单眼雾视与双眼同时雾视主观验光结果比较

Comparison of subjective refraction results between monocular fogging and binocular simultaneous fogging

摘要

目的 比较“单眼雾视”与“双眼同时雾视”主观验光结果的临床一致性，为验光实践中雾视方式的选择提供依据。方法 采用诊断性试验设计，于2023年11月纳入川北医学院62名志愿者(17~23岁)，随机分为两组。每位受试者均接受“单眼雾视”与“双眼同时雾视”两种主观验光，并于检查前完成右眼未雾视主观验光作为对照。比较不同雾视方法测得的球镜度、柱镜度及散光矢量J₀、J₄₅的差异，通过组内相关系数与Bland-Altman图评价一致性。结果 两种雾视方法测得的球镜度、柱镜度、J₀和J₄₅差异均无统计学意义(P>0.05)。与未雾视相比，两种雾视方法测得的球镜度均较低(P<0.01)。两种雾视方法测得球镜度、柱镜度的组内相关系数分别为0.99和0.95，一致性极好；J₀和J₄₅的组内相关系数分别为0.36和0.15，一致性较差。结论 “单眼雾视”与“双眼同时雾视”主观验光在球镜度和柱镜度方面具有良好的一致性和可互换性。考虑到检查效率，建议临床优先选用“双眼同时雾视”方法。

Abstract

Objective To compare the clinical agreement of subjective refraction results obtained with “monocular fogging” versus “binocular simultaneous fogging”, thereby providing evidence for selecting the fogging method in clinical practice. Methods In this diagnostic test study, 62 volunteers aged 17-23 years from North Sichuan Medical College were enrolled in November 2023 and randomly assigned to two groups. Each participant underwent both “monocular fogging” and “binocular simultaneous fogging” subjective refraction, with a baseline non-fogging subjective refraction performed on the right eye before testing as control. Differences in spherical power, cylindrical power, and astigmatic vector components J₀ and J₄₅ between the two fogging methods were compared. Agreement was assessed using the intraclass correlation coefficient (ICC) and Bland-Altman plots. Results No statistically significant differences were found in spherical power, cylindrical power, J₀, or J₄₅ between the two fogging methods (P>0.05). Compared with non-fogging refraction, both fogging methods yielded lower spherical powers (P<0.01). The ICCs for spherical power and cylindrical power between the two fogging methods were 0.99 and 0.95, indicating excellent agreement, while those for J₀ and J₄₅ were 0.36 and 0.15, indicating poor agreement. Conclusion “Monocular fogging” and “binocular simultaneous fogging” show excellent agreement and interchangeability for spherical and cylindrical power measurements in subjective refraction. Given the higher efficiency, “binocular simultaneous fogging” is recommended for clinical priority.

关键词

单眼雾视 / 双眼同时雾视 / 主观验光

Key words

Monocular fogging / Binocular simultaneous fogging / Subjective refraction

参考文献

[1] Camp AS , Shane TS , Kang JL , et al. Evaluating self-refraction and ready-made spectacles for treatment of uncorrected refractive error[J]. Ophthalmic Epidemiol, 2018, 25(5/6): 392-398. doi: 10.1080/09286586.2018.1500615

[2] Elliott DB . What is the appropriate gold standard test for refractive error?[J]. Ophthalmic Physiol Opt, 2017, 37(2): 115-117. doi: 10.1111/opo.12360

[3] Logan NS , Radhakrishnan H , Cruickshank FE , et al. IMI accommodation and binocular vision in myopia development and progression[J]. Invest Ophthalmol Vis Sci, 2021, 62(5): 4. doi: 10.1167/iovs.62.5.4

[4] Manna P , Karmakar S , Bhardwaj GK , et al. Accommodative spasm and its different treatment approaches: a systematic review[J]. Eur J Ophthalmol, 2023, 33(3): 1273-1286. doi: 10.1177/11206721221136438

[5] Lin Z , Vasudevan B , Ciuffreda KJ , et al. The difference between cycloplegic and non-cycloplegic autorefraction and its association with progression of refractive error in Beijing urban children[J]. Ophthalmic Physiol Opt, 2017, 37(4): 489-497. doi: 10.1111/opo.12381

[6] Turull-Mallofré A , García-Guerra CE , Mestre C , et al. Influence of power and the time of application of fogging lenses on accommodation[J]. Biomed Opt Express, 2023, 14(10): 5488-5498. doi: 10.1364/boe.486442

[7] 瞿佳 . 眼视光学理论和方法[M]. 3版 北京: 人民卫生出版社, 2018: 83

[8] 齐备 . 眼镜验光员-高级[M]. 北京: 中国劳动社会保障出版社, 2008: 96

[9] Thibos LN , Wheeler W , Horner D . Power vectors: an application of Fourier analysis to the description and statistical analysis of refractive error[J]. Optom Vis Sci, 1997, 74(6): 367-375. doi: 10.1002/j.1538-9235.1997.tb04707.x

[10] Koo TK , Li MY . A guideline of selecting and reporting intraclass correlation coefficients for reliability research [J]. J Chiropr Med, 2016, 15(2): 155-163. doi: 10.1016/j.jcm.2016.02.012

[11] Bland JM , Altman DG . Measuring agreement in method comparison studies[J]. Stat Methods Med Res, 1999, 8(2): 135-160. doi: 10.1191/096228099673819272

[12] Carracedo G , Carpena-Torres C , Pastrana C , et al. Accuracy and precision of automated subjective refraction in young hyperopes under cycloplegia [J]. J Optom, 2023, 16(4): 252-260. doi: 10.1016/j.optom.2023.03.001

[13] Liu XT , Ye L , Chen C , et al. Evaluation of the necessity for cycloplegia during refraction of Chinese children between 4 and 10 years old [J]. J Pediatr Ophthalmol Strabismus, 2020, 57(4): 257-263. doi: 10.3928/01913913-20200407-01

[14] Wilson S , Ctori I , Shah R , et al. Systematic review and meta-analysis on the agreement of non-cycloplegic and cycloplegic refraction in children[J]. Ophthalmic Physiol Opt, 2022, 42(6): 1276-1288. doi: 10.1111/opo.13022

[15] Guo XX , Shakarchi AF , Block SS , et al. Noncycloplegic compared with cycloplegic refraction in a Chicago school-aged population[J]. Ophthalmology, 2022, 129(7): 813-820. doi: 10.1016/j.ophtha.2022.02.027

[16] Lin JJ , Chen T , Lin ZQ , et al. Optical fogging is an effective method of reducing overestimation of myopia [J]. Photodiagnosis Photodyn Ther, 2025, 55: 104751. doi: 10.1016/j.pdpdt.2025.104751

[17] Sha J , Fedtke C , Tilia D , et al. Effect of cylinder power and axis changes on vision in astigmatic participants[J]. Clin Optom, 2019, 11: 27-38. doi: 10.2147/OPTO.S190120

基金资助

四川省科技厅研究项目(2023NSFSC0595)

国家级大学生创新训练项目(202310634024)

川北医学院青年项目(CBY22-QNA15)

川北医学院大学生创新训练项目(XJ202310634216)

国家级大学生创新训练项目(202410634011)