Clinical Study Of Virtual Occlusion Exercise In The Treatment Of Anisometropic Amblyopia And Ametropic Amblyopia

Background and Objective:Amblyopia is one of the most common ocular diseases which affecting the development of children's monocular or binocular visual acuity and binocular visual function.Early diagnosis and treatment of amblyopia is an important work in the prevention and treatment of children's ocular diseases in China.Aiming at the possible shortcomings of the traditional occlusion method in the treatment of amblyopia,brain vision exercise——virtual occlusion exercise was applied to treat the patients with anisometropic amblyopia and ametropic amblyopia,so as to explore the role and clinical value of virtual occlusion exercise in the treatment of anisometropic and ametropic amblyopia.Methods: Research subjects:185 patients with anisometropic amblyopia and ametropic amblyopia(collectively referred to as refractive-related amblyopia)were diagnosed in the ophthalmological clinic of Yantai Yuhuangding Hospital from June 2017 to February 2019.Patients with organic ocular lesions,who could not cooperate with conventional amblyopia treatment,those with preterm birth less than 8 months,those with other systemic diseases and growth retardation of children of the same age were excluded.There were 93 cases(122 eyes)in the experimental group,with an average age of 5.81 ±1.74 years,41 males and 52 females,the average diopter of amblyopia eyes was 5.54 ±2.03 D,and that of the control group was 92 cases(134 eyes),with an average age of 6.08 ±1.89 years.There were 45 males and 47 females,the average diopter of amblyopia eyes was 5.74 ±2.32 D,mild amblyopia was 70 eyes,moderate amblyopia was 59 eyes,severe amblyopia was 5 eyes.There were no significant differences in age,sex,amblyopia degree and amblyopia type between the two groups before treatment.Research methods:All the enrolled patients with conventional mydriatic optometry,determine the appropriate diopter,at least wearing glasses 1.5 months.All patients were randomly divided into experimental group and control group by random number method.The experimental group received virtual occlusion exercise twice a day for 20 minutes each time.At least 2 hours apart.During the exercise,polarized 3D glasses were used on the basis of wearing refractive glasses.Follow the on-screen instructions to complete the corresponding training mission,no extra occlusion treatment on the dominant eye.The patients in the control group were treated with traditional occlusion treatment,requiring the patients to wear appropriate refractive glasses.The traditional occlusion method were mainly cover the dominant eye three days and open one day in 3 years old patients,and 5:1 in 4-5 years old patients,6:1 in 6-8 years old patients,cover dominant eye all the time in patients over 8 years old.For children with binocular amblyopia,alternate occlusion method was adopted according to age and degree of amblyopia,and the occlusion treatment plan was adjusted at any time according to the results of reexamination.Aiming at the patients with fine dependence,according to their own situation to take flexible occlusion scheme,must ensure that every day in patients with mild to moderate amblyopia cover the dominant eye at least 2 hours strictly and at least 6 hours to cover the dominant eye in patients with severe amblyopia.The changes of visual acuity in amblyopia eye and binocular stereopsis were observed after treatment in the follow-up experimental group and the control group.Results:After 1-3 months,the average treatment time was 64.16±25.68 days.The visual acuity of the experimental group was improved from 0.55±0.18 to 0.75±0.19 after treatment.The difference of visual acuity has statistical significance.The visual acuity of the control group was improved from 0.53±0.21 to 0.71±0.21 after treatment.The difference of visual acuity has statistical significance.The total effective rate of virtual occlusion exercise was 70%,and that of traditional occlusion treatment was 64%,There was no significant difference in the total effective rate between the two groups(?2 = 1.154,P = 0.283 > 0.05).There was no significant difference in the clinical efficacy of amblyopia patients of different degrees before and after treatment between the two groups.The stereopsis acuity in the experimental group was better than before.The difference has statistical significance(?2 = 15.997,P = 0.001 < 0.05).The stereopsis acuity in the control group was better than that before.But there was no significant statistic difference(?2 = 4.195,P = 0.241 > 0.05).There was no significant difference in stereopsis between the experimental group and the control group before treatment(?2= 4.540,P = 0.209 > 0.05).There was significant difference after treatment(?2 = 10.848,P = 0.013 < 0.05).the visual acuity of the patients less than 7 years old in the experimental group was improved after treatment,the total effective rate was 72%,and the near stereopsis was improved,the difference was statistically significant(?2=3.753,P=0.003<0.05).The visual acuity of the patients less than 7 years old in the control group was improved after treatment.The total effective rate was 67%.The near stereopsis was no significant difference between before and after treatment(?2=3.780,P=0.286>0.05).The visual acuity of the patients older than 7 years old in the experimental group was improved after treatment,and the total effective rate was 60%.There was no significant difference in the level of near stereopsis between before and after treatment(?2=3.921,P=0.270>0.05).There was no significant difference in the total effective rate between the two groups.The visual acuity of the patients older than 7 years old in the control group was improved after treatment,and the total effective rate was 50%.There was no significant difference in the level of near stereopsis between before and after treatment(?2=2.540,P=0.468>0.05).There was no significant difference in the total effective rate between the two groups.Conclusion:Virtual occlusion exercise can improve the visual acuity of amblyopia eye in patients suffered from anisometropic amblyopia and ametropic amblyopia as some as traditional occlusion treatment;Virtual occlusion exercise has obvious effect on improving binocular stereopsis in patients with anisometropic amblyopia and ametropic amblyopia.The treatment time in Virtual occlusion exercise is shorter than traditional occlusion.