Function, content and method of binocular visual function examination

Original title of

: function, content and method of binocular visual function examination

1. BCC examination of

regulation response, measurement method of regulation lag and regulation lead, and the normal value is + 0.25 ~ + 0.75D.

1. The integrated optometer is built into the subject’s far ametropia correction degree and near pupillary distance. Place the FCC sight mark at 40cm from the myopia pole, Turn the ± 0.50 of the two auxiliary lenses to the 90 º position (its negative dispersion axis is at 90 º) without additional lighting. Open the subject’s eyes and look at the FCC visual target at 40 cm.

2. The horizontal line reported by the examinee is clear, indicating that the examinee is adjustment lag. At the same time, the positive spherical mirror is added in front of both eyes until the horizontal and vertical lines are also clear. The added positive spherical mirror is its adjustment lag.

3. The vertical line reported by the examinee is clear, indicating that the examinee is adjusting the lead. At the same time, add a negative spherical mirror in front of both eyes until the horizontal and vertical lines are also clear. The added negative spherical mirror is its adjustment lead.

4. If the horizontal line and vertical line of the subject’s report are equally clear, it indicates that the subject’s regulatory response is zero.

2. NRA checks the negative relative regulation of

, that is, the ability of both eyes to reduce regulation when the collection remains relatively stable, and the normal value is + 2.25 ~ + 2.50d.

1. The examinee sat comfortably behind the comprehensive optometer, placed it in the far ametropia correction degree, near pupil distance and good lighting.

2. Let the examinee’s eyes focus on the top line of the best visual acuity on the 40 cm near vision chart at the same time.

3. Add a spherical mirror in front of both eyes at the same time until the subject reports that the visual mark begins to blur and returns to the previous film. Record the increased degree of positive spherical mirror, That is, its negative relative adjustment (NRA).

4. If the detection value is normal, it indicates that there is no adjustment participation, and the measured degree is the real degree; if the detection value is low, it indicates that there is adjustment participation, that is, pseudomyopia, which needs mydriasis treatment; if the detection value is high, it indicates that the negative mirror is overcorrected or the positive mirror is undercorrected.

3. PRA examination

Positive relative adjustment, that is, when the set remains relatively stable, the adjustment ability of both eyes can be increased, and the normal value is > -2.50d.

1. The examinee sat comfortably behind the comprehensive optometer, placed it in the far ametropia correction degree, near pupil distance and good lighting.

2. Let the examinee’s eyes focus on the top line of the best visual acuity on the 40 cm near vision chart at the same time.

3. Add negative spherical mirror in front of both eyes until the subject reports that the visual target continues to be blurred. Record the increased degree of negative spherical mirror, That is, positive relative adjustment (PRA).

4. If the measured value is lower than the degree of myopia growth measured by optometry, the subject can not accept new glasses through adjustment training;

5. The PRA is low and the exophoria is oblique, so glasses must be worn when looking close.

4. Adjustment flexibility check. The adjustment flexibility of

is ± 2.00d flip beat (flipper) check and measure the number of cycles per minute, in CPM. The adjustment flexibility represents the adjustment ability, speed and endurance. When NRA and pra cannot be checked or young children do not cooperate, it can quickly estimate whether the adjustment is normal, which part of adjustment and relaxation is wrong. The normal value is 12 CPM for one eye and 8 ~ 10 CPM for both eyes.

1. The subject wears ametropic corrective glasses, the right eye is open and the left eye is closed. Look at the 0.6 myopia mark examination card at 40cm.

2. The examiner places the positive lens of the ± 2.00d flip shot lens in front of the right eye of the subject, and instructs the subject to look at the letters of the myopia mark inspection card. When the subject reports that the visual mark becomes clear, the examiner immediately reverses the negative lens to the subject’s eyes, and then reverses the lens immediately when the subject reports that the visual mark becomes clear. Record the number of cycles for the subject to see the visual target in one minute (seeing + 2.00d and – 2.00d is a cycle).

3. The left eye adjustment flexibility is the same as the right eye, and then the binocular adjustment flexibility is checked.

4. The binocular adjustment flexibility is basically the same as the monocular adjustment flexibility, just open both eyes.

5. During the measurement of binocular adjustment flexibility, in order to avoid monocular suppression, polarizing lenses can be used during the examination. During measurement, the subject shall wear polarizing glasses. If he can only see two columns of visual markers, it indicates that the subject has monocular suppression, which shall be indicated in the record.

5. Adjustment amplitude check

by measuring the adjustment amplitude of the subject, and according to the formula of minimum adjustment amplitude 15-0.25 × Age or check the normal value table of adjustment amplitude (Donder) to evaluate whether the adjustment amplitude of the subject is abnormal.

(I) approach method

1. The subject wears ametropic corrective glasses, covers his left eye and illuminates normally.

2. The optometrist holds the proximity marker and places it 40cm in front of the examined eye, Ask the examinee to look at the line of sight mark on his best vision (usually 0.8 line of sight mark), and move close to the examinee with the sight mark at a speed of about 5cm / s until the examinee reports that the sight mark begins to appear continuous blur.

3. Measure the distance between the sight scale and the subject’s glasses plane with the sight scale, and the reciprocal of the distance is the adjustment amplitude of the subject’s right eye. In the same way, check the adjustment amplitude of the left eye and both eyes.

(II) negative lens method

1. The far ametropia correction degree of the subject is built in the comprehensive optometer, covering his left eye and normal lighting.

2. Place the near sight mark at 40cm from the myopia pole, so that the subject can look at the sight mark on the line with the best vision (usually 0.8 a line of sight mark). Gradually increase the negative spherical mirror of -0.25d in front of the subject until the subject reports that the sight mark is continuously blurred for the first time, and record the lens degree of the previous piece.

3. The total amount of negative spherical mirror increased plus 2.50d is the adjustment amplitude of the subject. The adjustment amplitude of the left eye and both eyes of the same legal examiner.

6. Far and near horizontal obliquity

at present, the commonly used examination methods of esotropia mainly include alternating covering method, Markov rod method and von Graefe. The latter two methods need to be carried out on the basis that the subject has both eyes at the same time.

(I) covering method: this method is a qualitative examination.

a) covering removing covering test: the examiner covers one eye with a covering plate and observes whether the covering eye rotates after removing the covering. If it rotates, it indicates that the patient has significant strabismus. If the covering eye moves from outside to inside after removing the covering, it indicates that the patient has exotropia. If it moves from inside to outside, it indicates that the patient has esotropia. If there is vertical movement, there is vertical strabismus. At the moment of removing the cover, the cover eye moves from top to bottom to the upper hidden angle of the eye. At the moment of removing the covering, the covering eye moves from bottom to top to the upper hidden oblique of the opposite eye. Remove the cover plate to allow the examiner enough time to establish binocular vision, cover the other eye, and observe again whether the covered eye rotates after removing the cover plate. If the covered eye returns to the normal position after removing the cover plate, and the uncovered eye shows strabismus, then the covered eye is the gaze eye. If the covered eye is still in the strabismus position after removing the cover, it indicates that the uncovered eye is the gaze eye.

B) alternating masking test: masking – de masking test to establish the gaze, and check from covering the strabismus. Quickly move the cover plate from the right eye to the left eye, and then return to the right eye to observe the movement of the eye with the cover removed. After several alternating covers, the observed eye movement is estimated by the degree of prism with the base towards the eye movement direction. Constantly adjust the degree of the prism until there is no eye movement when covering alternately.

(II) Mahalanobis bar method: this method must be carried out on the basis that the subject has both eyes looking at the same time.

1. The subject sits comfortably behind the comprehensive optometer, dims the indoor light, and places its far ametropia correction degree and far pupillary distance in the optometer. The auxiliary lens RMH of the right eye is adjusted to 90 º (i.e. there is a red horizontal Markov rod in the right eye hole), the left eye is open, and the rotating prism is zeroed, moved to the front of the left eye hole, and position 0 is placed in the vertical direction.

2. The subject looks at a point light source 5 meters away. At this time, the right eye sees a red vertical line, and the left eye sees a point light source.

3. The point light source seen by the subject is just on the red vertical line, indicating that the subject has no hidden inclination in the horizontal direction.

4. The subject sees the red vertical line on the right and the point light source on the left, that is, the image seen by the right eye is on the right and the image seen by the left eye is on the left, which is ipsilateral diplopia, indicating that the subject is implicit oblique. At this time, gradually increase the base outward prism in front of the non gazing eyes until the point just falls on the vertical line. The added prism is its implicit inclination.

5. The subject sees the red vertical line on the left and the point light source on the right, that is, the image seen by the right eye is on the left and the image seen by the left eye is on the right, which is cross diplopia, indicating that the subject is exophoric. At this time, gradually increase the base inward prism in front of the non gazing eyes until the point just falls on the vertical line. The added prism is its external hidden inclination.

6. Mahalanobis bar method was used to check close horizontal esotropia. When the Mahalanobis bar method is used to check the short-range horizontal esotropia, it is only necessary to adjust the far pupil distance to the near pupil distance, and move the point light source from 5m to 40cm. Other operation steps and result judgment are the same as above.

(III) von Graefe method: this method must be carried out on the basis that the subject has both eyes at the same time.

1. The visual mark adopts a single visual mark on the line above the subject’s best corrected monocular vision.

2. After the subject sits comfortably on the comprehensive optometer, place the subject’s far ametropia correction degree and far pupillary distance. Let the subject close his eyes gently, move the rotating prism to the front of the eye hole, and adjust the prism in front of the right eye to 6 Δ Bu, left eye prism set to 12 Δ BI。

3. The subject opened his eyes and asked him how many visual markers he saw. You should see two visual aids, One is in the lower right (seen by the right eye) and one is in the upper left (seen by the left eye).

4. Let the subject look at the visual mark in the lower right (seen by the right eye) and always keep the visual mark clear.

5. The optometrist informed the subject that he would gradually move the upper left visual mark to the right. When the upper left visual mark moved directly above the lower right visual mark, the subject was asked to report.

6. Optometrist at 2 per second Δ The speed reduces the prism of the left eye, Until the subject reports that the upper and lower visual indicators are vertically aligned (i.e. two visual indicators are on a vertical line). Record the bottom direction and degree of the front prism of the left eye at this time.

7. Continue to move the prism in the same direction until the subject sees that the visual target becomes one at the lower left and one at the upper right, and then move the prism in the opposite direction to align the upper and lower visual targets vertically again. Record the bottom direction and degree of the front prism of the left eye at this time.

8. The average value of the prism obtained in the above two steps is the hidden inclination of the subject. If the average value of the prism is the prism with the base facing inward, the subject is exophoric. If the average value is the prism with the base facing outward, the subject is implicit oblique. If the average value is a prism with the base upward, the subject is a downward hidden oblique. If the average value is the prism with the base facing down, the subject is upward hidden oblique. If the average value is 0, the subject has no horizontal esotropia.

9. Adjust the far pupil distance to the near pupil distance, move the test distance to 40cm of the myopia pole, and use the small square sight mark in the near sight mark. According to the above steps, close horizontal esotropia can be measured.

7、 AC / a check

(I) gradient AC / a value

Gradient AC / a value refers to the change in the collection amount of adjustability after the adjustment is changed by 1.00d by changing the lens. The usual method is to first check the horizontal deviation of the subject after wearing corrective glasses. On this basis, add + 1.00d to both eyes, check the horizontal deviation of the subject, and then add -1.00d to both eyes, check the horizontal deviation of the subject after wearing corrective glasses. The difference between the two times is divided by 2D, which is the AC / a value. When checking the gradient AC / a value, the von Graefe method is usually used to check the short-range horizontal inclination. The normal value is 3 ~ 5 Δ/ D。

1. After the examinee sits comfortably on the comprehensive optometer, the far ametropia correction degree of the examinee is preset, and the pupillary distance is adjusted to the near pupillary distance.

2. Use von Graefe’s method to check the close horizontal inclination of the subject at this time, And record the value (the implicit skew, i.e. Bo value, is recorded as + value, and the implicit skew, i.e. Bi value, is recorded as – value).

3. On the basis of the correction degree of far ametropia, after adding + 1.00d spherical mirror, check the horizontal deviation of the subject at this time and record the value. After adding -1.00d spherical mirror, check the horizontal deviation of the subject at this time and record the value. During the measurement, the subject shall always keep the visual mark clear.

4. The gradient AC / a value is obtained by dividing the two changes in step 3 by the increased adjustment amount 2D.

(II) calculated AC / a value

the calculated AC / a value is obtained by dividing the change of the total collection amount of the subject from near to far by the change of its adjustment amount.

1. After checking the horizontal deviation of the subject at long and near distances by Markov rod method or von Graefe method, calculate the AC / a value according to the formula: AC / a = PD + m (HN HF).

2. Where: PD is the distant pupil distance of the subject, in cm, and M is the gazing distance when measuring close-up cryptotropia, in M. Usually 40cm, i.e. 0.4m.

HN refers to the horizontal inclination at short distance (the implicit inclination is recorded as + value and the external inclination is recorded as – value) HF refers to the horizontal inclination at long distance (the implicit inclination is recorded as + value and the external inclination is recorded as – value)

8. Long and short distance Bi / Bo inspection

usually uses the rotating prism on the comprehensive optometer to measure the convergence and dispersion range. Use the base to face inward (BI) and the prism with the base facing outward (Bo) to measure the horizontal convergence and divergence force, and obtain the values of blur point, rupture point and recovery point.

(I) remote Bi / Bo examination

1. The subject sits comfortably behind the comprehensive refractometer, puts in the correction degree of far diopter error, and uses the distance of pupil.

2. The visual mark adopts a single visual mark on the line of the best corrected visual acuity of the tested eye.

3. Adjust the rotating prisms on both sides to obtain the prism of Bi and Bo.

4. The subject looked at a single visual target with both eyes and reported blurred points and rupture points.

5. Conduct Bi inspection first, and record fuzzy points, rupture points and recovery points.

6. Conduct Bo inspection and record with the same method.

7. Record results: record the fuzzy point / rupture point / recovery point values of remote Bi and Bo respectively.

8. Expected value of long-distance horizontal convergence and dispersion range:

fuzzy point, rupture point, recovery point

Bi No 7 ± 34 ± 2

Bo 9 ± 4 19 ± 8 10 ± 4

(II) close Bi / Bo examination of

1. After the subject sits comfortably on the comprehensive optometer, place it into the far ametropia correction degree and near pupillary distance.

2. The vertical small letters on the proximity label card shall be used as the visual label, with a distance of 40cm.

3. Adjust the rotating prisms on both sides to obtain the prism of Bi and Bo.

4. The subject opened his eyes, looked at a single visual target vertically arranged near him, and reported blur points and rupture points.

5. First conduct Bi inspection and record the fuzzy point, rupture point and recovery point.

6. Conduct Bo inspection with the same method.

7. Record results: record the fuzzy point / rupture point / recovery point values of close Bi and Bo respectively.

8. Expected value of short-range horizontal convergence and dispersion range:

fuzzy point, rupture point, recovery point

Bi 13 ± 4 21 ± 4 13 ± 5

Bo 7 ± 5 21 ± 6 11 ± 7

9. NPC inspection

collective near point is to measure the distance from the near point to the midpoint of the line between the rotation centers of the two eyes. The examination results of the collection near point can be used as an important factor to diagnose whether the subject has abnormal collection function in clinic.

1. The examinee wore ametropia correction glasses, sat comfortably on the seat, and the room was well illuminated.

2. Align the pupillary distance zero position with the subject’s outer canthus.

3. Place a small adjustable sight mark (usually a sight mark with the size of 0.8 lines of proximity sight mark) at 40cm in front of the subject’s eyes.

4. Gradually move the sight mark closer to the subject at the speed of 3 ~ 5cm / s, tell the subject to pay close attention to the sight mark, and report when the sight mark becomes two, that is, when diplopia occurs. Record the distance from the sight mark to the midpoint of the connecting line between the rotation centers of the two eyes at this time, which is the collective near point distance (rupture point value).

5. Move the sight mark farther and ask the subject when the sight mark will return to one. Record the distance from the sight mark to the midpoint of the connecting line between the rotation centers of the two eyes at this time, which is the recovery point value.

6. Record the results: usually record the rupture point / recovery point value at the collection near point, such as 8cm / 12cm. The expected value of the near point of

and

sets: 6 ~ 10cm. Some people believe that if the collection near point is less than 5cm, it indicates that the subject may have excessive collection.

10. Worth-4-dots examination

worth-4-dots examination: check whether there are monocular inhibition, diplopia and binocular vision functions.

1. After sitting comfortably on the comprehensive optometer, the subject darkened the indoor light, and placed its far ametropia correction degree and far pupillary distance in the optometer. Open your eyes, Separate binocular vision with red and green filter (right RL and left GL of comprehensive optometry auxiliary film). Wear red filter on the right eye and green filter on the left eye.

2. Show worth-4-dots visual mark. At this time, the subject sees two red visual marks on the right eye and three green visual marks on the left eye. Make his eyes look at the visual mark and say how many visual marks he sees and their colors.

3. See three green lights – the right eye is suppressed; See 2 red lights – the left eye is suppressed; See 5 lights, 2 red and 3 green – diplopia; See 4 lights, 1 red, 2 green and 1 mixed – normal.

11. Stereopsis examination

stereopsis examination: check whether there is stereopsis.

1. The examinee sat comfortably behind the comprehensive optometer, dimmed the indoor light, and placed his far-use ametropia in the optometerCorrection degree and distal pupillary distance. Release both eyes, separate binocular vision with polarizing filter (auxiliary sheet P of comprehensive Optometry) and show stereoscopic vision mark.

2. Make the subject look at the vision mark with both eyes to judge whether it has a sense of distance.

12. The measurement of convergence and dispersion sensitivity

is usually 12 Δ Bo and 3 Δ Bi reverse prism for inspection, 12 on one side Δ Bo, 3 on the other side Δ Bi, measure the number of cycles per minute, in CPM.

1. The examinee wears ametropic corrective glasses and sits comfortably on the seat with good lighting.

2. The visual mark shall be the vertical small letter visual mark in the proximity visual acuity chart, and the subject shall hold the proximity visual mark with both hands and place it at 40 cm in front of his eyes.

3. The optometrist will be 12 Δ Bo and 3 Δ Place the prism on one side of the Bi reverse prism in front of the subject’s eyes, ask the subject to look at the vertical small letter visual mark at 40cm, and report that the visual mark changes into a clear vertical mark, the optometrist will immediately reverse the prism on the other side of the reverse prism to the subject’s eyes, and then reverse the prism immediately when the subject reports that the visual mark changes into a clear vertical mark again. Record the number of cycles in which the examinee regards the visual markers as a clear vertical row of visual markers in one minute (12 completed) Δ Bo and 3 Δ Bi is one cycle).

4. Recording results: close range convergence and dispersion sensitivity: 6 times / min. Expected value of short-range convergence and dispersion sensitivity: 13 times / min.