摘要
目的分析低视力门诊中视力残疾患者的病因,评估助视器的使用效果和弃用原因以及助视器在改善视力、提升生活质量方面的有效性。设计前瞻性队列研究。研究对象2025年1-5月在北京同仁医院就诊的150例视力残疾患者,其中女性81例。方法视力残疾患者验配远用助视器和近用助视器。在助视器验配前和配戴助视器1个月后,应用低视力视力表、中文版低视力患者生活质量量表(Chinese-version low vision quality of life questionnaire,CLVQOL)对患者的视力、生活质量方面进行评估比较,并对助视器的使用效果及弃用原因等进行评估。主要指标视力残疾的病因、最佳矫正视力(best corrected visual acuity,BCVA)、脱盲率(BCVA≥0.05的眼数/盲眼总数×100%)、脱残率(BCVA≥0.3的眼数/低视力眼总数×100%)、助视器的有效率(能改善视功能且能满意或基本完成视觉工作的助视器例数/助视器总数)、弃用原因、CLVQOL分数。结果视力残疾患者(年龄8~76岁)的前三位病因依次为黄斑病变(34.0%)、视神经病变(24.67%)、视网膜色素变性(14%)。配戴远用光学助视器后,视力残疾患者的最佳矫正视力由1.3±0.4提高至0.8±0.3(t=43.65,P<0.001),脱盲率、脱残率分别为82.22%、38.10%。近用光学助视器和电子助视器的有效率分别为71.3%、100%(χ^(2)=14.95,P=0.01),电子助视器的有效率高于10 D、12 D、16 D树脂眼镜(χ^(2)=7.78、8.82、10.16,P=0.02、0.006、0.002)。远用光学助视器、近用光学助视器的弃用率分别为9.85%、15.65%。视力改善不明显、工作距离近、不能行走时配戴为助视器弃用的主要原因,差异有统计学意义(χ^(2)=8.60,P=0.006)。助视器的弃用与病因有关,而与性别和文化程度无关。在150例患者中,132例完成了助视器验配前后的CLVQOL量表分析。助视器验配后,CLVQOL总分由74.94±10.41提高至88.5±13.86(t=37.36,P<0.001),其中光感、远视力和移动、调节能力、阅读和精细工作、日常生活能力分数均较验配前明显提升(P均<0.001)。不同性别、文化程度与CLVQOL分数之间无显著相关性(P=0.06,0.38)。结论眼底疾病和视神经病变为低视力门诊中常见的视力残疾的主要病因。个性化验配和合理使用助视器可以提高助视器的有效率、减少弃用率,并提高视力残疾患者的生活质量。
Objective To investigate the causes of visual disability patients in low vision clinic,and evaluate the usage effectiveness and reasons for discontinuation of low vision aids and the effectiveness in improving visual acuity and quality of life.Design Prospective cohort study.Participants The study was conducted on 150 patients with visual disability recruited from Beijing Tongren Hospital during the period of January 2025 to May 2025,including 81 females.Methods Far and near low vision aids were prescribed for visual disability patients.The low vision acuity chart and the Chinese-version low vision quality of life questionnaire(CLVQOL)were applied to evaluate and compare the improvement of visual acuity and quality of life in visual disability patients before and one month after fitting low vision aids.The effectiveness and the reasons for abandonment of low vision aids were also evaluated.Main Outcome Measures Etiology of visual disability,best-corrected visual acuity(BCVA),the rate of visual acuity relieved from blindness(number of eyes with BCVA≥0.05/total number of blind eyes×100%),the rate of visual acuity relieved from visual disability(number of eyes with BCVA≥0.3/total number of eyes with low vision×100%),effectiveness rate of visual aids(number of visual aids that improved visual function and can satisfactory or basically complete visual tasks/tatal number of visual aids),reasons for discontinuation,CLVQOL scores.Results The main causes of visual disability patients(aged 8~76 years)were macular degeneration(34.0%),optic neuropathy(24.67%),retinal pigment degeneration(14%),respectively.After fitting distance optical low vision aids,BCVA of visually disability patients improved from 1.3±0.4 to 0.8±0.3(t=43.65,P<0.001).The rate of visual acuity relieved from blindness and from visual disability were 82.22%and 38.10%,respectively.The efficacy rates of optical low vision aids and electronic vision enhancement devices were 71.3%、100%,respectively,with the differences being statistically significant(χ^(2)=14.95,P=0.01).Electronic vision enhancement devices demonstrated superior effectiveness compared to+10 D,+12 D,and+16 D optical magnifiers(χ^(2)=7.78,8.82,10.16;P=0.02,0.006,0.002).The discontinuation rates for far and near optical low vision aids were 9.85%and 15.65%,respectively.The main reasons for discontinuation of low vision aids were minimal visual improvement,close working distance,and poor usability while walking,with the differences being statistically significant(χ^(2)=8.60,P=0.006).The discontinuation of low vision aids were associated with the underlying etiology but independent of gender and educational attainment.Among 150 patients,132 patients completed the CLVQOL scale before and after low vision aids fitting.After fitting low vision aids,the overall score of CLVQOL has significantly improved compared to before fitting low vision aids,the quality of life scores increased from 74.94±10.41 to 88.5±13.86(t=37.36,P<0.001).The scores of the dimensions of light perception,distant vision and mobility,psychological adjustment,reading and fine work,and daily activities in CLVQOL scale have significantly improved compared to before fitting low vision aids,with a statistically significant difference(all P<0.001).There was no significant correlation between gender,educational level and CLVQOL scores(P=0.06,0.38).Conclusions Fundus diseases and optic neuropathy have become the main causes of visual disability in low vision clinic.The personalized fitting and proper utilization of low vision aids could enhance its effectiveness,reduce discontinuation rates,and improve the quality of life in visual disability patients.
作者
赵伟奇
孟恋汐
赵玉
韩林希
杨晓慧
Zhao Weiqi;Meng Lianxi;Zhao Yu;Han Linxi;Yang Xiaohui(Beijing Tongren Eye Center,Beijing Tongren Hospital,Capital Medical University,Beijing Key Laboratory of Ophthalmology and Visual Science,Beijing 100730,China)
出处
《眼科》
2025年第6期482-488,共7页
Ophthalmology in China
基金
北京研究型病房卓越计划项目(BRWEP2024W172050107)。
关键词
视力残疾
助视器
康复
弃用原因
低视力患者生活质量量表
Visual disability
Low vision aids
Rehabilitation
Reasons for discontinuation
Low vision quality of life questionnaire
