PSYCH OpenIR  > 健康与遗传心理学研究室
视野缺损的自然评估与恢复
Alternative TitleAssessment and Rehabilitation of Visual Field Defects
赵金
Subtype硕士
Thesis Advisor黄昌兵
2019-06
Degree Grantor中国科学院大学
Place of Conferral中国科学院心理研究所
Degree Name理学硕士
Degree Discipline应用心理学
Keyword视野缺损 知觉学习 记忆掩蔽
Abstract

人类之所以能看到世间万物,是因为眼睛在接受到各种各样的视觉信息后,经过一系列的传递与处理,最后形成视觉意识。视野是指在任一瞬间眼睛能看见的空间范围。正常的视野对人类的各种活动,如开车、阅读和运动等都非常重要。眼部和视路病变以及外伤性脑损伤、肿瘤等都有可能造成视野缺损,这不仅会给人们的生活带来巨大的不便与危险,还可能会使病人丧失生活信心,给社会带来危害以及经济损失。

目前临床上对视野缺损的评估方式主要是使用自动视野计进行测量,此种方式以光点为刺激,基于视野缺损患者的主观感受进行测量,得到的结果容易低估患者受损侧残余的视觉能力。当前国内外缺乏针对视野缺损恢复的行之有效的临床措施和方法,因此研究视野缺损的客观评估方式以及恢复策略具有非常重要的意义。

在研究一中,设计了一种新型的跨视野视觉记忆掩蔽范式,可以评估视野缺损患者的缺损视野是否存在残余视功能。该测试使用二选一迫选(2-AFC)延迟空间频率辨别范式,通过将掩蔽刺激放在患者的的缺损视野和相对完好的视野来对患者缺损视野的辨别能力进行测量,以达到评估患者缺损视野是否存在残余视功能目的。实验1中,19名正常被试完成2(掩蔽刺激呈现位置:左、右)*(掩蔽刺激呈现方式:同侧、对侧)4种条件下的测试。结果发现,正常被试在不同条件下都表现出了与前人研究结果类似的记忆掩蔽效应,表明此种效应可能具有独特的掩蔽刺激视网膜位置非特异性。在实验二中,我们探讨了跨视野视觉记忆掩蔽范式在更多视网膜位置的有效性。6名正常被试完成2(离心度:30, 50) *2 (掩蔽刺激呈现方式:同侧、对侧)*6(掩蔽刺激呈现位置:左、右、左上、右上、左下、右下)24种条件下的测试,结果提示这种新型掩蔽范式的掩蔽效应并不具有严格的视网膜位置特异性。实验1和实验2的结果为评估偏盲患者残余视功能提供了方法基础。在实验3中,我们对22名视野缺损患者使用新型掩蔽范式进行测试,结果发现视野缺损患者的受损视野并不是完全丧失了功能,至少对5-20周期/度(c/d )的光栅仍然具有一定辨别能力,为设计针对性恢复措施提供了理论基础。

在研究二中,我们开发了一种渐进式跨视野关联训练方法,对视野缺损患者进行长期训练,并通过临床的视野检查来考察训练前后患者的视野功能变化情况。选取了10名视野功能以及稳定的视野缺损患者,根据详细的眼科检查结果,为每名病人量身定制了训练方案;训练在家进行,要求每天至少训练1次,每隔60天上传训练数据,并进行一次临床检查。结果发现,经过3-9个月训练后,所有训练位置的对比敏感度(CS)平均提高1.682士1.252 dB,患者的临床视野检测结果均显示视野的受损程度减轻,其中双眼的平均缺损程度(MD)减少了2.153士0.380 dB,光敏感性(MS)平均提高了1.948士1.320 dB,患者报告主观视觉质量有改善。

我们的研究提示:为了更全面的评估视野缺损患者的视野受损情况,除了必要的临床视野检查外,还需要考虑加上其他功能的测试;成年视野缺损患者的视觉系统依然具有可塑性,基于知觉学习的渐进式跨视野关联训练为视野缺损的恢复提供了新思路。

Other Abstract

After receiving various kinds of visual information, our visual system undergoes a series of transmission and processing, and finally forms percept and consciousness. Visual field refers to the scope and range of spaces that the eye can see at any instant. Normal visual field is very important for human activities such as driving, reading, and sports. Many ocular and visual pathway changes as well as various tumors and traumas may cause different types of visual field defect, which will not only bring enormous inconvenience and danger to patients' daily life but also cause them to lose confidence in life, eventually resulting in harms to our society and losses to the economy.

At present, clinical evaluation of visual field defect is mainly based on automatic perimetry, which uses light spot as stimulation to measure patient's subjective sensitivity across visual field. The examination has been reported to underestimate the residual visual ability of patients with visual field defect. On the other hand, there are currently no effective clinical training methods for visual field defects around the world. Therefore, it is of great significance and practically meaningful to explore more objective assessment methods and recovery strategies for visual field defect.

In Study 1,a new trans-view visual memory masking paradigm was designed to evaluate whether there is residual visual function in the defect field of visual field defect patients. The test uses a two-to-one forced-selection (2-AFC) delay spatial frequency discrimination paradigm to measure the patient's defect field of view by placing the masking stimulus in the patient's defect field of view and relatively intact field of view to assess patient defect Whether the field of view has a residual visual function. In the first experiment, 19 normal subjects completed the test under the condition of 2 (masking stimulus presentation position: left and

right) *2 (masking stimulus presentation mode: ipsilateral, contralateral). It was found that normal subjects showed similar memory masking effects under previous conditions, indicating that this effect may have a unique masking stimulation of the retinal position non-specificity. In Experiment 2, we explored the effectiveness of the trans-view visual memory masking paradigm in more retinal locations; 6 normal subjects completed 2 (centrifugation: 30, 50)*2 (masking stimulus presentation: ipsilateral, contralateral) *6 (masking stimulus presentation position: left, right, upper left, upper right, lower left, lower right) test under the conditions, the results suggest that the masking effect of this new masking paradigm does not have strict retinal positional specificity; The results of Experiment 1 and Experiment 2 provide a methodological basis for assessing residual visual function in patients with hemianopia.

In study 2, we developed a cross-visual field progressive training method to recover visual field defect, gauged by the visual field changes of patients before and after training measured by Humphrey automated visual filed testing. In experiment 4, 10 subjects with stable visual field impairment were trained at home for 3一9 months. The results showed that contrast sensitivity averaged across all trained locations increased by 1.682 士1.252dB. The mean defect degree (MD) of both eyes reduced by 2.153 士0.380 dB and the light sensitivity (MS) increased by 1.948士1.320 dB on average.

Our results suggest that besides the necessary clinical visual field examination, more comprehensive evaluation of visual functions should be introduced in the management of hemianopia patients. The proposed cross-visual field progressive training method can significantly reduce the extent of visual field defects and effectively improve the sensibility of patients suffering from it, showing potential in recovering defective visual field.

Pages52
Language中文
Document Type学位论文
Identifierhttp://ir.psych.ac.cn/handle/311026/29316
Collection健康与遗传心理学研究室
Recommended Citation
GB/T 7714
赵金. 视野缺损的自然评估与恢复[D]. 中国科学院心理研究所. 中国科学院大学,2019.
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