Sheard准则和Percival准则在评估双眼视症状中的运用（转）

摘　要　目的：运用Sheard准则和Percival准则对近阅读视疲劳等双眼视失平衡症状进行评估，从而探讨Sheard准则和Percival准则的显著性和特异性及其临床意义。方法：对53位大学生进行眼屈光检查，同时检测远近分离性隐斜，远近辐辏，正相对调节，负相对调节，辐辏近点，调节幅度等眼动参数并以问卷形式搜集个体的双眼视症状。计算AC/A参数，绘制每个个体的双眼单视清晰区并检测其对Sheard准则和Percival准则的符合性。结果：Sheard准则对双眼视症状的显著性为80%，特异性为59%，而Percival准则对双眼视症状的显著性为50%，特异性为77%。结论：Sheard准则和Percival准则为评价双眼水平位均衡的有效方法。Sheard准则有高度的显著性，特别对于外隐斜者；而percival准则有较高的特异性。
关键词　双眼视症状　Sheard准则　Percival准则

Sheard and Percival criteria in binocular vision

Xu Dan,Lu Fan,Qu Jia.The Eye hospital,Wenzhou Medical College,Wenzhou 325027

　　Abstract　Objective:This study uses Sheard and Percival criteria to evaluate binocular symptoms and analyze the significance and specificity of these criteria.Methods:Fifty-three college students were randomly selected.For each subject,manifest refraction,distance and near disassociated phoria,negative relative accommodation,positive relative accommodation,and near point convergence were measured.Binocular symptoms were ascertained for each subject through a questionnaire.We plotted the zone of clear single binocular vision (ZCSBV) for each subject and used the Sheard criterion and Percival criterion to predict asthenopic symptoms.Results:Sheard criterion had higher sensitivity (80%) than Percival criterion (59%) in predicting binocular symptoms,especially with exophoria.However,Percival criterion had higher specificity(77%) than Sheard criterion(50%).More subjects with severe binocular symptoms did not meet criterion than those who only had minor binocular vision symptoms.Conclusion:Sheard and Percival criteria are effective diagnostic aids or guides to predict ocular symptoms.Sheard criterion had a greater sensitivity than Percival criterion in predicting binocular symptoms,especially in exophoria but Percival criterion had higher specificity than Sheard criterion.


　　Key words　Binocular vision syndrome　Sheard's criterion　Percival criterion

　　在近距离工作中，调节和辐辏的相互协调作用是双眼清晰舒适视物的基础。近工作时，相当一部分个体表现出复视、头痛、视疲劳等症状，这些症状的出现都与调节和辐辏的失调有关。本研究的目的在于通过比较不同屈光度组的双眼视症状的差异，分析调节和辐辏失调在近阅读视疲劳中的作用，并运用Sheard法则和Percival法则对双眼水平位的均衡进行评估和诊治。

1　对象和方法
1.1　对象　随机取53位受试者，均为在校大学生，年龄18～20岁，均无眼部系统性疾病，测定其双眼的屈光状态。在受测试当时，有46位是近视，7位是正视组(+0.75～-0.25D)。在近视者中，按屈光度又可分为低度近视组(-0.50～-3.00D)，中度近视组(-3.25～-6.00D)，高度近视组(-6.25D～)。以上各组双眼屈光度差低于2.50D，而屈光参差组E的双眼屈光度之差高于或等于2.50D。
1.2　方法
1.2.1　对53位大学生进行眼屈光检查并检测远近分离性隐斜，远近辐辏，正相对调节，负相对调节，辐辏近点，调节幅度等眼动参数。
1.2.2　以问卷形式搜集个体的双眼视症状。
1.2.3　计算AC/A参数，绘制每个个体的双眼单视清晰区并检测其对Sheard准则和Percival准则的符合性。将符合Sheard准则或Percival准则的定义为符合规则，将既不符合Sheard准则又不符合Percival准则的定义为不符合规则。

2　结果


　　症状程度、不同屈光度和符合规则的关系见表1，表2，Sheard准则和Percival准则衡量双眼视症状的作用见表3，表4。

表1　症状程度和规则的符合性的关系