儿童斜弱视的理论与治疗——多伦多大学Agnes Wong副教授专访

小儿斜视简述

一般认为，斜视是指眼睛视物时不能同时注视目标，可以是内斜、外斜或上下斜视。根据流行病学调查，在西方国家，很多儿童生下来就存在内斜视，这一点和中国的情况不同，中国很少儿童天生内斜视。当发现儿童出现视物不正时我们应当了解一些知识：一是很多人错误地认为视物不正仅仅是导致美观问题，但实际上还会导致视力发育障碍；二是斜视时立体视也会出现问题。

对于斜视患儿，首先应当排除是否存在大脑疾患，此外应当注意配戴眼镜能否帮助矫正斜视。对于远视患儿，有时简单的配戴眼镜就能帮助他们矫正斜视。远视患儿在视物时很难对焦，通常为了能视物清楚他们会很努力地聚焦，该机制使眼睛发生内斜。如果配戴眼镜后斜视仍然存在，则通常下一步要做的是通过眼肌手术来恢复眼球运动正常功能。

In children with eye misalignment， the first thing we need to rule out is whether there is a brain problem that might be causing eye misalignment in the first place. The second thing we want to look at is whether glasses can help. In some children， they are far-sighted. By simply wearing glasses， it can help control their eye turn. If the glasses doesn’t help and the eye turn remains， then usually the next step is to offer eye muscle surgery when the eye turn becomes stable.

弱视治疗理论

治疗弱视的主要方法是让患儿或者家长遮盖好眼。不管是使用眼罩遮盖还是通过不常用的散瞳剂来使眼睛视物模糊的方法，其目的都是让弱视眼工作。遮盖法使用了上百年，但成功率仅约50%，主要原因之一是依从性较差。患儿不喜欢眼被遮盖，因为这样看起来很丑，并容易引起社会歧视。
目前有很多研究工作涉及改进治疗方法（如知觉学习法，即在特殊活动中重复刺激视觉系统）。通过视频游戏不停地训练患者能够提高视力；通过降低视力较佳眼的对比敏感度能够提高双眼的协作能力；改变大脑的神经递质（如左旋多巴）的方法在部分患者中也有一定效果。

There are many research activities currently looking at improving the treatment and outcomes other than patching.
● Perceptual learning whereby the visual system is repeatedly stimulated during specialized activities.
● Lower the contrast of a stimulus perceived by the good eye to promote binocular co-operation in both eyes.
● Change the neurotransmitter balance in the brain， such as giving patients L-dopa.
So there is a lot of active research going on looking at different treatments for lazy eye.