Sreenivasan Vidhyapriya, Babinsky Erin E, Wu Yifei, Candy T Rowan
Invest Ophthalmol Vis Sci. 2016 May 1;57(6):2678-88. doi: 10.1167/iovs.15-17877.
Binocular alignment typically includes motor fusion compensating for heterophoria. This study evaluated heterophoria and then accommodation and vergence responses during measurement of fusional ranges in infants and preschoolers.
Purkinje image eye tracking and eccentric photorefraction (MCS PowerRefractor) were used to record the eye alignment and accommodation of uncorrected infants (n = 17; 3-5 months old), preschoolers (n = 19; 2.5-5 years), and naïve functionally emmetropic adults (n = 14; 20-32 years; spherical equivalent [SE], +1 to -1 diopters [D]). Heterophoria was derived from the difference between monocular and binocular alignments while participants viewed naturalistic images at 80 cm. The presence or absence of fusion was then assessed after base-in (BI) and base-out (BO) prisms (2-40 prism diopters [pd]) were introduced.
Mean (±SD) SE refractions were hyperopic in infants (+2.4 ± 1.2 D) and preschoolers (+1.1 ± 0.6 D). The average exophoria was similar (P = 0.11) across groups (Infants, -0.79 ± 2.5 pd; Preschool, -2.43 ± 2.0 pd; Adults, -1.0 ± 2.7 pd). Mean fusional vergence range also was similar (P = 0.1) for BI (Infants, 11.2 ± 2.5 pd; Preschool, 8.8 ± 2.8 pd; Adults, 11.8 ± 5.2 pd) and BO (Infants, 14 ± 6.6 pd; Preschool, 15.3 ± 8.3 pd; Adults, 20 ± 9.2 pd). Maximum change in accommodation to the highest fusible prism was positive (increased accommodation) for BO (Infants, 1.69 ± 1.4 D; Preschool, 1.35 ± 1.6 D; Adults, 1.22 ± 1.0 D) and negative for BI (Infants, -0.96 ± 1.0 D; Preschool, -0.78 ± 0.6 D; Adults, -0.62 ± 0.3 D), with a similar magnitude across groups (BO, P = 0.6; BI, P = 0.4).
Despite typical uncorrected hyperopia, infants and preschoolers exhibited small exophorias at 80 cm, similar to adults. All participants demonstrated substantial fusional ranges, providing evidence that even 3- to 5-month-old infants can respond to a large range of image disparities.
双眼视轴矫正通常包括运动融合以补偿隐斜视。本研究评估了婴儿和学龄前儿童在融合范围测量过程中的隐斜视，以及随后的调节和聚散反应。
使用浦肯野图像眼动追踪和偏心摄影验光法（MCS PowerRefractor）记录未矫正的婴儿（n = 17；3 - 5个月大）、学龄前儿童（n = 19；2.5 - 5岁）和单纯功能性正视成年人（n = 14；20 - 32岁；等效球镜度[SE]，+1至 -1屈光度[D]）的眼位对准和调节情况。当参与者在80厘米处观看自然图像时，隐斜视由单眼和双眼视轴对准的差异得出。然后在引入内聚（BI）和外展（BO）棱镜（2 - 40棱镜度[pd]）后评估是否存在融合。
婴儿（+2.4 ± 1.2 D）和学龄前儿童（+1.1 ± 0.6 D）的平均（±标准差）SE屈光度为远视。各组间平均外隐斜相似（P = 0.11）（婴儿，-0.79 ± 2.5 pd；学龄前儿童，-2.43 ± 2.0 pd；成年人，-1.0 ± 2.7 pd）。BI（婴儿，11.2 ± 2.5 pd；学龄前儿童，8.8 ± 2.8 pd；成年人，11.8 ± 5.2 pd）和BO（婴儿，14 ± 6.6 pd；学龄前儿童，15.3 ± 8.3 pd；成年人，20 ± 9.2 pd）的平均融合聚散范围也相似（P = 0.1）。对于BO，最高可融合棱镜引起的调节最大变化为正值（调节增加）（婴儿，1.69 ± 1.4 D；学龄前儿童，1.35 ± 1.6 D；成年人，1.22 ± 1.0 D），对于BI为负值（婴儿，-0.96 ± 1.0 D；学龄前儿童，-0.78 ± 0.6 D；成年人，-0.62 ± 0.3 D），各组间幅度相似（BO，P = 0.6；BI，P = 0.4）。
尽管存在典型的未矫正远视，但婴儿和学龄前儿童在80厘米处表现出与成年人相似的小外隐斜。所有参与者都表现出较大的融合范围，这表明即使是3至5个月大的婴儿也能对大范围的图像视差做出反应。
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