Accommodation, acuity, and their relationship to emmetropization in infants.
Accommodation, acuity, and their relationship to emmetropization in infants.
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婴儿的适应性、敏锐度及其与正视化的关系。
DOI：
10.1097/opx.0b013e3181a6174f
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发表时间：
2009
期刊：
影响因子：
--
通讯作者：
Zadnik,Karla
中科院分区：
文献类型：
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作者：
Mutti,DonaldO;Mitchell,GLynn;Jones,LisaA;Friedman,NinaE;Frane,SaraL;Lin,WendyK;Moeschberger,MelvinL;Zadnik,Karla
目的：评价婴儿的调节、视力和正视化之间的关系。方法：对262名3、9和18个月的正常出生体重儿分别用Mohindra和动态检影进行远距和近距(57 Cm)的散焦检测。优视提供了相同年龄段的视力数据。结果：单变量线性回归分析表明，屈光不正的变化与离焦的距离或距离无关。屈光不正的变化与远(R2=0.17，p&t；0.0001)和近(R2=0.13，p&t；0.0001)的调节反应呈线性相关。与屈光不正线性效应预测的变化相比，正视化最差的十个受试者在远近远视离焦的平均水平较高(p<；0.043)。Logistic回归分析显示，随着3个月后远视程度的增加，18个月达到+2.00度或以下远视的几率降低，或者如果Mohindra检影近视合并视力好于1.25logMAR[受检者操作特征曲线下的面积=0.78(95%CI=0.68~0.88)]的中位数水平。结论：睫状肌麻痹屈光不正程度是预测18个月龄前正视化的最佳单一因素，视力和Mohindra检影对预测正视化的贡献较小。散焦和屈光不正变化之间缺乏相关性，这不支持响应远视散焦水平的正视化的简单模型。婴儿在3个月大时能够在一系列中度远视屈光不正的情况下保持准确的平均调节水平。屈光不正的变化和调节反应之间的联系表明调节是正视化的一个合理的视觉信号。
Purpose.To evaluate the relationship between accommodation, visual acuity, and emmetropization in human infancy.Methods.Defocus at distance and near (57 cm) was assessed using Mohindra and dynamic retinoscopy, respectively, in 262 normal birthweight infants at 3, 9, and 18 months of age. Preferential looking provided acuity data at the same ages. The spherical equivalent refractive error was measured by cycloplegic retinoscopy (cyclopentolate 1%).Results.Univariate linear regression analyses showed no associations between the change in refractive error and defocus at distance or near. Change in refractive error was linearly related to the accommodative response at distance (R 2= 0.17, p< 0.0001) and near (R 2= 0.13, p< 0.0001). The ten subjects with the poorest emmetropization relative to the change predicted by the linear effects of their refractive error had higher average levels of hyperopic defocus at distance and near (p< 0.043). Logistic regression showed a decrease in the odds of reaching+ 2.00 diopter or less hyperopia by 18 months with increasing levels of hyperopia at 3 months, or if Mohindra retinoscopy was myopic combined with acuity better than the median level of 1.25 logMAR [area under the receiver operating characteristic curve= 0.78 (95% CI= 0.68 to 0.88)].Conclusions.The level of cycloplegic refractive error was the best single factor for predicting emmetropization by 18 months of age, with smaller contributions from visual acuity and Mohindra retinoscopy. The lack of correlation between defocus and change in refractive error does not support a simple model of emmetropization in response to the level of hyperopic defocus. Infants were capable of maintaining accurate average levels of accommodation across a range of moderate hyperopic refractive errors at 3 months of age. The association between the change in refractive error and accommodative response suggests that accommodation is a plausible visual signal for emmetropization.