Watanabe Kumiko, Hara Naoto, Kimijima Masumi, Kotegawa Yasue, Ohno Koji, Arimoto Ako, Mukuno Kazuo, Hisahara Satoru, Horie Hidenori
Department of Ophthalmology, Kanagawa Dental College of Medicine, Yokohama Clinic, Yokohama, Japan.
Nippon Ganka Gakkai Zasshi. 2012 Oct;116(10):929-36.
School children with myopia were trained using a visual stimulation device that generated an isolated blur stimulus on a visual target, with a constant retinal image size and constant brightness. Uncorrected visual acuity, cycloplegic refraction, axial length, dynamic accommodation and papillary reaction were measured to investigate the effectiveness of the training.
There were 45 school children with myopia without any other ophthalmic diseases. The mean age of the children was 8.9 +/- 2.0 years (age range; 6-16)and the mean refraction was -1.56 +/- 0.58 D (mean +/- standard deviation). As a visual stimulus, a white ring on a black background with a constant ratio of visual target size to retinal image size, irrespective of the distance, was displayed on a liquid crystal display (LCD), and the LCD was quickly moved from a proximal to a distal position to produce an isolated blur stimulus. Training with this visual stimulus was carried out in the relaxation phase of accommodation. Uncorrected visual acuity, cycloplegic refraction, axial length, dynamic accommodation and pupillary reaction were investigated before training and every 3 months during the training.
Of the 45 subjects, 42 (93%) could be trained for 3 consecutive months, 33 (73%) for 6 months, 23 (51%) for 9 months, and 21 (47%) for 12 months. The mean refraction decreased by 0.83 +/- 0.56 D (mean +/- standard deviation) and the mean axial length increased by 0.47 +/- 0.16 mm at 1 year, showing that the training bad some effect in improving the visual acuity. In the tests of the dynamic accommodative responses, the latency of the accommodative-phase decreased from 0.4 +/- 0.2 sec to 0.3 +/- 0.1 sec at 1 year, the gain of the accommodative-phase improved from 69.0 +/- 27.0% to 93.3 +/- 13.4%, the maximum speed of the accommodative-phase increased from 5.1 +/- 2.2 D/sec to 6.8 +/- 2.2 D/sec and the gain of the relaxation-phase significantly improved from 52.1 +/- 26.0% to 72.7 +/- 13.7% (corresponding t-test, p < 0.005). No significant changes were observed in the pupillary reaction.
The training device was useful for improving the accommodative functions and accommodative excess, suggesting that it may be able to suppress the progression of low myopia, development of which is known to be strongly influenced by environmental factors.
使用一种视觉刺激设备对近视小学生进行训练，该设备在视觉目标上产生孤立的模糊刺激，视网膜图像大小和亮度恒定。测量未矫正视力、睫状肌麻痹验光、眼轴长度、动态调节和瞳孔反应，以研究训练的有效性。
45名患有近视且无其他眼科疾病的小学生。儿童的平均年龄为8.9±2.0岁（年龄范围6 - 16岁），平均屈光度为-1.56±0.58 D（平均值±标准差）。作为视觉刺激，在液晶显示器（LCD）上显示黑色背景上的白色圆环，视觉目标大小与视网膜图像大小的比例恒定，与距离无关，然后将LCD从近端快速移动到远端位置以产生孤立的模糊刺激。在调节的放松阶段进行这种视觉刺激训练。在训练前以及训练期间每3个月对未矫正视力、睫状肌麻痹验光、眼轴长度、动态调节和瞳孔反应进行研究。
45名受试者中，42名（93%）能够连续训练3个月，33名（73%）能够训练6个月，23名（51%）能够训练9个月，21名（47%）能够训练12个月。1年后平均屈光度降低了0.83±0.56 D，平均眼轴长度增加了0.47±0.16 mm，表明训练在提高视力方面有一定效果。在动态调节反应测试中，调节相的潜伏期在1年后从0.4±0.2秒降至0.3±0.1秒，调节相的增益从69.0±27.0%提高到93.3±13.4%，调节相的最大速度从5.1±2.2 D/秒增加到6.8±2.2 D/秒，放松相的增益从52.1±26.0%显著提高到72.7±13.7%（相应的t检验，p<0.005）。瞳孔反应未观察到显著变化。
该训练设备有助于改善调节功能和调节过度，表明它可能能够抑制低度近视的进展，已知低度近视的发展受环境因素强烈影响。
