老------视

Presbyopia老视WuGuangboO.D.SchoolofOptometryandOphthalmologyatWenzhouMedicalCollege“老视（presbyopia)”presby(old)…opia(vision)老视•概述–定义–调节与年龄–症状与体征•验光–远矫正–近附加–试戴•矫正方式Presbyopia•Introduction–Definition–Accommodationandage–Symptomsandsigns•Refraction–Distancerefraction–Nearrefraction–Trialframe•Correction什么是老视?•老视(视觉科学词典的解释)---随着年龄增长，眼调节能力下降，以致在远用屈光矫正之外加正透镜才能看清近距离物体。Whatispresbyopia?•Presbyopia(bytheDictionaryofVisualScience)---Areductioninaccommodativeabilityoccurringnormallywithageandnecessitatingapluslensadditionforsatisfactoryseeingatnear.YoungemmetropiceyeDistancevisionNearvisionNearobjectDistanceobjectEmmetropiawithpresbyopiaDistancevisionNearvisionNearobjectDistanceobjectEmmetropiawithpresbyopiaaftercorrectionDistancevisionNearvisionNearobjectDistanceobjectaccommodation•Nearpiont–Thenearestpointthathecanseeclearlywithmaximumaccommodationthathecanafford.•Farpiont–Thefarestpointthathecanseewithhisaccommodationatrest.•AmplitudeofAccommodation–Thepowerdifferencebetweennearpoint(diopter)andfarpoint(diopter).FPANPA调节•近点：付出最大调节时所能看清的最近点•远点：调节完全放松时所能看清的最远点•调节幅度：远点与近点之间的差值（以屈光度为单位）FPANPAAmplitudeofAccommodationFPANPAThedifference,expressedindiopters,betweenthefarandnearpointsofaccommodationRangeofAccommodationThedifference,expressedindistanceunit,betweenthefarandnearpointsofaccommodation.Theunitisusuallymeterorcentimeter.FPANPAAmplitudeofAccommodationAmplitudeofAccommodation(D)Age(years)05101520020406080AmplitudeofAccommodation•MaximumAmplitude=25-0.4*(age)•AverageAmplitude=18.5-0.3*(age)•MinimumAmplitude=15-0.25*(age)调节幅度•最大调节幅度=25-0.4*(年龄)•平均调节幅度=18.5-0.3*(年龄)•最小调节幅度=15-0.25*(年龄)AmplitudeofAccommodationat40yearsold•MaximumAmplitude=25-0.4*(age)=25-0.4*40=9D•AverageAmplitude=18.5-0.3*(age)=18.5-0.3*40=6.5D•MinimumAmplitude=15-0.25*(age)=15-0.25*40=5DAmplitudeofAccommodationat50yearsold•MaximumAmplitude=25-0.4*(age)=25-0.4*50=5D•AverageAmplitude=18.5-0.3*(age)=18.5-0.3*50=3.5D•MinimumAmplitude=15-0.25*(age)=15-0.25*50=2.5DAmplitudeofAccommodationat60yearsold•MaximumAmplitude=25-0.4*(age)=25-0.4*60=1D•AverageAmplitude=18.5-0.3*(age)=18.5-0.3*60=0.5D•MinimumAmplitude=15-0.25*(age)=15-0.25*60=0DAgeandAmplitudeofAccommodation(Donder’stable)AgeAmplitudeofAccommodationAgeAmplitudeofAccommodation1011.00356.501510.25405.50209.50453.50258.50601.25307.50701.00Accommodationapparatus(afterWolff,1976)CiliarybodyCrystallineLensZonularfibersIrisAccommodationCiliarybodyZonularfiberslensRelaxedaccommodationUseaccommodation(afterKoretz&Handelman,1988)AccmmodationapparatusZonularfiberslensanteriorsurfacePosteriorsurfaceCiliaryprocessCiliarymusclePhoto:AGlasserPhoto:AGlasserAccommodation---OpticaltheoryrelaxaccommodatedFarobjectsNearobjectsSymptoms•Visionatthepatient'snormalnearpointbecomesblurred•Readingdifficulty•Movethereadingmaterialawayfromtheeye•Needstrongerilluminationforreading•Hasdifficultywithsustainreading症状•正常阅读距离下，字体模糊•阅读困难•移远阅读物•喜欢在光线亮的环境阅读•持续性的阅读困难症状•阅读时眼疲劳•流泪•头痛•与远视相似的其它症状Symptoms•Pullingoreyestrainwithreading•Complaintsoffatiguewithreading•Tearing•Headache•Suchsymptomsashyperopia•“…Myarmsaretooshort...”Presbyopia•“…can’treadmaps”Signs•ReducedVisualAcuityatnear•DecreasedAmplitudeofAccommodation•MorelaggingofAccmmodation体征•近视力下降•调节幅度下降•调节滞后量增加Relativefactoronpresbyopia•Refractivestatue•Refractiveerrorcorrection•Demandofnearassignment•Statureandarmlet•Geographicfactor•Medicine老视的相关因素•屈光状态•屈光矫正方式•近距离工作性质•身高和手臂长度•生活的地理位置•药物WhatCausesPresbyopia?•anage-relatedprocess•Presbyopiaisgenerallybelievedtostemfromagraduallossofflexibilityinthenaturallensinsideyoureye.Presbyopia•LensFactors–hardening–decreasedcapsuleelasticity–continuedgrowth(volume)–refractiveindexchange•CiliaryMuscleFactor–decreasedmuscletoneCauseby…HELMHOLTZtheoryHardeningofCrystallinelens01234020406080100Age(years)pressure(afterGlasser&Campbell,1998)continuegrowthoflens0.160.32020406080100Weightoflens(gram)0.300.240.200.280.260.220.18(afterGlasser&Campbell,1998)Age(years)MyopiawithpresbyopiaDistancevisionMyopiaaftercorrectionDistanceobjectDistanceobjectMyopiawithpresbyopiaMyopiaaftercorrectionnearobjectnearobjectPresbyopiaandhyperopiaquestion•老视是屈光不正•老视就是远视•老视与远视的矫正镜片都为正透镜•年龄越大，老花度数越大•近视眼，年纪大了，老花与近视抵消，不需要戴眼镜