第一部分：使用开放视野远距离光学投射读写装置对青少年儿童调节反应和脉络膜的影响

目的：比较青少年儿童在使用开放视野远距离光学投射读写装置（optical homework projector, OHP）和常规近距离两种读写模式下调节反应和脉络膜的差异，并进一步探究OHP在近视防控领域的潜在作用。

方法：纳入2020年10月至2021年10月前往北京大学人民医院眼视光中心就诊的35例青少年儿童。本研究采用自身前后对照，分为调节和脉络膜两个部分。使用开放视野红外自动验光仪记录受试者在戴镜足矫并使用OHP、戴+0.50D欠矫眼镜并使用OHP，33cm处戴镜足矫、33cm处戴+0.50D欠矫眼镜四种状态下连续注视视标3分钟内的调节反应，比较四种情况下的调节误差和调节微波动，选取调节误差和调节微波动最小的方式进行脉络膜部分的研究。使用SD-OCT/OCTA分别在试验开始前、受试者完成任务1（调节误差和调节微波动最小的方式：戴+0.50D欠矫眼镜并使用OHP阅读30分钟），完成任务2（真实世界中阅读方式：近距离足矫阅读30分钟）之后进行全面的脉络膜评估，观察的指标包括黄斑中心凹下脉络膜厚度（SFChT）、脉络膜容积（CV）和脉络膜毛细血管血流空隙占比（FV%）。

结果：根据调节部分的测量结果，受试者在戴镜足矫并使用OHP时表现出调节超前(-0.81±0.27D, p<0.001)和最小的调节微波动(0.13±0.04, p<0.001)，所以选取此种方式进行脉络膜部分的研究。与基线值比较，在完成任务1后，中心凹下脉络膜厚度、脉络膜容积和脉络膜毛细血管血流空隙变化分别为12.90±4.71μm, 0.24±0.21 mm³和-0.14%±3.66%；在完成任务2后，相应指标的变化分别为-5.93±7.48μm, -0.14±0.22 mm³和 1.59%±2.92%，且这三组指标的变化量在两个任务之间有显著性差异（三种情况下P＜0.001）。     

结论：研究表明使用OHP对青少年儿童调节功能和脉络膜的积极影响。这些发现表明OHP或许具有减缓近视进展的潜在价值。

第二部分：青少年儿童近距离用眼习惯的临床研究

目的：基于观察到的青少年儿童在使用OHP和近距离阅读时调节和脉络膜部分不同的变化，探索两种用眼习惯下产生普遍性个体差异的真实世界客观原因。

方法：选取2020年10月至2021年10月前往北京大学人民医院眼视光中心就诊的596名7-15岁青少年儿童。在所有患者完成睫状肌麻痹验光和复验后发放问卷。采用自行设计的《青少年儿童眼健康情况及近距离读写情况调查问卷》，以电子问卷和纸质问卷两种形式发放并收集数据。问卷包括青少年儿童基本信息、眼部屈光状态、近距离读写习惯、家庭光环境情况四个方面的20项问题。收集的数据经过规格化和数量化处理后用SPSS 25.0进行相关性分析，P<0.05为差异有统计学意义。

结果：将睫状肌麻痹验光后屈光度高于-0.50D的情况定义为近视，调查结果显示高达69.92%的青少年儿童患有近视。一年级至六年级儿童的近视患病率分别为：69.85%，57.89%，66.80%，70.06%，76.07%，75.51%。阅读距离＜20cm，具有不良读写姿势的占比分别为23.83%和78.19%。儿童在读写时只开吊灯、只开台灯、吊灯和台灯都开的家庭比例分别为47.48%、6.04%和46.48%。此外，81.82%的青少年儿童在近距离读写中感受到了不同程度的视疲劳。双眼屈光度差异与照明方式、阅读姿势、阅读距离和视疲劳之间存在相关性（r=-0.277，P=0.021；r=0.345，P＜0.001；r=-0.11，P=0.005；r=0.16，P＜0.001）。

结论：青少年儿童在近距离读写过程中普遍存在读写习惯不良、阅读距离较近以及照明环境较暗的问题。使用OHP可以有效解决上述问题，因此从宏观客观角度上可以支持使用OHP阅读与常规近距离阅读之后的差异性反应。

 

Part 1: Influence of a Novel Optical Homework Projector (OHP) on Accommodation and Choroidal Response in Young Children

Objective This study investigated whether the accommodation and choroidal changes obtained with a novel invented optical homework projector (OHP) in young children differed from those obtained under habitual near-work distances, and explored the potential role of OHP in myopia control.

Methods A total of 35 children aged 8–13 years admitted to the optometry Center of the Peking University People’s Hospital from October 2020 to October 2021 participated in this study. This study was a self-control design and composed of two parts, accommodative part and choroidal part. Sustained accommodative response (AR)  within 3 min while focusing on an accommodative visual target via the OHP with full-correction (PF), via the OHP with +0.50 D under-correction (PU), at 33 cm with full-correction (NF), and at 33 cm with +0.50 D under-correction (NU) were measured with an open-field infrared autorefractor, then accommodative error and microfluctuations under these four viewing conditions were compared, and the condition with the least accommodative lag and microfluctuations was chosen for further evaluation of choroidal changes. Participants also underwent a comprehensive choroidal assessment by spectral domain optical coherence tomography and optical coherence tomography angiography, including measurements of subfoveal choroidal thickness (SFChT), choroidal volume (CV) and choriocapillaris flow void percentage (FV%) at baseline, after task1 (the reading mode with the least accommodative error and the accommodative microfluctuations: reading via PU), and after task2 (reading in the real world: near-distance reading) for a sustained 30-min period.

Results PU was chosen as the intervention for reading in the second experimental session since participants showed accommodative leads (-0.81±0.27D, p＜0.001) and the least microfluctuations (0.13±0.04, p < 0.001) under this viewing condition. SFChT, CV and FV% increased by 12.90±4.71μm, 0.24±0.21mm³ and -0.14%±3.66% after task 1, respectively, and -5.93±7.48μm, -0.14±0.22mm³ and 1.59%±2.92% after task 2, respectively. All parameters showed significant differences between the two tasks (p < 0.001 for all).

Conclusions This study highlights the positive influence of the OHP on accommodation and choroid in children’s eyes. These findings suggest that the OHP may have the potential to slow myopia progression in the future.

 

Part 2: A clinical study on near-work viewing habits of young children

Objective To explore the propriate reasons for the opposite changes observed when viewing via the OHP and when viewing under near-work distances on accommodation and choroidal response in Children from the perspective of real environment.

Methods A total of 596 children aged 7–15 years admitted to the optometry Center of the Peking University People’s Hospital from October 2020 to October 2021 were recruited in this study. All participants were given questionnaire after assessments of refraction both at the pupil was dilated and then returned to the normal size. Self-designed questionnaire on ocular health and near-distances reading and writing habits of children was issued in paper or electronic forms. The questionnaire included 20 questions on four aspects: basic information of children, refractive state of eyes, near-work reading and writing habits, and family light environment. The collected data was used for correlation analysis after being normalized and quantified, and statistical significance was set at P<0.05.

Results If we defined the refractive error ≤-0.50D after cycloplegic refraction as myopia, then the percentage of myopic children was up to 69.92% according to our results, with the prevalence of myopia in children from grade one to six was 69.85%, 57.89%, 66.80%, 70.06%, 76.07%, 75.51%, respectively. The children with near distances less than 20 cm and those had poor posture when read and write accounted for 23.83% and 78.19% respectively. The proportion of families with only chandelier, only table lamp, both chandelier and table lamp on when children read and write were 47.48%, 6.04% and 46.48% respectively. In addition, 81.82% children reported different degrees of eye fatigue during near-distances reading and writing. The interocular differences in refractive error was correlated with lighting, reading posture, reading distance and eye fatigue (r=-0.277，P=0.021；r=0.345，P＜0.001；r=-0.11，P=0.005；r=0.16，P＜0.001).

Conclusions Poor reading and writing habits, short reading distances and poor illumination are common risk factors for myopia when children do near-distances reading and writing. The use of OHP eliminates these risk factors induced by near work. Thus, it can be used to explain the different changes of accommodative and choroidal response observed when children use the OHP and when they do near-distances viewing.

 

第一章 文献综述 1
1.1 问题的提出 1
1.2 国内外研究现状 2
1.2.1高强度的近距离工作时带来的相关问题 2
1.2.2 当前控制近视进展的主要理论和相关手段 6
1.2.3目前用于评估近视控制效果的方法 11
1.2.4 小结 13
1.3 论文的主要内容 14
第二章 使用开放视野远距离光学投射读写装置对青少年儿童调节反应和脉络膜的响 15
2.1研究内容 15
2.1.1 研究对象 15
2.1.2 研究方法 15
2.1.3 试验步骤 17
2.1.4 统计学方法 22
2.2结果 23
2.2.1 本研究受试者信息 23
2.2.2 调节部分结果 23
2.2.3 脉络膜部分结果 26
2.2.4 各项指标间的相关性分析 31
2.3讨论 31
2.3.1 使用OHP对人眼调节功能的影响 31
2.3.2 使用OHP对人眼脉络膜的影响 32
第三章 青少年儿童近距离用眼习惯的临床研究 35
3.1研究内容 35
3.1.1 研究对象 35
3.1.2 研究方法 35
3.1.3 统计学方法 36
3.2调查问卷结果 37
3.2.1 本研究受试者基本信息 37
3.2.2 青少年儿童近距离阅读习惯分析 37
3.2.3 青少年儿童不良读写习惯与双眼屈光度差异的相关性分析 39
3.3 讨论 39
第四章 研究存在的问题 42
4.1第一部分 42
4.2 第二部分 42
第五章 结论和展望 43
5.1 结论 43
5.2 展望 43
参考文献 44
缩写释义 55
附录 56
开放视野远距离光学读写装置 56
致 谢 57
北京大学学位论文原创性声明和使用授权说明 59
个人简历、在学期间发表的学术论文与研究成果 60

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