Smith Earl L, Hung Li-Fang, Arumugam Baskar, Wensveen Janice M, Chino Yuzo M, Harwerth Ronald S
College of Optometry, University of Houston, TX 77204, USA; Brien Holden Vision Institute, Sydney, Australia.
College of Optometry, University of Houston, TX 77204, USA; Brien Holden Vision Institute, Sydney, Australia.
Vision Res. 2017 May;134:26-42. doi: 10.1016/j.visres.2017.03.004. Epub 2017 Apr 18.
We investigated the potential causal relationships between anisometropia, amblyopia and strabismus, specifically to determine whether either amblyopia or strabismus interfered with emmetropization. We analyzed data from non-human primates that were relevant to the co-existence of anisometropia, amblyopia and strabismus in children. We relied on interocular comparisons of spatial vision and refractive development in animals reared with 1) monocular form deprivation; 2) anisometropia optically imposed by either contact lenses or spectacle lenses; 3) organic amblyopia produced by laser ablation of the fovea; and 4) strabismus that was either optically imposed with prisms or produced by either surgical or pharmacological manipulation of the extraocular muscles. Hyperopic anisometropia imposed early in life produced amblyopia in a dose-dependent manner. However, when potential methodological confounds were taken into account, there was no support for the hypothesis that the presence of amblyopia interferes with emmetropization or promotes hyperopia or that the degree of image degradation determines the direction of eye growth. To the contrary, there was strong evidence that amblyopic eyes were able to detect the presence of a refractive error and alter ocular growth to eliminate the ametropia. On the other hand, early onset strabismus, both optically and surgically imposed, disrupted the emmetropization process producing anisometropia. In surgical strabismus, the deviating eyes were typically more hyperopic than their fellow fixating eyes. The results show that early hyperopic anisometropia is a significant risk factor for amblyopia. Early esotropia can trigger the onset of both anisometropia and amblyopia. However, amblyopia, in isolation, does not pose a significant risk for the development of hyperopia or anisometropia.
我们研究了屈光参差、弱视和斜视之间潜在的因果关系，特别是要确定弱视或斜视是否会干扰正视化过程。我们分析了与儿童屈光参差、弱视和斜视共存相关的非人灵长类动物的数据。我们依赖于对以下饲养动物的空间视觉和屈光发育进行眼间比较：1）单眼形觉剥夺；2）通过隐形眼镜或框架眼镜光学造成的屈光参差；3）通过激光烧灼中央凹产生的器质性弱视；4）通过棱镜光学造成的斜视或通过眼外肌的手术或药物操作产生的斜视。生命早期出现的远视性屈光参差会以剂量依赖的方式导致弱视。然而，当考虑到潜在的方法学混淆因素时，没有证据支持以下假设：弱视的存在会干扰正视化过程或促进远视，或者图像退化程度决定眼睛生长方向。相反，有强有力的证据表明，弱视眼能够检测到屈光不正的存在并改变眼球生长以消除屈光不正。另一方面，早期发生的斜视，无论是光学造成的还是手术造成的，都会破坏正视化过程，导致屈光参差。在手术性斜视中，偏斜眼通常比其注视眼的同眼更远视。结果表明，早期远视性屈光参差是弱视的一个重要危险因素。早期内斜视可引发屈光参差和弱视的发生。然而，孤立的弱视对远视或屈光参差的发展并不构成重大风险。
