Hong J, Fu J, Li L
Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Institute of Ophthalmology, Beijing Key Laboratory of Ophthalmology & Visual Sciences, Beijing 100730, China.
Zhonghua Yan Ke Za Zhi. 2024 May 11;60(5):440-446. doi: 10.3760/cma.j.cn112142-20231018-00154.
To explore the differences in clinical characteristics and interocular interactions between patients with anisometropic amblyopia and ametropic amblyopia. Cross-sectional study. The newly diagnosed anisometropic (the binocular difference in spherical equivalent≥1.00 D) amblyopia patients and ametropic amblyopia patients (aged 4 to 6 years) in Beijing Tongren Hospital from January 2020 to December 2022 were involved. Patients were further categorized by the refractive status after cycloplegia, including hyperopia, myopia, astigmatism, hyperopia with astigmatism, myopia with astigmatism, mild anisometropia and severe anisometropia. Quantitative measurements of best-corrected visual acuity (logMAR), stereoacuity (transformed to log units), perceptual eye position and interocular suppression were performed, and the differences between groups were analyzed. The rank sum test was used for statistical evaluation. The average age of 45 ametropic amblyopia patients (21 males and 24 females) and 84 anisometropic amblyopia patients (48 males and 36 females) was 5.0 (4.0, 5.0) years and 5.0 (4.0, 6.0) years, respectively. The interocular differences in spherical equivalent [2.56 (1.50, 4.19) D vs. 0.25 (0.13, 0.56) D] and best-corrected visual acuity [0.40 (0.18, 0.70) logMAR vs. 0.07 (0.00, 0.12) logMAR] were larger in patients with anisometropic amblyopia than those with ametropic amblyopia. The anisometropic amblyopia patients had worse stereoacuity [2.60 (2.00, 2.90) log arcsec vs 2.00 (2.00, 2.30) log arcsec] and deeper suppression [20.0% (13.3%, 40.0%) vs. 10.0% (0, 23.3%)], compared with the ametropic amblyopia patients. The differences were all statistically significant (<0.05). The suppression and stereoacuity between patients with hyperopic anisometropic amblyopia [suppression, 30.0% (17.5%, 50.0%); stereoacuity, 2.90 (2.30, 2.90) log arcsec] and astigmatic anisometropic amblyopia [suppression, 10.0% (0, 20.0%); stereoacuity, 2.00 (2.00, 2.30) log arcsec] were significantly different (<0.05). The differences of suppression and stereoacuity between patients with severe (binocular difference in spherical equivalent>2.50 D) [suppression, 30.0% (20.0%, 53.3%); stereoacuity, 2.90 (2.57, 2.90) log arcsec] and mild anisometropia [suppression, 20.0% (0, 30.0%); stereoacuity, 2.00 (2.00, 2.90) log arcsec] were also statistically significant (<0.05). Patients with anisometropic amblyopia have deeper binocular suppression, worse stereoacuity and more severe binocular interaction abnormality than those with ametropic amblyopia. The severity of anisometropia affects the degree of the interaction abnormality.
探讨屈光参差性弱视与屈光不正性弱视患者的临床特征及双眼相互作用的差异。横断面研究。纳入2020年1月至2022年12月在北京同仁医院新诊断的屈光参差性(双眼等效球镜差值≥1.00 D)弱视患者和屈光不正性弱视患者(年龄4至6岁)。患者根据睫状肌麻痹后的屈光状态进一步分类,包括远视、近视、散光、远视散光、近视散光、轻度屈光参差和重度屈光参差。进行最佳矫正视力(logMAR)、立体视锐度(转换为对数单位)、感知眼位和双眼抑制的定量测量,并分析组间差异。采用秩和检验进行统计学评价。45例屈光不正性弱视患者(男21例,女24例)和84例屈光参差性弱视患者(男48例,女36例)的平均年龄分别为5.0(4.0,5.0)岁和5.0(4.0,6.0)岁。屈光参差性弱视患者的双眼等效球镜差值[2.56(1.50,4.19)D对0.25(0.13,0.56)D]和最佳矫正视力[0.40(0.18,0.70)logMAR对0.07(0.00,0.12)logMAR]的眼间差异大于屈光不正性弱视患者。与屈光不正性弱视患者相比,屈光参差性弱视患者的立体视锐度更差[2.60(2.00,2.90)log角秒对2.00(2.00,2.30)log角秒],抑制更深[20.0%(13.3%,40.0%)对10.0%(0,23.3%)]。差异均有统计学意义(<0.05)。远视性屈光参差性弱视患者[抑制,30.0%(17.5%,50.0%);立体视锐度,2.90(2.30,2.90)log角秒]与散光性屈光参差性弱视患者[抑制,10.0%(0,20.0%);立体视锐度,2.00(2.00,2.30)log角秒]之间的抑制和立体视锐度差异有统计学意义(<0.05)。重度(双眼等效球镜差值>2.50 D)患者[抑制,30.0%(20.0%,53.3%);立体视锐度,2.90(2.57,2.90)log角秒]与轻度屈光参差患者[抑制,20.0%(0,30.0%);立体视锐度,2.00(2.00,2.90)log角秒]之间的抑制和立体视锐度差异也有统计学意义(<0.05)。屈光参差性弱视患者比屈光不正性弱视患者有更深的双眼抑制、更差的立体视锐度和更严重的双眼相互作用异常。屈光参差的严重程度影响相互作用异常的程度。