Kinoshita S
Department of Ophthalmology, Kyoto Prefectural University of Medicine, Japan.
Nippon Ganka Gakkai Zasshi. 1994 Dec;98(12):1256-68.
Using a computer-assisted infrared optometer with a pupillograph, we tried to obtain basic understanding of accommodative disturbance and its by investigating tonic (dark focus) level of accommodation and quasi-static accommodative response. In normal volunteers in whom either visual fatigue, general fatigue, or drunkeness was loaded intentionally, myopic shift of refraction, increased refractive fluctuation, and miosis were induced in all cases but the effect on amplitude of accommodative response was minimal. Subjects that worked at a computer terminal all day for 2 years, but not controls, developed myopic change at a statistically significant level. The effect on tonic level of accommodation of subject age, sustained near-vision tasks, and topical application of autonomic-related drugs was investigated. In subjects with severe eyestrain, myopic shift of tonic accommodation and prominent pupillary unrest were observed, suggesting increased parasympathetic excitation. One patient who was accidentally exposed to diisopropyl fluorophosphate, a potent cholinesterase inhibitor, showed a phenomenon similar to that mentioned above. Chaos attractors based upon the Shil'nikov phenomenon were introduced for evaluation of microfluctuation and pupillary unrest, as first applied by Sumida et al. Topical application of low-dose cyclopentolate hydrochloride was effective for treating accommodative abnormality in professional computed workers, who sometimes develop abnormal parasympathetic excitation. Based on quasi-static accommodation measurements, accommodative abnormality after head and neck injury, including whiplash injury, was divided into two completely different states: accommodative spasm and palsy. Since quasi-static accommodation was greatly affected by satellite ganglion block, sympathetic innervation from cervical ganglions may strongly influence accommodative response. Hyperthyroidism, which may be accompanied by sympathetic hyper-excitation, showed diminished accommodative response. In patients after refractive surgery by excimer laser, there was no difference in accommodative response before and after surgery, although tonic accommodation was slightly unstable after surgery. These findings suggest that the evaluation of tonic level or a similar state of accommodation and pupillary unrest will yield extremely valuable information in regard to various accommodative disturbances.
我们使用配备瞳孔记录仪的计算机辅助红外验光仪，通过研究调节的紧张（暗焦点）水平和准静态调节反应，试图对调节障碍及其机制有基本的了解。在故意施加视觉疲劳、全身疲劳或醉酒的正常志愿者中，所有情况下均诱发了屈光的近视性移位、屈光波动增加和瞳孔缩小，但对调节反应幅度的影响极小。整天在计算机终端工作2年的受试者出现了具有统计学意义的近视变化，而对照组则未出现。研究了受试者年龄、持续近视力任务以及局部应用自主神经相关药物对调节紧张水平的影响。在有严重眼疲劳的受试者中，观察到紧张性调节的近视性移位和明显的瞳孔不稳定，提示副交感神经兴奋增加。一名意外接触强效胆碱酯酶抑制剂二异丙基氟磷酸酯的患者表现出与上述相似的现象。Sumida等人首次应用基于希利尼科夫现象的混沌吸引子来评估微波动和瞳孔不稳定。局部应用低剂量盐酸环喷托酯对治疗有时会出现异常副交感神经兴奋的职业计算机工作者的调节异常有效。基于准静态调节测量，头部和颈部损伤（包括挥鞭伤）后的调节异常被分为两种完全不同的状态：调节痉挛和麻痹。由于准静态调节受星状神经节阻滞的影响很大，颈神经节的交感神经支配可能强烈影响调节反应。可能伴有交感神经兴奋亢进的甲状腺功能亢进症表现为调节反应减弱。在准分子激光屈光手术后的患者中，尽管术后紧张性调节略有不稳定，但手术前后的调节反应没有差异。这些发现表明，评估调节的紧张水平或类似状态以及瞳孔不稳定将为各种调节障碍提供极其有价值的信息。
