臨床案例Clinicalcase病理性近視致低視力康復(fù)Rehabilitationoflowvis

臨床案例Clinicalcase病理性近視致低視力康復(fù)Rehabilitationoflowvisionduetopathologicalmyopia目錄Contents病歷摘要Abstractofmedicalrecord第一部分Part1病例分析Caseanalysis第二部分Part2疾病介紹Introductiontodisease第三部分Part3教學(xué)病例討論Teachingcases教學(xué)病例討論Teachingcases病例摘要第一部分Part1Abstractofmedicalrecord一、患者基本信息Basicinformationofpatient患者，男性，51歲。Patient,male,51yearsold.主訴：自幼雙眼視物模糊，加重近5年。Blurredvisioninbotheyessincechildhood,aggravatedfornearly5years.既往史：患者既往體健，否認(rèn)高血壓、糖尿病等病史，否認(rèn)藥物過敏史，否認(rèn)眼部及其他全身手術(shù)病史。Previoushistory:Thepatientwasingoodhealthanddeniedmedicalhistoryofhypertension,diabetes,drugallergy,andeyeandothersystemicoperations.現(xiàn)病史：患者自幼視物模糊，診斷為“雙眼近視”,一直堅持配戴眼鏡，近5年來自覺雙眼戴鏡視力明顯下降。發(fā)病以來，神志清，精神可，生命體征平穩(wěn)，二便正常。Historyofpresentdisease:Thepatienthadblurredvisionsincechildhoodandwasdiagnosedas"binocularmyopia".Healwaysinsistedonwearingglassesandfeltthathisbinocularvisionhaddecreasedsignificantlyinthepast5years.Sincetheonset,themindisclear,thespiritcan,thevitalsignsarestable,andthebowelisnormal.體格檢查：體健，全身及一般狀態(tài)未見明顯異常。Physicalexamination:healthy,noobviousabnormalityingeneralbodyandgeneralstate.一、患者基本信息Basicinformationofpatient眼科檢查Eyeexamination檢查項目

主要內(nèi)容

OD(D)OS(D)OU(D)檢查項目Checkitem

主要內(nèi)容Maincontents

OD(D)OS(D)OU(D)原遠(yuǎn)用處方

遠(yuǎn)距-12.00D=4.0(0.1)

-12.00D=4.0(0.1)

4.0(0.1)Originalfarsightednessprescription近距-12.00D=4.0(0.1)

-12.00D=4.0(0.1)

4.0(0.1)主覺驗光

遠(yuǎn)距-19.00/-1.00×90=4.3(0.2)-14.00/2.50×90=4.3(0.2)4.3(0.2)Subjectiverefraction近距-17.00/-1.00×90=4.3(0.2)-12.00/2.50×90=4.3(0.2)4.4(0.25)眼壓Intraocularpressure16.3mmHg15.2mmHg對比敏感度視力0.640.64Contrastsensitivityvision對比視野Contrastfieldofview

視野縮窄Narrowingofvisualfield

視野縮窄Narrowingofvisualfield角膜映光法檢查keratoscopy

正位Rightposition遮蓋試驗Coveringtestexo,-8△@N&D眼球運(yùn)動EyemovementSAFE裂隙燈檢查Slit-lampexamination雙眼瞼形態(tài)正常，啟閉可，結(jié)膜清，角膜透明，前房深清，虹膜紋理清，

瞳孔圓，對光反射正常，晶狀體輕度混濁，玻璃體混濁

Normaleyelidshape,openandclose,conjunctivaclear,corneatransparent,anteriorchamberdeepclear,iristextureclear,

Thepupilisround,thelightreflexisnormal,thelensisslightlycloudy,thevitreousbodyiscloudy眼底檢查Fundusexamination

視網(wǎng)膜豹紋狀改變，C/D約0.2，視盤周圍及黃斑區(qū)見脈絡(luò)膜縮，

斑中心凹反光未見(圖1-1)Leopardpatternchangesinretina,C/Dabout0.2,choroidalcontractionaroundopticdiscandmaculararea,Noreflectioninfovea(Figure1-1)一、患者基本信息Basicinformationofpatient特殊檢查Specialexamination

(1)眼軸檢查；OD31.86mm;

OS30.16mm。(1)Ocularaxisexamination;OD31.86mm;OS30.16mm.(2)眼底OCT:雙眼黃斑區(qū)視網(wǎng)膜走行不平，局部表面反射粗糙。神經(jīng)上皮層可見無反射區(qū)，部分視網(wǎng)膜萎縮且層次不清，RPE/CCL反射紊亂,不均勻增寬。(2)fundusOCT:theretinainthemacularareaofbotheyesisuneven,andthelocalsurfacereflectionisrough.Non-reflectiveareascanbeseenintheneurocorticallayer,someretinalatrophyandunclearlayers,RPE/CCLreflexdisorder,unevenwidening.(3)B超：雙眼玻璃體輕度混濁，后鞏膜葡萄腫。(3)B-ultrasound:slightopacityofvitreousbodyinbotheyesandposteriorscleralstaphyloma.一、患者基本信息Basicinformationofpatient特殊檢查Specialexamination

特殊檢查Specialexamination

(4)視野檢查：雙眼生理盲點(diǎn)擴(kuò)大，右眼鼻側(cè)下方視野縮小，左眼下方及顳側(cè)視野縮小。(4)Visualfieldexamination:thephysiologicalblindspotofbotheyesisenlarged,thevisualfieldbelowthenoseoftherighteyeisnarrowed,andthevisualfieldbelowthelefteyeandthetemporalfieldisnarrowed.一、患者基本信息Basicinformationofpatient特殊檢查Specialexamination

二、診斷判定疾病過程Diagnosisanddeterminationofthediseaseprocess【診斷】【Diagnosis】①二級低視力①Grade2lowvision②雙眼病理性近視②Pathologicalmyopiaofbotheyes③并發(fā)性白內(nèi)障③Complicatedcataract【治療】【Treatment】

病理性近視眼目前尚無特異性治療方法，主要進(jìn)行屈光矯正及低視力康復(fù)，如出現(xiàn)并發(fā)癥則對癥治療。

Atpresent,thereisnospecifictreatmentforpathologicalmyopia,mainlyrefractivecorrectionandlowvisionrehabilitation,andsymptomatictreatmentifcomplicationsoccur.

病理性近視的治療思路，首先是矯正屈光不正，可以通過配戴框架眼鏡、角膜接觸鏡、角膜屈光手術(shù)或有晶體眼人工晶體植入

手術(shù)。

Thetreatmentideaofpathologicalmyopia,thefirstistocorrecttherefractiveerror,canbebywearingframeglasses,cornealcontactlenses,cornealrefractivesurgeryorintraocularlensimplantationsurgery.

對于進(jìn)展性近視，如有需要可以行后鞏膜加固手術(shù)。

Forprogressivemyopia,posteriorscleralreinforcementsurgerymaybeperformedifnecessary.

另外，病理性近視患者，容易發(fā)生并發(fā)性白內(nèi)障，如發(fā)生白內(nèi)障，可以行白內(nèi)障手術(shù)治療；發(fā)生視網(wǎng)膜脫離，可以行激光治療或

視網(wǎng)膜脫離修復(fù)手術(shù)治療；對視網(wǎng)膜下新生血管膜及黃斑出血者，采取抗VEGF治療、激光治療及光動力學(xué)治療等。

Inaddition,patientswithpathologicmyopiaarepronetocomplicatedcataract,suchascataract,cataractsurgerycanbeperformed;Retinaldetachmentcanbetreatedwithlasertherapyorretinaldetachmentrepairsurgery.Thepatientswithsubretinalneovascularizationmembraneandmacularhemorrhageweretreatedwithanti-VEGFtherapy,lasertherapyandphotodynamictherapy.二、診斷判定疾病過程Diagnosisanddeterminationofthediseaseprocess康復(fù)Rehabilitation1.康復(fù)需求及日常生活能力評估1.Assessmentofrehabilitationneedsanddailylivingability患者為51歲男教師，通過溝通和交流，得知患者在工作中需要批改學(xué)生作業(yè)，且平時有閱讀紙質(zhì)書本，喜歡用手機(jī)瀏覽新聞，因為近距離看不清晰，影響工作效率；遠(yuǎn)距離不能看清楚學(xué)生的上課反應(yīng)等前來就診?；颊呦Ｍ軌蚪柚祻?fù)手段，讓自己近距離工作更加順利，并能更清楚地看清遠(yuǎn)距離物體。另外，患者還有一個困擾覺得自己配戴的鏡片太厚重，影響外觀和舒適度，希望能改善外觀。Thepatientisa51-year-oldmaleteacher.Throughcommunicationandcommunication,Ilearnedthatthepatientneedstocorrectstudents'homeworkatwork.Besides,heusuallyreadspaperbooksandlikestobrowsenewsbymobilephone,becausehecannotseeclearlyatcloserange,whichaffectsworkefficiency.Hecametoseeadoctorbecausehecouldnotseehisstudents'reactionsinclassfromadistance.Patientshopetobeabletouserehabilitationmethodstomaketheircloseworkmoresmoothlyandtoseedistantobjectsmoreclearly.Inaddition,thepatientalsohasaproblemthatthelenshewearsistooheavy,affectingtheappearanceandcomfort,andhopestoimprovetheappearance.2.康復(fù)計劃2.Rehabilitationplan(1)解釋病史和康復(fù)計劃(1)Explainmedicalhistoryandrehabilitationplan(2)視覺功能康復(fù)(2)Visualfunctionrehabilitation患者主覺驗光：OD-19.00/-1.00×90=4.3(02)；OS-14.00/-2.50×90=4.3(0.2)；OU4.3(0.2)@D，ADD：+2.00DS，遠(yuǎn)距離給予全矯試戴略感頭暈，無法適應(yīng)。由于其左右眼也存在較大的屈光參差，且患者有看近需求，因此采用單眼視，將右眼球鏡屈光度降低5.0D。此時，患者配戴舒適度增加，且自覺遠(yuǎn)近清晰度均可。

Patient'smainoptometry:OD-19.00/-1.00×90=4.3(02);OS-14.00/-2.50×90=4.3(0.2);OU4.3(0.2)@D,ADD:+2.00DS,slightlydizzyandunabletoadaptwhengivenfullcorrectionatadistance.Duetothelargeanisometropiaintheleftandrighteyes,andtheneedtoseeclosely,monocularvisionwasadopted,andtherighteyesphericaldiopterwasreducedby5.0D.Atthistime,thepatient'swearingcomfortincreases,andtheawarenessofdistanceandclaritycanbe.處方一：0D-14.00/-1.00×90=4.0(0.1);OS-14.00/-2.50×90=4.3(0.2)。Prescription1:0D-14.00/-1.00×90=4.0(0.1);OS-14.00/-2.50x90=4.3(0.2).處方二：配RGP鏡片OD-15.5DS=4.4(0.25);OS-12.00DS=4.4(0.25)、0U4.4(0.25)。Prescription2:WithRGPlensOD-15.5DS=4.4(0.25);OS-12.00DS=4.4(0.25),0U4.4(0.25).

康復(fù)Rehabilitation

近視力康復(fù)：患者雙眼的最佳矯正近視力均為0.2,考慮患者需要經(jīng)常批改作業(yè)及閱讀需求，由于患者舒適閱讀的視力需求為4.5(0.3)-4.6(0.4),40cm視力為4.3(0.2),如提高到4.6(0.4),則閱讀距離移到20cm,則需要5.0D的調(diào)節(jié)。Nearvisionrehabilitation:Thebestcorrectednearvisioninbotheyesofthepatientswas0.2.Consideringthatthepatientsneededtocorrecthomeworkandreadfrequently,andsincethevisualrequirementforcomfortablereadingis4.5(0.3)-4.6(0.4),andthevisualacuityof40cmis4.3(0.2),ifthereadingdistanceisimprovedto4.6(0.4),5.0Dadjustmentisrequiredwhenthereadingdistanceismovedto20cm.康復(fù)Rehabilitation因此，提高近視力的方法有以下幾種：Therefore,thereareseveralwaystoimprovenearvision:①雙眼近用處方OD-14.00/-1.00×90；OS-9.00/-2.50×90,視力可以達(dá)到0.5。②采用上述提及的單眼視屈光矯正(一只眼看遠(yuǎn)，一只眼看近):OD-14.00/-1.00×90;OS-14.00/-2.50×90。③雙眼仍然在40cm處看近，OD-14.00/-1.00×90；OS-14.00/-2.50×90(遠(yuǎn)用處方)，此時左右眼近視力均4.3(0.2),再采用4x鎮(zhèn)紙式放大鏡視力可以達(dá)到4.8(0.6)；或者采用帶超長臂自由活動放大鏡視力可達(dá)4.6(0.4)。①PrescriptionOD-14.00/-1.00×90fornearuseofbotheyes;OS-9.00/-2.50×90,visioncanreach0.5.②Usethemonocularrefractivecorrectionmentionedabove(oneeyefar,oneeyenear):OD-14.00/-1.00×90;OS-14.00/-2.50x90.③Botheyesarestilllookingcloseat40cm,OD-14.00/-1.00×90;OS-14.00/-2.50×90(distantprescription),atthistime,thenearvisionoftheleftandrighteyesare4.3(0.2),andthevisionofthe4xpaperweightmagnifyingglasscanreach4.8(0.6);Oruseafreemovingmagnifyingglasswithanextralongarmtoachieveavisionof4.6(0.4).建議患者近用眼鏡式助視器(批改作業(yè)、閱讀等)、鎮(zhèn)紙式放大鏡(閱讀)、帶長臂放大鏡(批改作業(yè))配合使用。對于電子產(chǎn)品的閱讀，可以使用手機(jī)或電腦本身的放大軟件APP,以及手機(jī)設(shè)置中的字體大小，選擇特大字體。Itisrecommendedthatpatientsusecloseglasses(correctinghomework,reading,etc.),paperweightmagnifyingglass(reading),andmagnifyingglasswithlongarm(correctinghomework)together.Forthereadingofelectronicproducts,youcanusetheenlargingsoftwareAPPofthemobilephoneorcomputeritself,aswellasthefontsizeinthemobilephoneSettings,selectalargefont.康復(fù)Rehabilitation

3)遠(yuǎn)視力康復(fù)：患者遠(yuǎn)視力4.3(0.2),自覺日常生活中行走等沒有問題，但無法看清楚課堂上學(xué)生的課堂表現(xiàn)，給予患者4x單筒望遠(yuǎn)鏡，視力可達(dá)4.8(0.6),用于看遠(yuǎn)處細(xì)節(jié)時使用。

3)Farvisionrehabilitation:Thepatienthasafarvisionof4.3(0.2)andnoproblemsinwalkingindailylife,butcannotseethestudents'classroomperformanceclearly.Thepatientisgiven4xmonocularswithavisionupto4.8(0.6),whichisusedforseeingdistantdetails.4)視野康復(fù)：由于周邊視網(wǎng)膜變性，周邊視野略有縮小，可考慮擴(kuò)大視野康復(fù)。予以倒置望遠(yuǎn)鏡試戴，患者覺視力下降明顯，看不清眼前細(xì)節(jié)，自覺目前沒有這樣的需求，建議暫時不采用增大視野的裝置，告知獨(dú)立行走時務(wù)必小心周邊，需要頻繁轉(zhuǎn)動頭位來留意周邊視野情況，避免碰撞。

4)Visualfieldrehabilitation:Duetoperipheralretinaldegeneration,theperipheralvisualfieldisslightlyreduced,andyoucanconsiderexpandingvisualfieldrehabilitation.Totryontheinvertedtelescope,thepatientfeelsthatthevisualacuityhasdecreasedsignificantly,cannotseethedetailsinfrontoftheeyes,consciousthatthereisnosuchneed,itisrecommendednottousethedevicetoincreasethevisualfieldforthetimebeing,informedthatwhenwalkingindependently,becarefulaboutthesurrounding,needtofrequentlyturntheheadtopayattentiontotheperipheralvision,toavoidcollision.5)其他康復(fù)措施：由于近距離戴框架眼鏡時工作距離相對較近(20cm),長時間工作會導(dǎo)致肩頸部酸痛，建議使用閱讀架或調(diào)整桌面高度，改善舒適度；同時，建議近距離工作時，使用較強(qiáng)的照明，并且推薦使用長燈臂、亮度可調(diào)節(jié)的落地?zé)?/p>

5)Otherrehabilitationmeasures:Becausetheworkingdistanceisrelativelyclose(20cm)whenwearingframeglassesatcloserange,theshoulderandneckwillbesorewhenworkingforalongtime.Itisrecommendedtouseareadingrackoradjusttheheightofthedesktoimprovecomfort;Atthesametime,itisrecommendedtousestronglightingwhenworkingincloseproximity,anditisrecommendedtouseafloorlampwithalonglamparmandadjustablebrightness康復(fù)Rehabilitation6)康復(fù)訓(xùn)練：首先在康復(fù)護(hù)士和醫(yī)師的幫助下，教會患者使用助視器，并告知每種助視器的優(yōu)點(diǎn)及局限性，以及適用于何種距離場景，并分別對每一種助視器的使用進(jìn)行培訓(xùn)。6)Rehabilitationtraining:Firstofall,withthehelpofrehabilitationnursesanddoctors,teachpatientstousevisualAIDS,andinformeachoftheadvantagesandlimitationsofvisualAIDS,aswellassuitableforwhatdistancescenes,andconducttrainingontheuseofeachkindofvisualAIDS.7)心理康復(fù)：通過對患者的心理問卷的自評法及醫(yī)師、護(hù)士在康復(fù)過程中的他評法，初步判斷患者的心理健康情況，該患者有輕度焦慮傾向，主要問題在于擔(dān)心自己的視力會進(jìn)一步下降，影響生活和工作。針對患者的顧慮，通過對高度近視可能導(dǎo)致的并發(fā)癥進(jìn)行進(jìn)一步的解釋，告知患者定期做眼底檢查，如有問題積極處理，打消患者的顧慮。7)Psychologicalrehabilitation:Throughtheself-evaluationofthepatient'spsychologicalquestionnaireandtheotherevaluationofdoctorsandnursesintherehabilitationprocess,thepatient'smentalhealthwasinitiallyjudged.Thepatienthadamildanxietytendency,andthemainproblemwasthathewasworriedthathisvisionwouldfurtherdeclineandaffecthislifeandwork.Inviewoftheconcernsofpatients,throughfurtherexplanationofthecomplicationsthatmaybecausedbyhighmyopia,patientsareinformedtodofundusexaminationregularly,andifthereisaproblem,activelydealwithittodispeltheconcernsofpatients.康復(fù)Rehabilitation【隨訪】【Follow-up】(1)低視力?？泼?個月隨訪1次。(1)Lowvisionspecialistfollowupatevery3months.(2)眼底內(nèi)科每半年隨訪1次，散瞳檢查眼底情況。(2)fundusmedicalfollow-uponceeverysixmonths,mydriasisexaminationfundusconditions.隨訪Follow-upvisit教學(xué)病例討論Teachingcases

病例分析Caseanalysis第二部分Part2分析Analysis【病例特點(diǎn)】【CaseCharacteristics】患者為雙眼病理性近視導(dǎo)致的視覺功能障礙，視覺功能發(fā)生了不可逆轉(zhuǎn)的損害?；颊邽橹心昴行?，在職教師，目前仍在工作，有明顯的看近與看遠(yuǎn)的視覺康復(fù)需求。Thepatienthasvisualdysfunctioncausedbypathologicalmyopiaofbotheyes,andthevisualfunctionhasbeenirreversiblydamaged.Thepatientisamiddle-agedmale,ateacher,whoisstillworkingatpresent,andhasobviousvisualrehabilitationneedsforseeingnearandfar.【診斷思路】【Diagnosticthinking】患者病史、?？茩z查和輔助檢查資料均明確，無須鑒別。Thepatient'shistory,specialtyexaminationandauxiliaryexaminationdatawereclearanddidnotneedtobeidentified.【治療思路】【Therapeuticidea】病理性近視的治療思路，首先是矯正屈光不正，可以通過配戴框架眼鏡、角膜接觸鏡(如RGP)、角膜屈光手術(shù)或ICL晶體植入手術(shù)，如有需要可以進(jìn)行后鞏膜加固手術(shù)。另外，病理性近視患者，容易發(fā)生并發(fā)性白內(nèi)障，如發(fā)生白內(nèi)障，可以行白內(nèi)障手術(shù)治療；發(fā)生視網(wǎng)膜脫離，可以行激光治療或視網(wǎng)膜脫離修復(fù)手術(shù)治療；發(fā)生脈絡(luò)膜新生血管，則需要進(jìn)行抗新生血管治療。Thetreatmentideaofpathologicalmyopiaistocorrecttherefractiveerrorfirst,bywearingframeglasses,cornealcontactlenses(suchasRGP),cornealrefractivesurgeryorICLlensimplantationsurgery,ifnecessary,posteriorscleralreinforcementsurgery

canbeperformedtostrengthenthesclera.Inaddition,patientswithpathologicmyopiaarepronetocomplicatedcataract,suchascataract,cataractsurgerycanbeperformed;Retinaldetachmentcanbetreatedwithlasertherapyorretinaldetachmentrepairsurgery.Ifchoroidalneovascularizationoccurs,antineovascularizationtherapyisrequired.康復(fù)思路Rehabilitationthinking(1)根據(jù)患者的年齡、職業(yè)、目前的眼部情況及康復(fù)需求，給予患者看遠(yuǎn)、看近的視覺功能康復(fù)，來滿足患者批改作業(yè)、看書、使用手機(jī)的需求，以及看清楚遠(yuǎn)處細(xì)節(jié)的需求。(1)Accordingtothepatient'sage,occupation,currenteyeconditionandrehabilitationneeds,givepatientsthevisualfunctionrehabilitationofseeingfarandneartomeettheneedsofpatientstocorrecthomework,readbooks,usemobilephones,andseeclearlydistantdetails.(2)由于周邊視網(wǎng)膜變性，周邊視野損害，如有需要，可以安排視野康復(fù)和行走技能的康復(fù)。(2)Duetoperipheralretinaldegenerationandperipheralvisualfielddamage,visualfieldrehabilitationandwalkingskillsrehabilitationcanbearrangedifnecessary.(3)由于近距離閱讀距離較近，可以使用閱讀架改善舒適度，并提供帶長臂的強(qiáng)照明。(3)Duetotheclosereadingdistance,readingstandscanbeusedtoimprovecomfortandprovidestronglightingwithlongarms.(4)通過心理問卷自評法和他評法，發(fā)現(xiàn)該患者為輕度焦慮，針對患者的擔(dān)心問題，醫(yī)師給予詳細(xì)的講解，打消其顧慮。(4)Throughthepsychologicalquestionnaireself-assessmentandotherassessmentmethod,itwasfoundthatthepatientwasmildlyanxious,andthedoctorgaveadetailedexplanationtothepatient'sworriestodispelhisconcerns.(5)患者經(jīng)常需要使用電腦、手機(jī)等電子產(chǎn)品，可以使用電腦和手機(jī)的放大軟件及使用大字體來幫助改善視覺效果。(5)Patientsoftenneedtousecomputers,mobilephonesandotherelectronicproducts,theycanusethecomputerandmobilephonemagnificationsoftwareanduselargefontstohelpimprovethevisualeffect.教學(xué)病例討論Teachingcases

疾病介紹Introductiontodisease第三部分

Part3三、疾病介紹Diseaseintroduction病理性近視是因眼軸過度增長而造成的眼底后極部損害為特征的高度近視，它有以下幾個特征：眼軸不斷增長，眼球后極部向后擴(kuò)張形成后鞏膜葡萄腫；近視度數(shù)隨年齡增長不斷增加；造成眼球后極部視網(wǎng)膜與脈絡(luò)膜的損害。Pathologicalmyopiaisahighmyopiacharacterizedbydamagetotheposteriorpoleofthefunduscausedbyexcessivegrowthoftheaxisoftheeye.Ithasthefollowingcharacteristics:theaxisoftheeyecontinuestogrow,andtheposteriorpoleoftheeyeballexpandsbackwardtoformposteriorscleralstaphyloma;Thedegreeofmyopiaincreasedwithage,

causingdamagetotheretinaandchoroidoftheposteriorpoleoftheeyeball.視力的減退可因并發(fā)性白內(nèi)障、視網(wǎng)膜脫離、脈絡(luò)膜新生血管等引起。病理性近視是我國引起低視力的主要病因之一，患者屈光度多在-10.00D以上甚至達(dá)-40.00D。我國是世界上近視眼最多的國家之一，目前我國高中生近視患病率達(dá)80%以上，病理性近視在人群中的患病率為1%～2%、隨著兒童青少年近視發(fā)病年齡提前、進(jìn)展增快，病理性近視的比率仍將上升，病理性近視導(dǎo)致的低視力風(fēng)險也隨之增加。Thelossofvisioncanbecausedbycomplicatedcataract,retinaldetachment,choroidalneovascularizationandsoon.PathologicalmyopiaisoneofthemaincausesoflowvisioninChina,andthediopterofpatientsismorethan-10.00Doreven-40.00D.Chinaisoneofthemostnearsightedcountriesintheworld,atpresent,theprevalenceofmyopiainhighschoolstudentsinourcountryismorethan80%,theprevalenceofpathologicalmyopiainthepopulationis1%~2%,withtheonsetofmyopiainchildrenandadolescents,therateofpathologicalmyopiawillcontinuetorise,andtheriskoflowvisioncausedbypathologicalmyopiawillalsoincrease.低視力特點(diǎn)Characteristicsoflowvision這些患者由于戴高屈光度的負(fù)透鏡，而使得視網(wǎng)膜成像顯著縮小、看遠(yuǎn)處物體時似乎更遠(yuǎn)一些，屈光不正-10.00D以上時，視網(wǎng)膜成像顯著縮小、發(fā)生辨認(rèn)困難，因而有些患者不愿意接受眼鏡。若出現(xiàn)眼底等病變，矯正視力無法提高。Thesepatientsworenegativelenseswithhighdiopter,whichmadetheretinalimagesignificantlysmallerandappearedfartherawayfromdistantobjects,refractiveerrorsexceeding-10.00Dresultinsignificantretinalimagingreduction,leadingtodifficultiesinrecognition.病理性近視后期，各種并發(fā)癥導(dǎo)致矯正視力無法提高。Advancedstagesofpathologicalmyopiacancausecomplicationsthatpreventimprovementincorrectedvision.不戴鏡可獲得較好的近視力，但患者的遠(yuǎn)點(diǎn)太近，如-15.00D的近視，遠(yuǎn)點(diǎn)在眼前6.7cm,長時間在6.7cm距離近讀易發(fā)生疲勞和工作不便。Goodmyopiamightbeattainablewithoutglasses,farpointsintheaffectedeyearetooclose.Forinstance,with-15.00Dmyopia,thefarpointisapproximately6.7cminfrontoftheeye,causingfatigueandinconvenienceduringprolongedclosereadingwithadistanceof6.7cminfrontoftheeye.屈光矯正原則Theprincipleofrefractivecorrection病理性近視所致的低視力在康復(fù)方面的首要措施是仔細(xì)進(jìn)行屈光檢查，配戴合適的眼鏡，改善遠(yuǎn)視力。Thefirststepsinrehabilitationoflowvisionduetopathologicalmyopiaaretaking