Horwood Anna M, Riddell Patricia M
Infant Vision Laboratory, School of Psychology & Clinical Language Sciences, University of Reading, United Kingdom; Orthoptic Department, Royal Berkshire Hospital, Reading, United Kingdom.
Infant Vision Laboratory, School of Psychology & Clinical Language Sciences, University of Reading, United Kingdom.
J AAPOS. 2014 Dec;18(6):576-83. doi: 10.1016/j.jaapos.2014.08.009.
To propose an alternative and practical model to conceptualize clinical patterns of concomitant intermittent strabismus, heterophoria, and convergence and accommodation anomalies.
Despite identical ratios, there can be a disparity- or blur-biased "style" in three hypothetical scenarios: normal; high ratio of accommodative convergence to accommodation (AC/A) and low ratio of convergence accommodation to convergence (CA/C); low AC/A and high CA/C. We calculated disparity bias indices (DBI) to reflect these biases and provide early objective data from small illustrative clinical groups that fit these styles.
Normal adults (n = 56) and children (n = 24) showed disparity bias (adult DBI 0.43 [95% CI, 0.50-0.36], child DBI 0.20 [95% CI, 0.31-0.07]; P = 0.001). Accommodative esotropia (n = 3) showed less disparity-bias (DBI 0.03). In the high AC/A-low CA/C scenario, early presbyopia (n = 22) showed mean DBI of 0.17 (95% CI, 0.28-0.06), compared to DBI of -0.31 in convergence excess esotropia (n=8). In the low AC/A-high CA/C scenario near exotropia (n = 17) showed mean DBI of 0.27. DBI ranged between 1.25 and -1.67.
Establishing disparity or blur bias adds to AC/A and CA/C ratios to explain clinical patterns. Excessive bias or inflexibility in near-cue use increases risk of clinical problems.
提出一种替代性的实用模型,用以概念化间歇性共同性斜视、隐斜视以及集合与调节异常的临床模式。
尽管比率相同,但在三种假设情况下可能存在偏向差异或模糊的“风格”:正常;调节性集合与调节的比率(AC/A)高且集合性调节与集合的比率(CA/C)低;AC/A低且CA/C高。我们计算了差异偏向指数(DBI)以反映这些偏向,并从小规模说明性临床组中提供符合这些风格的早期客观数据。
正常成年人(n = 56)和儿童(n = 24)表现出差异偏向(成人DBI为0.43 [95%可信区间,0.50 - 0.36],儿童DBI为0.20 [95%可信区间,0.31 - 0.07];P = 0.001)。调节性内斜视(n = 3)表现出的差异偏向较小(DBI为0.03)。在AC/A高 - CA/C低的情况下,早期老花眼(n = 22)的平均DBI为0.17(95%可信区间,0.28 - 0.06),相比之下,集合过强性内斜视(n = 8)的DBI为 - 0.31。在AC/A低 - CA/C高的情况下,外斜视(n = 17)的平均DBI为0.27。DBI范围在1.25至 - 1.67之间。
确定差异或模糊偏向可补充AC/A和CA/C比率,以解释临床模式。近距离线索使用中的过度偏向或不灵活性会增加临床问题的风险。