第二部分 双眼视功能检查

第二部分 双眼视功能检查 一、BCC检查 调节反应，调节滞后和调节超前的测量方法，正常值为+0.25~+0.75D。 1. 综合验光仪内置入被检者远用屈光不正矫正度数，近用瞳距。将FCC视标置于近视标杆40?处，将两眼辅助镜片的?0.50转至90º位置(其负散轴位于90º)，不需要额外增加照明，让被检者双眼睁开，注视40?处的FCC视标。 2. 被检者报告水平线较清晰，说明被检者为调节滞后，在双眼前同时增加正球镜至横竖线条同样清晰，所增加的正球镜即为其调节滞后量。 3. 被检者报告垂直线清晰，说明被检者为调节超前，在双眼前同时增加负球镜至横竖线条同样清晰，所增加的负球镜即为其调节超前量。 4. 若被检者报告水平线和垂直线同样清晰，说明被检者的调节反应量为零。 二、NRA检查: 负相对调节，即在集合保持相对稳定的情况下，双眼所能减少调节的能力，正常值为+2.25~+2.50D。 1. 被检者舒适地坐在综合验光仪后，置于其远用屈光不正矫正度数，近用瞳距，良好照明。 2. 让被检者双眼同时注视40?近用视力表最佳视力的上一行视标。 3. 在双眼前同时增加正球镜，直至被检者报告视标开始变模糊，退回前一片。记录增加的正球镜度数，即为其负相对调节(NRA)。 4. 检测值正常说明无调节参与，测得的度数是真实度数; 检测值偏低说明有调节参与，即假性近视，需要散瞳处理; 检测值偏高说明负镜过矫或正镜欠矫。 三、PRA检查 正相对调节，即在集合保持相对稳定的情况下，双眼所能增加调节的能力，正常值>-2.50D。 1. 被检者舒适地坐在综合验光仪后，置于其远用屈光不正矫正度数，近用瞳距，良好照明。 2. 让被检者双眼同时注视40?近用视力表最佳视力的上一行视标。 3. 在双眼前同时增加负球镜，直至被检者报告视标持续模糊。记录增加的负球镜度数，即为其正相对调节(PRA)。 4. 检测值若低于验光测得近视增长的度数，被检者无法接受新眼镜，可通过调节训练; 5. PRA低加上外隐斜，看近必须要戴镜。 四、调节灵活度检查 调节灵活度是采用?2.00D翻转拍(Flipper拍)进行检查，测量每一分钟的循环次数，其单位为cpm。调节灵活度代表了调节能力、速度、持久力，在无法进行NRA、PRA检查或者低龄儿童不合作的情况下可快速估测调节是否正常、调节和放松哪部分出现问题。正常值为单眼12cpm，双眼8~10cpm。 1. 被检者戴屈光不正全矫眼镜，右眼处于打开状态，左眼关闭。注视40cm处的0.6近视标检查卡。 rational concept to allow network more in line with the objective laws of the future development of the city. 1.5.2 planning research areas: throughout the city, with an area of 13,000 km2, cover 2 districts and 8 counties of the city, including downtown and city levels. Planning range: main for City Center City, area for 1268km2, North to cases field Xiang, and Jin Pingzhen, and Gao Dian Zhen, and huangshazhen, and Liu home town North Township territories, East Nan XI Zhen, and Jiangnan East Township territories, South to horse home, and song home, and Li Zhuang Zhen, and South wide town, and Zhao field Street do South administrative border, West to baixizhen, and dish dam town, and thought slope Xiang West Township territories. 1.6 planning target 1.6.1 General target this items research to will Yibin city built Yangtze River upstream chuan Yunnan Guizhou combined Department Regional Center City, support city space of ordered expand for target, reference Yibin city integrated traffic planning (2014-2030 years) and the Yibin City City general planning (2013-2030 years) of research results, using science, and advanced of network research method, building more level, and more mode of track traffic system, Meet at different levels of the city's rail transportation needs and quality requirements. 1.6.2 target 1, refined urban development axis of urban development concepts, judgments, rail-guided downtown from solo to group-development of the network, from one Center to center city with axial development. 2, network planning adapted to Yibin City status and future development needs, demonstrates rational scale of rail transport to meet the needs 2. 检查者将?2.00D翻转拍镜片的正镜片置于被检者右眼前，嘱被检者注视近视标检查卡字母，当被检者报告视标变清晰时，检查者立即将负镜片反转至被检者眼前，待被检者报告视标变清晰时再立即反转镜片。记录一分钟被检者看清视标的循环次数(看清，2.00D和,2.00D为一个周期)。 3. 左眼调节灵活度的检查与右眼相同，而后进行双眼调节灵活度的检查。 4. 双眼调节灵活度的检查与单眼调节灵活度的检查方法基本相同，只需将两眼都打开即可。 5. 双眼调节灵活度测量过程中为了避免被检者有单眼抑制现象的发生，检查时可使用偏振镜片。测量时被检者戴上偏振眼镜，若其只能看到两列视标说明被检者有单眼抑制，需在记录中标明。 五、调节幅度检查 通过测量被检者的调节幅度，并根据最小调节幅度公式15-0.25×年龄或查调节幅度正常值表(Donder)，评估被检者的调节幅度是否存在异常。 (一)移近法 1. 被检查者戴屈光不正全矫眼镜，遮盖其左眼，正常照明。 2. 验光师手持近用视标置于被检查眼前40cm处，请被检者注视其最佳视力上一行视标(通常为0.8一行视标)，并以约5cm/s的速度将近用视标向被检者移近，直至被检者报告视标开始出现持续性模糊为止。 3. 用视标尺测量此时视标距被检者眼镜平面的距离，该距离的倒数即为被检者右眼的调节幅度。同样方法检查左眼、双眼的调节幅度。 (二)负镜片法 1. 在综合验光仪内置人被检者的远用屈光不正矫正度数，遮盖其左眼，正常照明。 2. 将近用视标置于近视标杆40cm处，让被检者注视最佳视力上一行视标(通常为0.8一行视标)。在该眼前逐渐增加-0.25D的负球镜，直至被检者报告视标首次出现持续性模糊，记录上一片的镜片度。 3. 所增加的负球镜总量再加上2.50D为被检者的调节幅度。同法检者左眼、双眼的调节幅度。 六、 远、近距离水平隐斜 目前常用的隐斜视的检查方法主要有交替遮盖法、马氏杆法和vonGraefe。其中后两种方法需要在被检者有双眼同时视的基础上进行。 (一)遮盖法:本方法为定性检查。 a) 遮盖-去遮盖试验:检查者用遮盖板遮住一眼，观察遮盖眼去遮盖后有无转动，如有转动，说明病人存在显斜视，如果遮盖眼去遮盖后由外向内运动，说明病人有外斜视，由内向外运动，说明有内斜视。若存在垂直方向的运动，说明有垂直斜视。去遮盖瞬间遮盖眼由上往下移动为该眼的上隐斜。去遮盖瞬间遮盖眼由下往上移动为对侧眼的上隐斜。移去遮盖板，让检查者有足够时间建立双眼视，遮盖另一眼，再一次观察遮盖眼去遮盖后有无转动，如移去遮盖板后，被遮盖眼回到正位，而未遮盖眼显示斜视，那么，被遮盖眼为注视眼，如果，被遮盖眼在去遮盖后，仍然在斜视位，说明，未遮盖眼为注视眼。 rational concept to allow network more in line with the objective laws of the future development of the city. 1.5.2 planning research areas: throughout the city, with an area of 13,000 km2, cover 2 districts and 8 counties of the city, including downtown and city levels. Planning range: main for City Center City, area for 1268km2, North to cases field Xiang, and Jin Pingzhen, and Gao Dian Zhen, and huangshazhen, and Liu home town North Township territories, East Nan XI Zhen, and Jiangnan East Township territories, South to horse home, and song home, and Li Zhuang Zhen, and South wide town, and Zhao field Street do South administrative border, West to baixizhen, and dish dam town, and thought slope Xiang West Township territories. 1.6 planning target 1.6.1 General target this items research to will Yibin city built Yangtze River upstream chuan Yunnan Guizhou combined Department Regional Center City, support city space of ordered expand for target, reference Yibin city integrated traffic planning (2014-2030 years) and the Yibin City City general planning (2013-2030 years) of research results, using science, and advanced of network research method, building more level, and more mode of track traffic system, Meet at different levels of the city's rail transportation needs and quality requirements. 1.6.2 target 1, refined urban development axis of urban development concepts, judgments, rail-guided downtown from solo to group-development of the network, from one Center to center city with axial development. 2, network planning adapted to Yibin City status and future development needs, demonstrates rational scale of rail transport to meet the needs b) 交替遮盖试验:遮盖-去遮盖试验确立注视眼，从遮盖斜眼开始检查。从右眼到左眼迅速移动遮盖板，然后再回到右眼，观察拿走遮盖的眼睛的运动，经过数次交替遮盖后，用基底朝向眼睛移动方向的三棱镜度数估计所观察到的眼睛的移动量。不断调整三棱镜的度数，直到交替遮盖时不再出现眼球运动为止。 (二)马氏杆法:本方法须在被检者有双眼同时视的基础上进行。 1. 被检者舒适地坐在综合验光仪后，将室内光线调暗，验光仪中置入其远用屈光不正矫正度数和远用瞳距。右眼的辅镜片RMH调至90º(即右眼视孔内为红色水平向马氏杆)，左眼处于开放状态，并将旋转棱镜归零后移至左眼孔前，将0位置于垂直方向。 2. 被检者注视5米远处的一点光源。此时右眼看到是一条红色的竖线，左眼看到的是点光源。 3. 被检者看到的点光源恰好在红色竖线上，说明被检者无水平向隐斜。 4. 被检者看到红色竖线在右边，点光源在左边，即右眼看到的像在右边，左眼看到的像在左边，为同侧性复视，说明被检者为内隐斜。此时在非注视眼前逐渐增加基底向外的三棱镜，直至点刚好落在竖线上。所加的三棱镜即为其内隐斜量 5. 被检者看到红色竖线在左边，点光源在右边，即右眼看到的像在左边，左眼看到的像在右边，为交叉性复视，说明被检者为外隐斜。此时在非注视眼前逐渐增加基底向内的三棱镜，直至点刚好落在竖线上。所加的三棱镜即为其外隐斜量。 6. 马氏杆法检查近距离水平向隐斜视。马氏杆法检查近距离水平向隐斜视时，只需将远用瞳距调整为近用瞳距，点光源从5米移至40厘米处即可，其他操作步骤和结果判断同上。 (三)Von Graefe 法:本方法须在被检者有双眼同时视的基础上进行。 1. 视标采用被检者单眼最佳矫正视力上一行的单个视标。 2. 被检者舒适地坐在综合验光仪后，置入被检者远用屈光不正矫正度数和远用瞳距。让被检者轻轻闭上眼睛，将旋转棱镜移至视孔前，将右眼前棱镜调至ΔΔ6BU，左眼棱镜调至12BI。 3. 被检者睁开双眼，询问其看到几个视标。此时应看到两个视标，一个在右下方(为右眼所见)，一个在左上方(为左眼所见)。 4. 让被检者注视右下方的视标(右眼所见)，并始终保持视标清晰。 5. 验光师告知被检者他将会使左上方的视标逐渐向右移动，当左上方视标移至右下方视标的正上方时请被检者报告。 Δ6. 验光师以每秒2的速度减少左眼的棱镜度，直到被检者报告上下两个视标垂直向对齐(即两个视标一条垂直线上)。记录此时左眼前三棱镜的底向和度数。 7. 继续向同一方向移动三棱镜，至被检者看到视标变为一个在左下方，一个在右上方，再反方向移动三棱镜，再次使上下两个视标垂直向对齐。记录此时左眼前三棱镜的底向和度数。 8. 上述两步中所得三棱镜的平均值为被检者的隐斜量。三棱镜平均值是基底朝内的三棱镜，则被检者为外隐斜。平均值是基底朝外的三棱镜，则被检者为rational concept to allow network more in line with the objective laws of the future development of the city. 1.5.2 planning research areas: throughout the city, with an area of 13,000 km2, cover 2 districts and 8 counties of the city, including downtown and city levels. Planning range: main for City Center City, area for 1268km2, North to cases field Xiang, and Jin Pingzhen, and Gao Dian Zhen, and huangshazhen, and Liu home town North Township territories, East Nan XI Zhen, and Jiangnan East Township territories, South to horse home, and song home, and Li Zhuang Zhen, and South wide town, and Zhao field Street do South administrative border, West to baixizhen, and dish dam town, and thought slope Xiang West Township territories. 1.6 planning target 1.6.1 General target this items research to will Yibin city built Yangtze River upstream chuan Yunnan Guizhou combined Department Regional Center City, support city space of ordered expand for target, reference Yibin city integrated traffic planning (2014-2030 years) and the Yibin City City general planning (2013-2030 years) of research results, using science, and advanced of network research method, building more level, and more mode of track traffic system, Meet at different levels of the city's rail transportation needs and quality requirements. 1.6.2 target 1, refined urban development axis of urban development concepts, judgments, rail-guided downtown from solo to group-development of the network, from one Center to center city with axial development. 2, network planning adapted to Yibin City status and future development needs, demonstrates rational scale of rail transport to meet the needs 内隐斜。平均值是基底朝上的三棱镜，则被检者为下隐斜。平均值是基底朝下的三棱镜，则被检者为上隐斜。平均值为0，则被检者无水平向隐斜视。 9. 将远用瞳距调整为近用瞳距，测试距离移至近视标杆的40cm处，视标采用近用视标中的小方块视标，按以上步骤可测得近距离水平向隐斜视。 七、 AC/A检查 (一)梯度性AC/A值 梯度性AC/A值是指通过改变镜片从而使调节变化1.00D后，其调节性集合量的变化。通常采用的方法是首先检查出被检者戴矫正眼镜后看近的水平隐斜量，在此基础上双眼各加+1.00D，检查看近的水平隐斜量，再双眼各加-1.00D，检查看近的水平隐斜量，两次的差值，除以2D，即为其AC/A值。检查梯度性AC/AΔ值时通常采用vonGraefe法检查近距离的水平隐斜量。正常值为3,5/D。 1. 被检者舒适地坐在综合验光仪后，预置被检者的远用屈光不正矫正度数，瞳距调整为近用瞳距。 2. 用von Graefe法检查此时被检者近距离的水平隐斜量，并记录值(内隐斜即BO值记录为，值，外隐斜即BI值记录为,值)。 3. 双眼在远屈光不正矫正度数的基础上，增加+1.00D球镜后，检查一次此时被检者看近的水平隐斜量，并记录值，再增加-1.00D球镜后，检查一次此时被检者看近的水平隐斜量，并记录值。在测量过程中让被检者始终保持注视视标清晰。 4. 用3步中两次变化值，除以增加的调节量2D，即为其梯度性 AC/A值。 (二)计算性AC/A值 计算性AC/A值是根据被检者近看至看远时总的集合量的变化除以其调节量的变化而得。 1. 用马氏杆法或von Graefe法查得被检者的远距离和近距离的水平隐斜量后，根据公式:AC/A=PD，M(Hn,Hf)计算出AC/A值。 2. 式中:PD为被检者的远用瞳距，以厘米为单位， M为测量近距离隐斜时所注视的距离，以米为单位。通常为40cm，即0.4米。 Hn为近距离的水平隐斜量(内隐斜记录为，值，外隐斜记录为,值) Hf为远距离的水平隐斜量(内隐斜记录为，值，外隐斜记录为,值) 八、远、近距离BI/BO检查 通常使用综合验光仪上的旋转棱镜测量聚散范围。用基底朝内(BI)和基底朝外(BO)的三棱镜测量水平聚散力，得到模糊点、破裂点和恢复点数值。 (一)远距离BI/BO检查 1. 被检者舒适地坐在综合验光仪后，置入其远用屈光不正矫正度数，远用瞳距。 2. 视标采用被检眼最佳矫正视力上一行的单个视标。 3. 调整两侧旋转棱镜得到BI和BO的三棱镜。 4. 被检者双眼注视单个视标，并报告模糊点和破裂点。 5. 先进行BI检查，记录模糊点、破裂点、恢复点。 6. 同法进行BO检查并记录。 rational concept to allow network more in line with the objective laws of the future development of the city. 1.5.2 planning research areas: throughout the city, with an area of 13,000 km2, cover 2 districts and 8 counties of the city, including downtown and city levels. Planning range: main for City Center City, area for 1268km2, North to cases field Xiang, and Jin Pingzhen, and Gao Dian Zhen, and huangshazhen, and Liu home town North Township territories, East Nan XI Zhen, and Jiangnan East Township territories, South to horse home, and song home, and Li Zhuang Zhen, and South wide town, and Zhao field Street do South administrative border, West to baixizhen, and dish dam town, and thought slope Xiang West Township territories. 1.6 planning target 1.6.1 General target this items research to will Yibin city built Yangtze River upstream chuan Yunnan Guizhou combined Department Regional Center City, support city space of ordered expand for target, reference Yibin city integrated traffic planning (2014-2030 years) and the Yibin City City general planning (2013-2030 years) of research results, using science, and advanced of network research method, building more level, and more mode of track traffic system, Meet at different levels of the city's rail transportation needs and quality requirements. 1.6.2 target 1, refined urban development axis of urban development concepts, judgments, rail-guided downtown from solo to group-development of the network, from one Center to center city with axial development. 2, network planning adapted to Yibin City status and future development needs, demonstrates rational scale of rail transport to meet the needs 7. 记录结果:分别记录远距离BI和BO的模糊点/破裂点/恢复点数值。 8. 远距离水平聚散范围期望值: 模糊点 破裂点 恢复点 BI 无 7?3 4?2 BO 9?4 19?8 10?4 (二)近距离BI/BO检查 1. 被检者舒适地坐在综合验光仪后，置入其远用屈光不正矫正度数，近用瞳距。 2. 视标采用近用视标卡上的竖排小字母视标，距离40cm。 3. 调整两侧旋转棱镜得到BI和BO的三棱镜。 4. 被检者睁开眼睛注视近处竖排的单个视标，并报告模糊点和破裂点。 5. 先进行BI检查记录模糊点、破裂点、恢复点。 6. 同法进行BO检查。 7. 记录结果:分别记录近距离BI和BO的模糊点/破裂点/恢复点数值。 8. 近距离水平聚散范围期望值: 模糊点 破裂点 恢复点 BI 13?4 21?4 13?5 BO 7?5 21?6 11?7 九、NPC检查 集合近点是测量从近点到两眼旋转中心连线的中点的距离。集合近点的检查结果在临床上可以作为诊断被检者是否存在集合功能异常的重要因素。 1. 被检者戴上屈光不正矫正眼镜，舒适地坐在座椅上，房间照明良好。 2. 将瞳距零位与被检者眼外眦部对齐。 3. 将一小的调节视标(通常使用近用视标0.8行大小的视标)置于被检者两眼正前方40cm处。 4. 将视标以3,5cm/s的速度逐渐移近被检者，告诉被检者努力注视视标，并报告何时视标变成两个，即何时发生复视。记录此时视标至两眼旋转中心连线 的中点的距离即为集合近点距离(破裂点值)。 5. 再将视标逐渐移远，问被检者何时视标又恢复成一个。记录此时视标至两眼回旋点连线中点的距离，即为恢复点值。 6. 记录结果:集合近点通常记录破裂点/恢复点值，如8cm/12cm。 集合近点的期望值:6,10cm。一些人认为集合近点如果小于5cm，说明被检者可能存在集合过度。 十 、 Worth-4-dots检查:检查是否存在单眼抑制、复视、双眼视功能。 1. 被检者舒适地坐在综合验光仪后，将室内光线调暗，验光仪中置入其远用屈光不正矫正度数和远用瞳距。双眼放开，用红绿滤片(综合验光仪辅助片右RL左GL)分离双眼视觉，右眼戴红色滤光片，左眼戴绿色滤光片。 2. 出示Worth-4-dots视标，此时被检者右眼看到2个红色视标，左眼看到3个绿色视标。令其双眼注视视标，说出看见几个视标和它们的颜色。 3. 看到3个绿灯——右眼被抑制; 看到2个红灯——左眼被抑制; rational concept to allow network more in line with the objective laws of the future development of the city. 1.5.2 planning research areas: throughout the city, with an area of 13,000 km2, cover 2 districts and 8 counties of the city, including downtown and city levels. Planning range: main for City Center City, area for 1268km2, North to cases field Xiang, and Jin Pingzhen, and Gao Dian Zhen, and huangshazhen, and Liu home town North Township territories, East Nan XI Zhen, and Jiangnan East Township territories, South to horse home, and song home, and Li Zhuang Zhen, and South wide town, and Zhao field Street do South administrative border, West to baixizhen, and dish dam town, and thought slope Xiang West Township territories. 1.6 planning target 1.6.1 General target this items research to will Yibin city built Yangtze River upstream chuan Yunnan Guizhou combined Department Regional Center City, support city space of ordered expand for target, reference Yibin city integrated traffic planning (2014-2030 years) and the Yibin City City general planning (2013-2030 years) of research results, using science, and advanced of network research method, building more level, and more mode of track traffic system, Meet at different levels of the city's rail transportation needs and quality requirements. 1.6.2 target 1, refined urban development axis of urban development concepts, judgments, rail-guided downtown from solo to group-development of the network, from one Center to center city with axial development. 2, network planning adapted to Yibin City status and future development needs, demonstrates rational scale of rail transport to meet the needs 看到5个灯，2红3绿——复视; 看到4个灯，1红2绿1混合——正常。 十一、 立体视检查:检查是否存在立体视。 1. 被检者舒适地坐在综合验光仪后，将室内光线调暗，验光仪中置入其远用屈光不正矫正度数和远用瞳距。双眼放开，用偏振滤片(综合验光仪辅助片P)分离双眼视觉，出示立体视视标。 2. 令被检者双眼注视视标，判断其是否有远近感。 十二、聚散灵敏度 ΔΔ聚散灵感度的测量通常是采用12BO和3BI反转棱镜进行检查，一侧为12ΔΔBO，另一侧为3BI，测量每一分钟的循环次数，其单位为cpm。 1. 被检者戴上屈光不正全矫眼镜，舒适地坐在座椅上，照明良好。 2. 视标采用近用视力表中的竖排小字母视标，让被检者双手持近用视标置于眼前40?处。 ΔΔ3. 验光师将12BO和3BI反转棱镜的一侧棱镜置于被检者双眼前，嘱被检者注视40?处的竖排小字母视标，并报告视标变化一列清晰的竖排标时，验光师立即将反转棱镜的另一侧棱镜反转至被检者眼前，待被检者再次报告视标变成一列清晰的竖排视标时再立即反转棱镜。记录一分钟被检者把视标看成一列清晰ΔΔ的竖排视标的循环次数(完成12BO和3BI为一次循环)。 4. 记录结果:近距离聚散灵敏度:6次/分钟。近距离聚散灵敏度的期望值:13次/分钟 rational concept to allow network more in line with the objective laws of the future development of the city. 1.5.2 planning research areas: throughout the city, with an area of 13,000 km2, cover 2 districts and 8 counties of the city, including downtown and city levels. Planning range: main for City Center City, area for 1268km2, North to cases field Xiang, and Jin Pingzhen, and Gao Dian Zhen, and huangshazhen, and Liu home town North Township territories, East Nan XI Zhen, and Jiangnan East Township territories, South to horse home, and song home, and Li Zhuang Zhen, and South wide town, and Zhao field Street do South administrative border, West to baixizhen, and dish dam town, and thought slope Xiang West Township territories. 1.6 planning target 1.6.1 General target this items research to will Yibin city built Yangtze River upstream chuan Yunnan Guizhou combined Department Regional Center City, support city space of ordered expand for target, reference Yibin city integrated traffic planning (2014-2030 years) and the Yibin City City general planning (2013-2030 years) of research results, using science, and advanced of network research method, building more level, and more mode of track traffic system, Meet at different levels of the city's rail transportation needs and quality requirements. 1.6.2 target 1, refined urban development axis of urban development concepts, judgments, rail-guided downtown from solo to group-development of the network, from one Center to center city with axial development. 2, network planning adapted to Yibin City status and future development needs, demonstrates rational scale of rail transport to meet the needs