Journal of Korean Ophthalmic Optics Society (한국안광학회지)

The Korean Ophthalmic Optics Society (한국안광학회)
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The Study of Distance and Near AC/A Ratio by Stimulus

조절자극 방식에 따른 원거리와 근거리 AC/A비에 관한 연구

  • Jo, Tae-Sik (Department of Optometry, Chodang University) ;
  • Kim, In-Suk (Department of Optometry, Chodang University) ;
  • Jang, Jung-Un (Department of Optometry, Chodang University)
  • Received : 2011.10.26
  • Accepted : 2011.12.17
  • Published : 2011.12.31
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Abstract

Purpose: This study was to investigate that near gradient AC/A ratio could be used to prescribe a patient with distance exophoria, we compared the difference between distance gradient AC/A ratio and near gradient AC/A ratio. Also, this thesis was to understand the relationship between calculated AC/A ratio and gradient AC/A ratio. Methods: Objective and subjective refractive error were corrected and we used Howell (3 m) chart for distance phoria tests and Howell-Kim (40 cm) chart for near phoria tests. The near gradient AC/A ratio and calculated AC/A ratio were used by Howell-Kim (40 cm) combined with +1.00 D, -1.00 D, +2.00 D and -2.00 D. Results: The average value of distance exophoria was 1.17${\pm}$1.17 $\Delta$, and the average value of near exophoria was 3.71${\pm}$2.80 $\Delta$ (t-test. p<0.001). The correlation of distance phoria with near phoria was little higher (r = 0.59, p < 0.001). Gradient AC/A ratios depending on measuring distance and stimulus were higher (r = 0.11~0.53. P < 0.001), when distance was shorter and stimulus to accommodation was more. Also, stimulus to accommodation by plus lens was higher than stimulus to accommodation by minus lens (paired t-test. p < 0.001). There was negative correlation between calculated AC/A ratio and gradient AC/A ratio. As the calculated AC/A ratio was higher, gradient AC/A ratio was lesser. Near gradient AC/A ratio was slightly higher than distance gradient AC/A ratio. Distance and near gradient AC/A ratio taken through the subjective -1.00 D were 1.30 $\Delta$/D and 1.68 $\Delta$/D(t-test. t=1.67, p < 0.001). Conclusions: There is negative correlation between calculated AC/A ratio and gradient AC/A ratio. Also, there is subtle difference between near gradient AC/A ratio and distance gradient AC/A ratio. Therefore, we need to measure distance gradient AC/A ratio when a practitioner prescribe glasses for a patient with distance exophoria.

목적: 본 연구는 근거리 경사 AC/A 비가 원거리 외사위 교정에 적용될 수 있는지를 알아 보기 위하여 원거리 및 근거리 경사 AC/A 비의 차이를 비교하고 또한 계산 AC/A 비와 경사 AC/A 비의 관계에 대하여 연구 하였다. 방법: 타각적 및 자각적 굴절검사에 의한 완전교정 후 원거리 경사 AC/A 비 검사는 -1.00 D를 가입한 후 Howell 시표(3 m용)를 사용하였으며, 근거리 경사 AC/A 비 검사는 +1.00 D, -1.00 D, +2.00 D와 -2.00 D를 각각 가입한 후 Howell-Kim(40 cm 용) 시표를 사용하여 사위검사와 계산 AC/A 비를 측정하였다. 결과: 원거리 사위는 평균 외사위 1.17${\pm}$1.17 $\Delta$, 근거리 평균 외사위 3.71${\pm}$2.80 $\Delta$으로 나타나(t-test. p < 0.001), 원근거리 사위의 상관관계(r = 0.59, p < 0.001)는 비교적 높게 나타났다. 경사 AC/A 비는 측정거리와 조절자극에 따라 다양하였고(r = 0.11~0.53. p < 0.001) 측정거리가 가까울수록 조절자극이 클수록 높았다. 또한 플러스 굴절력보다 마이너스 굴절력에 의한 조절자극이 높게 나타났다(t-test. p<0.001). 또한 계산 AC/A 비가 클수록 경사 AC/A 비는 오히려 낮아지는 음의 상관관계를 보였다. 원거리와 근거리에서 -1.00 D 부가한 경사 AC/A 비는 원거리가 1.30 $\Delta$/D 근거리가 1.68 $\Delta$/D로 근거리 AC/A 비가 유의적인 수준에서 약간 크게 나타났다(t-test. t=1.67, p<0.001). 결론: 본 연구를 통하여 계산 AC/A 비와 경사 AC/A 비의 음의 상관관계를 알 수 있었고, 근거리 경사 AC/A 비가 원거리 경사 AC/A 비보다 작지만 유의적 수준의 차이를 보여 원거리 외사위의 교정은 원거리 경사 AC/A비를 반드시 측정할 필요성이 있음을 알 수 있었다.

Keywords

References

  1. Fry G. A., "Fuether experiments on the accommodation convergence relationship", Am. J. Optom., 16:125-129(1939).
  2. Fry G. A. and Haines H. F., "Tait's analysis of the accommodative-convergence relationship", Am. J. Optom., 17:393-397(1940). https://doi.org/10.1097/00006324-194009000-00001
  3. Theodore Grosvenor, "Primary Care Optometry", 4th ed., Butterworth-Heinemann, pp.103(2002).
  4. John A. Pratt-Johnson, and Tillson G., "Management of strabismus and amblyopia: A practical guide", lst ed., Thieme medical publishers, New York, pp.258-262(1994).
  5. Von Noorden G. K., "The near vision complex: In Von Noorden G. K.: Binocular vision and Ocular motility: Theory and management of strabismus", 5th ed., St. louis, C. V. Mosby, pp.85-99(1996).
  6. Julio Prieto-Diaz and Carlos R. Souza-Dias, "Strabismus", 4th ed., Butterworth-Heinemann, pp.63-148(2000).
  7. Martens T., and Ogle K., "Observation on accommodative convergence", Am. J. Ophthalmol., 47:455-459(1959). https://doi.org/10.1016/S0002-9394(14)78051-1
  8. Wright K. W., "Motor aspect of strabismus. In: Wright K. W., Textbook of ophthalmology", lst ed., Baltimore: Williams & Wilkins, pp.233-253(1997).
  9. Ciuffreda K. J., Rosenfield M., and Chen H. W., "The AC/A ratio, age and presbyopia", Ophthalmic Physiological Opt., 17(4):307-315(1997). https://doi.org/10.1111/j.1475-1313.1997.tb00062.x
  10. Alpern M., Kincaid W. M., and Lubeck M. J., "Vergence and accommodation. III. Proposed definitions of AC/A ratios", Am. J. Ophthalmol., 48(1, Part2):141-148(1959). https://doi.org/10.1016/0002-9394(59)90252-1
  11. Jaedo Kim, Jack Alexander, and Hellen Swarbrick, "Accommodative response difference between binocular and monocular viewing for difference refractive error types", Invest Opthalmol. Vis. Sci., 42(4):2114(2001).
  12. William J. Benjamin, "Borish's Clinical Refraction", W. B. Saunders, pp.758(1998).
  13. Elliott D. B., "Clinical procedures in primary eye care", 2nd ed., Butterworth-Heinemann, London, pp.123-125(2003).
  14. Hung G. K., Ciuffreda K. J., and Rosenfield M., "Proximal contribution to a linear static model of accommodation and vergence", Ophthalmic Physiological Opt., 16(1):31-41(1996). https://doi.org/10.1016/0275-5408(95)00110-7
  15. Scheiman M., and Wick B., "Clinical management of binocular vision", 2nd ed., Lippincott Williams & Wilkins, Philadelphia, pp.4-616(2002).
  16. Wong E. P., Fricke T. R., and Dinardo C., "Interexaminer repeatability of new, modified prentice card compared with established phoria tests", Optom. vis. Sci., 79(6):370-375(2002). https://doi.org/10.1097/00006324-200206000-00010
  17. 김재도, "안경사를 위한 임상검안과 안기능이상 처방", 3판, 신광출판사, pp.176-260(2010).
  18. Morgan M., "The clinical aspects of accommodation and convergence", Am. J. Optom., 21:301-313(1944). https://doi.org/10.1097/00006324-194408000-00001
  19. 한경애, 성아영, "Gradient AC/A비와 Calculated AC/A비의 비교에 의한 근접성 폭주비(PC/A)에 관한 연구", 한국안광학회지, 9(2):223-231(2004).
  20. Scheiman M. and Wick B., "Diagnostic testing. In: Clinical management of binocular vision", 2nd ed., Lippincott Williams & Wilkins, pp.3-52(2002).
  21. Wick B., "Horizontal deviation. In: diagnosis and management in vision care", Amos. J. ed., Butterworth-Heinemann, Boston, pp.461-510(1987).
  22. Sheedy J. E., "Vision problems at video display terminals: a survey of optometrists", J. Am. Optom. Assoc., 63(10):687-692(1992).
  23. Grisham J. D., "Visual therapy results for convergence insufficiency: a literature review", Am. J. Optom. Physiol. Opt., 65(6):448-454(1988). https://doi.org/10.1097/00006324-198806000-00004