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Objective:To analyze the improving effect of visual therapy on the symptoms of asthenopia caused by abnormal visual function in adults.Methods:A serial case study was conducted.Ninety-three adult patients (186 eyes) with visual dysfunction caused by abnormal visual function who underwent training in the visual training room of the Optometry Center of Tianjin Eye Hospital from October 2018 to October 2019 were enrolled, among which there were 48 males and 45 females.The average age of patients was (30.43±6.39) years old.Binocular visual function examination included vision examination by phoropter, simultaneous vision and stereopsis by Worth 4 Dots test, distance and near heterophoria by Von-Graefe method test, fusion range by rotating prism method, the accommodation reaction by fusion cross cylindrical lens (FCC), the accommodation amplitude by minus technique, the accommodation flexibility and the vergence flexibility by flipper, and a personalized training program was formed on the basis of the above examination results.The training process was divided into initial examination, first review and second review, and each stage containing 5 times of training was followed by a review.The results of the initial examination, first review and second review were compared.The study protocol was approved by an Ethics Committee of Tianjin Eye Hospital (No.KY201906). Written informed consent was obtained from each patient prior to any examination.Results:The average near heterophoria was -8.0 (-15.3, -3.0) △ at the initial examination, and it was reduced to -5.0 (-9.0, 0.0) △ at the first review, showing significant difference (Z=-3.586, P<0.01). The mean accommodation amplitude of left and right eyes were 4.00 (3.25, 5.25)D and 4.00 (3.00, 5.00)D respectively before visual training, which were increased to 5.50 (4.25, 7.00)D and 5.00 (3.75, 7.00)D at the first review, showing significant differences (Z=-4.284, -3.995; both at P<0.01). The broken point and the recovery point of the long-distance positive fusion at the initial inspection were 7.5 (5.0, 15.8) △ and 0.0 (0.0, 4.0) △ respectively, which were increased to 11.0 (6.0, 22.0) △ and 4.0 (0.0, 7.0) △ respectively at the first review, showing significant differences (Z=-3.192, -3.748; both at P<0.01). The broken point and the recovery point of the near positive fusion at the initial inspection were 18.0 (8.0, 28.0) △ and 6.0 (0.0, 12.0) △, respectively, which were increased to 26.0 (21.5, 35.0) △ and 11.5 (6.0, 16.0) △ respectively at the first review, showing significant differences (Z=-4.695, -3.377; both at P<0.01). The monocular and binocular accommodation flexibility were increased from 2-3 cycles/minute at the initial examination to 10-12 cycles/minute at the first review, showing significant differences (all at P<0.01). Logistic regression analysis showed that age, distance heterophoria and near heterophoria were not related to the difference in accommodation improvement of the right and left eyes.At the initial examination, the average CISS score of 22 patients was (25.13±9.64) points, which was dropped to (19.18±7.22) points at the first review, showing significant difference ( t=6.79, P<0.01). The 67.60% (48/71) of the patients who did not answer the questionnaire had obvious improvement in their main complaints and physical signs, and 29.58% (21/71) of them had improvement but still needed more training, and 2.82% (2/71) had no improvement in visual fatigue symptoms. Conclusions:Systemic visual therapy can improve the visual function and alleviate symptoms majority of the adult patients with abnormal visual function, suggesting that adult visual function is still of strong plasticity.
RESUMO
Background The use of adaptive optics (AO) system in ophthalmic clinic and basic studies has increased in recent years.However,there are few reports on the stability of ocular aberrations after correction.Objective This study was to analyze the stability of aberration after correction by observing the repeatability of ocular aberration measurements.Methods Forty-one postgraduate school students and volunteers who meet the conditions were included from February to April 2014.The Zernike aberration coefficients including astigmatism (Z2-2,Z22),defocus (Z02),trefoil (Z33,Z3-3),coma (Z3-1,Z13),spherical aberration (Z40) and the value of root mean square (RMS) including 3rd-order to 7th-order aberrations,total higher-order aberrations (HOAs) and total ocular aberrations (TOAs) were measured by using AO system.The repeatability and stability of these data after corrected with AO system were analyzed.The repeatability was evaluated by ANOVA,within-subject standard deviation (Sw),repeatability (r) and intra-class correlation coefficients (ICC).The stability was evaluated by the nonparametric Friedman's rank test.Results AO system showed excellent repeatability on Z2-2,Z22,Z20 and TOA RMS (ICC＞ 0.9),good repeatability on Z13,Z33,Z3-3,Z40,3rd-order RMS,4th-order RMS,HOA RMS (ICC ＞ 0.75),poor repeatability on Z3-1,5th-order RMS,6th-order RMS,7th-order RMS (ICC ＜ 0.75).Repeatability (2.77 Sw) values ranged from 0.009 mm (7th-order RMS) to 0.163 mm (Z31).After low-order ocular aberrations were corrected,It was founded that Z2-2,Z22 reached stable state at the 4th second;Z02 was stable at the 6th second;Z3-3 and Z33 reached stable state at the 4th second and third second,separately;Z13 was stable from 3rd-second to 9th-second,Z3-1 was stable at the 4th-second.Z40 and HOA RMS were stable at the third second and fifth second,respectively.The Z2-2,Z02,Z22,Z3-3,Z3-1,Z33,Z40 and HOA RMS were significantly different among different time points before and after low-order aberrations correction (all at P ＜ 0.05).Z2-2,Z22,Z20 reached stable state at the 4th-second,3rd-second and 5th-second,respectively;Z3-3,Z33 reached stable state at the 2nd-second and 3rd-second,respectively;Z3-1and Z40 reached stable state at the 2nd-second;HOA RMS reached stable state at the 5th-second.Conclusions After correcting the human ocular aberration,different aberrations can reach stable state at different time.The time of Z02,Z22,Z3-3,Z3-1,Z40reaching stable state after 2nd-order to 5th-order ocular aberrations correction was earlier than those of lower-order aberrations correction.