作者：吴敏，刘丽娟
作者单位：1.首都医科大学附属北京同仁医院 验光配镜中心，北京 100730;2.北京市眼科研究所，北京 100005
【摘要】 目的 探讨新镜配戴不适与旧镜参数的相关关系。方法 57例新镜配戴不适者，经重新客观验光与主觉验光检查，确定优势眼，确认新镜度数无误后，询问旧镜配戴时间并检测旧镜度数、瞳距、前倾角、镜眼距等参数，分析两者的相关关系。结果 ①57例配镜者中有13例旧镜前倾角过大(25.80°±5.93°)或过小(-0.25°±4.95°)，调整新镜前倾角后继续配戴。②18例旧镜镜眼距偏小(6.78±1.80)mm，调整新镜镜眼距后继续配戴。③5例旧镜光学中心水平偏差(6.60±1.82)mm，2例垂直偏差(4.50±0.71)mm，向患者解释后继续配戴新镜。④5例因新、旧眼镜柱镜度数相差(-0.56±0.18)DC，患者配戴新镜后眼酸胀感明显，将两者柱镜差值减少到(-0.15±0.21)DC后舒适度提高。⑤12例旧镜双眼矫正视力差别较大，新镜优势眼矫正视力与辅助眼相同或略佳，配戴新镜有酸胀感，重新更换眼镜使双眼视力差别介于旧镜与新镜之间，清晰眼同旧镜，患者眼疲劳缓解。⑥2例旧镜负度数偏高(红绿视标G>R)，新镜根据验光结果降低度数验配，矫正视力虽达到0.99±0.02，但患者感觉清晰度下降，增加负度数使矫正视力达1.03±0.03后，患者接受。结论 旧镜度数、瞳距、前倾角、镜眼距等是影响新配眼镜舒适度的重要因素。
【关键词】 度数;瞳距;前倾角;镜眼距
The effect of the parameters of old spectacles on new ones that cause discomfort in patients
WU Min*， LIU Lijuan.
* Beijing Tongren Optometry Center， Beijing Tongren Hospital， Capital Medical University， Beijing China， 100730
[Abstract] Objective To investigate the effect of the parameters of old spectacles on the new ones that cause discomfort in patients. Methods Fifty-seven patients who were uncomfortable with their new spectacles were involved in the study. Data was collected on the length of time that the old spectacles were worn. Objective optometry (retinoscopy) and subjective optometry tests were repeated. The dominant eye was determined. Prescriptions for the old spectacles were checked (the diopters of sphere and cylinder and its axis). Measurements were taken of the front inclination angle of the old spectacles， the spectacle frame distance and pupillary distance. Results Among the 57 cases：①The front inclination angles in 13 cases were either big (25.80°±5.93°) or small(-0.25°±4.95°). Patients continued to wear the new spectacles after the inclination angles were adjusted. ②The spectacle frame distance of the old spectacles in 18 cases was (6.78±1.80)mm. Patients continued to wear the new spectacles after the spectacle frame distance was adjusted. ③The optical center of the lens in the old spectacles was horizontally decentered (6.60±1.82)mm in 5 cases， and vertically decentered (4.50±0.71)mm in 2 cases. Patients continued to wear the new spectacles after an explanation was given. ④In 5 cases， there was a difference in the diopters of cylinder between the new spectacles and the old ones (-0.56±0.18)DC. The new spectacles were adjusted. The difference in the diopters of cylinder between the new spectacles and the old ones was (-0.15±0.21)DC. ⑤In 12 cases， the difference in the corrected visual acuities between both eyes of the old spectacles was bigger than with the new ones. The corrected visual acuity of the dominant eye was better than the fellow eye or similar. The new spectacles were adjusted. The difference in the corrected visual acuities between both eyes with the newest spectacles was smaller than with the old ones， but the better corrected eye was the same as with the old spectacles. ⑥In 2 cases， the diopters of the old spectacles were higher (red-green test：G>R). The corrected visual acuities of the new spectacles were 0.99±0.02， but the patients experienced blurred vision. The new spectacles were adjusted. The corrected visual acuities of the newest spectacles were 1.03±0.03. Conclusion The results of this study suggest that the old spectacle’s prescription (the diopters of sphere and cylinder and its axis)， the optical center of the lens， the front inclination angle， and the spectacle frame distance are important factors for ensuring a comfortable fit when wearing new spectacles.
[Key words] diopter; pupillary distance; the front inclination angle; eye wire distance
眼科验光门诊常可遇到患者配戴新镜后出现头痛、眼胀、视物变形、视力模糊等现象，然而其中部分患者在重新验光检查后，度数变化不大甚至相同，但新镜的舒适度和(或)清晰度不如旧镜。本研究对新、旧眼镜的度数、瞳距、前倾角、镜眼距等的差别进行分析，进而探讨旧镜参数对新镜配戴舒适度的影响。
1 对象和方法
1.1 研究对象 2008年1月至2008年9月在北京同仁医院验光配镜中心就诊的57例配戴新镜不适患者，其中男性32例，女性25例;年龄17~65岁;双眼最佳矫正视力≥1.0。除外斜视、弱视等眼部疾患及眼部外伤、手术史。
1.2 检查方法
1.2.1 眼疾检查 问诊结合眼位(遮盖试验)、裂隙灯与眼底镜检查，排除斜视、弱视等眼部疾患，排除全身疾病及外伤、手术史等。
1.2.2 测量新、旧眼镜参数 包括度数、瞳距、前倾角(半圆仪)、镜眼距(直尺)。
1.2.3 验光检查 ①40岁以下患者均采取散瞳验光(美多丽眼水，日本)，20 min/次，共2次，40 min后进行电脑验光(Topcon RM-8800电脑验光仪，日本)与检影验光。次日按照“最高度数正镜片最好视力”的原则行小瞳主觉验光，并检查矫正视力(Topcon综合验光仪，日本)。②40岁及以上患者采取电脑验光结合小瞳主觉验光，验光完毕试戴镜15 min，根据患者所述清晰度与舒适度微调度数，测量远瞳距，开具处方。
1.2.4 优势眼检查 采用卡洞法判断最佳矫正状态下的优势眼：将带有1.5 cm×2.0 cm小孔的卡片放在面前15 cm处，让患者双眼通过小孔注视3 m远处、直径为2.5 cm的视标，挡住被试者的左眼，若能仍看到视标，则优势眼为右眼，若看不到视标则优势眼为左眼[1]。
1.3 统计学方法 采用SPSS 13.0软件行平均值计算。
2 结果
2.1 57例配镜者中有13例配戴新镜时出现视物变形，男8例，女5例，平均年龄(31.1±11.2)岁，旧镜配戴时间为(4.3±2.1)年。其中6例新镜的球柱镜度数、轴位与旧镜相同，7例度数略有差别，患者配戴试镜架时清晰度、舒适度均可接受，配戴新镜后感地面变形明显，经测量发现旧镜前倾角过大[5例(25.80°±5.93°)]或过小[8例(-0.25°±4.95°)]。调整新镜前倾角使其接近旧镜后，视物变形和不适感减轻，嘱患者继续配戴新镜。
2.2 18例患者配戴新镜后对其清晰度不满意，男10例，女8例，平均年龄(32.8±9.4)岁，旧镜配戴时间(4.6±1.8)年。其中8例新镜球镜度数、柱镜度数、轴位与旧镜相同，但患者感觉清晰度不如旧镜;另外10例新镜球镜负度数比旧镜增加(-0.29±0.22)DS，但患者觉清晰度与旧镜相似。经测量旧镜发现其镜眼距偏小，平均为(6.78±1.80) mm。调整新镜镜眼距使其接近旧镜，患者感觉清晰度增加，接受新镜。
2.3 7例患者配戴新镜眼睛有胀痛感，男4例，女3例，平均年龄(41.0±12.2)岁，旧镜配戴时间(6.0±2.1)年。新配眼镜的光学中心水平偏差、光学中心水平互差、光学中心垂直互差等均符合国家标准，经测量旧镜光学中心偏位[水平偏差5例(6.60±1.82)mm，垂直互差2例(4.50±0.71)mm]。向患者解释说明，并嘱其继续配戴新镜，逐渐适应。
2.4 5例患者配戴新镜视力虽有提高但出现头痛、视物变形等不适，男2例，女3例，平均年龄(29.8±10.7)岁，旧镜配戴时间(4.0±1.6)年。其中9眼是复性近视散光或单纯近视，新镜与旧镜比较球镜度数无明显变化，散光轴位变化2.50°±4.25°，散光度数增加了(-0.56±0.18)DC，患者眼酸胀、不适，故减少散光度数至只比旧镜增加(-0.15±0.21)DC，球镜度数、散光轴位未改变，舒适感明显好转，接受重新更换的眼镜。
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