目的：分析视觉训练对儿童视功能异常伴视疲劳的临床疗效。

方法：回顾性病例研究。收集2022-01/2023-04在西安市儿童医院视光中心行视觉训练的视功能异常伴视疲劳患者57例114眼，年龄8.25±1.94岁。记录患者训练前后的屈光度、视疲劳量表问卷及视功能检查，视功能主要包括Worth 4点灯检查双眼视，Von-Graefe法测量远、近隐斜视，梯度法检查AC/A，移近法测量集合近点，负镜片法测量调节幅度，交叉柱镜测量调节反应，翻转拍测量调节灵活度。根据患者视功能及视疲劳情况制定训练方案。训练1 mo分别与训练前及训练3 mo比较。

结果：训练前，训练1 mo时31例患者视疲劳量表得分分别为26.00±6.77、19.57±8.90分(P<0.05)。训练前与训练1 mo时比较，近距离隐斜度数，集合近点，左、右眼调节幅度，NRA及PRA，左、右眼及双眼调节灵活度均显著改善(均P<0.05)，远距离隐斜度数及调节反应比较无差异(均P>0.05)。训练3 mo与训练1 mo左、右眼调节幅度，NRA、PRA及近隐斜视比较无差异(均P>0.05)。训练前及训练1 mo，低度近视患者30例(SE：-1.99±1.22 D)，低度远视患者3例(SE：+1.01±0.13 D)及正视患者24例(SE：+0.25±0.11 D)的视功能参数无差异(均P>0.05)。训练1 mo后部分视功能大幅提高，训练3 mo时大部分视功能基本恢复正常。

结论：视觉训练可有效提高视功能异常伴视疲劳儿童的双眼视功能，改善视疲劳症状，是一种简单易行且能有效缓解儿童视疲劳的方法。

METHODS: Retrospective case study. The data of 57 patients(114 eyes), aged 8.25±1.94 years, who underwent visual training at the optometry center of Xi'an Children's Hospital between January 2022 and April 2023, were collected. Patient assessments before and after training included refractive errors, a visual fatigue scale questionnaire, and visual function tests. These tests included the Worth 4 Dot for binocular vision, the Von Graefe method for measuring latent strabismus at distance and near, the gradient method for assessing the accommodative convergence/accommodation(AC/A)ratio, the push-up test for convergence near point, the negative lens method for amplitude of accommodation, the cross-cylinder test for accommodative response, and the flipper test for accommodative flexibility. Training programs were tailored based on the initial assessments of visual function and asthenopia. Comparisons were made between pre-training, 1 and 3 mo post-training evaluations.

RESULTS: At baseline and 1 mo post-training, the visual fatigue scores were 26.00±6.77 and 19.57±8.90, respectively(P<0.05). Significant enhancements were observed in near phoria, convergence near point, and accommodative amplitude in both eyes, both negative relative accommodation(NRA)and positive relative accommodation(PRA), as well as accommodative flexibility in both eyes at 1 mo after therapy(all P<0.05), while no significant changes were found in distance phoria or accommodative response(all P>0.05). Furthermore, no significant differences were noted in the binocular amplitude of accommodation, NRA, PRA, and near phoria between 1 and 3 mo after training(all P>0.05). The visual function parameters of 30 patients with low myopia(SE: -1.99±1.22 D), 3 patients with low hyperopia(SE: +1.01±0.13 D)and 24 patients with emmetropia(SE: +0.25±0.11 D)were not statistically significant before training and at 1 mo after training(all P>0.05). Certain visual functions significantly improved at 1 mo after training, and most had returned normal by 3 mo.

CONCLUSION: Vision therapy significantly enhances binocular visual function and alleviates symptoms of asthenopia in children with visual dysfunction. It is an effective, straightforward, and easily applicable method for relieving children's visual fatigue.