到2014年6月在天津市眼科医院视觉训练工作室训练的难治性弱视20例,随机分为实验组和对照组各10例.实验组在应用自适应光学系统矫正低阶像差和高阶像差的基础上进行视知觉学习,对照组应用自适应光学系统只矫正低阶像差后进行视知觉学习.2组对象均每天训练1次,约50 min,连续训练10 d.训练前及训练后测量视力、对比敏感度(CS).采用配对t检验分别比较训练前后矫正视力、CS的变化.采用独立样本t检验及回归分析比较训练前、后实验组与对照组之间的CS.结果 最终完成研究的有16例,其中实验组9例,对照组7例.训练后实验组中低空间频率(1、2、4、8 c/d) CS明显提高,且差异有统计学意义(t=-2.501、-2.504、-2.649、-2.511,P＜O.05).与对照组相比,矫正高阶像差进行视知觉学习后1 c/d空间频率的CS提高了15.22倍(P＜0.05),4 c/d空间频率的CS提高了17.12倍,差异有统计学意义(P＜0.05).其他空间频率2组比较差异没有统计学意义.结论 应用自适应光学矫正高阶像差结合视知觉学习可以改善难治性弱视患者低空间频率的CS,长期治疗的效果还需要进一步的研究.