基于双眼推拉模型的视觉训练在9～16 岁屈光参差性弱视儿童中的应用

doi:10.3760/cma.j.cn115909-20190911-00246

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Abstract Objective: To compare the effectiveness of visual training based on the binocular push-pull model and traditional combined training for anisometropic amblyopia in patients aged 9 to 16 years. Methods: This was a prospective randomized, controlled study. A total of 64 patients (64 eyes) aged 9 to 16 years who had been diagnosed with anisometropic amblyopia were recruited in Nanning Aier Eye Hospital from June 2017 to March 2018. Patients were randomly divided into a push-pull training group (32 eyes) and a traditional combined training group (32 eyes). The two groups underwent visual training and refractive correction for 12 months. Patients in the push-pull training group were trained with video stimulation by binocular splitting without eye covering, and the training details were designed based on visual acuity (VA), eye position during perception, degree of inhibition, severity of visual impairment and the effect of the most recent training session. Meanwhile, patients in the traditional combined training group underwent fine training and red light flashing at the same time by covering the non-amblyopic eye. The best corrected visual acuity, zero-order stereopsis, first-order stereopsis, second-order stereopsis and refractive error before and after treatment were compared between the two groups. A rank sum test compared the therapeutic effect (grading data), and order of stereopsis between the groups. An independent samples t test compared the change in visual acuity between the groups. Results: After 12 months of treatment, a patient lost in each group. The push-pull training group had basically cured 7 eyes (23%), improved 24 eyes (77%), and failed 0 eyes (0%); the traditional combined training group basically cured 2 eyes (6%), improved 25 eyes (81%), and failed 4 eyes (13%). The differences of the therapeutic effects were statistically significant (Z=-2.490, P=0.013). The logMAR visual acuity total for distance in the push-pull training group improved 146 lines, which was higher than 89 lines for traditional combined training group. Furthermore, compared with the traditional combined training group, zero-order stereopsis, the first-order stereopsis and second-order stereopsis of the push-pull training group improved significantly (Z=-4.861, P<0.001; Z=-3.706, P<0.001; Z=-5.819, P<0.001). However, there was no significant difference in spherical refraction, cylinder refraction, or spherical equivalent between the two groups before and after treatment. Conclusions: Visual training based on the binocular push-pull model is superior to the traditional combined training in improving visual acuity and stereopsis of patients with anisometropic amblyopia aged 9 to 16 years.

Key words： push-pull training anisometropic amblyopia visual training

Received: 11 September 2019

Fund: Guangdong Province Major Special Foundation Project (2017B010110013)

Corresponding Authors: Quan Lin, Aier School of Ophthalmology, Central South University, Changsha 410015, China; Nanning Aier Eye Hospital, Nanning 530003, China (Email: 402701218@qq.com)

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