Table_7_Study of Geometric Illusory Visual Perception – A New Perspective in the Functional Evaluation of Children With Strabismus.DOCX

Despite the various perceptual-motor deficits documented in strabismus, there is a paucity of studies evaluating visual illusions in patients with strabismus. The aim of this study was to examine how the illusionary perception occurs in children/adolescents (10–15 years old) with strabismus with referral for surgery to correct ocular deviations. A controlled cross-sectional study was carried out in which 45 participants with strabismus and 62 healthy volunteers aged 10–15 years were evaluated. The behavioral response to three geometric illusions [Vertical-Horizontal illusion, Müller-Lyer illusion (Bretano version) and Ponzo illusion] and respective neutral stimuli (non-illusory images) regarding the estimation of image size and response time were measured using the Method of Adjustment. To analyze the influence of secondary factors: type of ocular deviation (convergent, divergent or associated with vertical deviation); amount of eye deviation; presence of amblyopia and stereopsis, a one-way ANOVA was performed. Among the tested illusions, children with strabismus showed greater susceptibility (p = 0.006) and response time (p = 0.004) to Ponzo’s illusory images. Children with strabismus and preserved stereopsis, on the other hand, showed similar susceptibility and response time to control group patients to the Ponzo illusion (p < 0.005). Patients with amblyopia showed overcorrection in the estimate of non-illusory Ponzo images (p = 0.046). Children with horizontal ocular deviation (esotropia or exotropia) associated with vertical deviation (hypertropia, DVD and/or alphabetical anisotropy) showed higher susceptibility to vertical adjustment images for the Müller-Lyer illusion (Brentano version) (p = 0.017). Individuals with strabismus tended to overcorrect the length of the straight-line segment adjusted for non-illusory images when testing non-illusory images in the Müller-Lyer test (Brentano version) (p = 0.009), as well as for the neutral images in the Vertical-Horizontal test (p = 0.000). The findings indicated impairment in the perception of geometric illusions and neutral figures, especially for the Ponzo illusion test by children with strabismus. As the behavioral response to illusory images may indirectly reflect the visual and morphofunctional alterations present in these individuals, we suggest that the investigation of visual illusory perception can be used as a new research strategy in the field of investigating the visual function in strabismus.

尽管已有研究证实斜视患者存在多种感知运动功能缺损，但针对斜视患者视觉错觉的相关研究仍较为匮乏。本研究旨在探究拟接受手术矫正眼位偏斜的斜视儿童及青少年（10~15岁）的错觉感知特征。本研究采用对照横断面研究设计，共纳入45名斜视患者与62名年龄10~15岁的健康志愿者作为研究对象。本研究采用调整法(Method of Adjustment)，测量被试对三类几何错觉[垂直-水平错觉(Vertical-Horizontal illusion)、缪勒-莱尔错觉(Müller-Lyer illusion，布雷塔诺(Bretano)版)、庞佐错觉(Ponzo illusion)]及其对应的中性刺激（非错觉图像）在图像大小估计与反应时上的行为学反应。为分析次要影响因素：眼位偏斜类型（集合性、分离性或合并垂直偏斜）、眼偏斜程度、弱视与立体视的存在与否，本研究采用单因素方差分析(one-way ANOVA)进行统计检验。在测试的三类错觉中，斜视儿童对庞佐错觉图像的易感性（p=0.006）与反应时（p=0.004）均显著更高。另一方面，保留立体视的斜视儿童，其对庞佐错觉的易感性与反应时与健康对照组无显著差异（p<0.005）。合并弱视的斜视患者在对非错觉庞佐图像的大小估计中表现出过度调整倾向（p=0.046）。合并垂直偏斜（上隐斜、分离性垂直偏斜及/或字母型异向性）的水平性眼偏斜患者（内斜视或外斜视），对缪勒-莱尔错觉（布雷塔诺版）的垂直调整任务表现出更高的易感性（p=0.017）。在缪勒-莱尔错觉（布雷塔诺版）测试中呈现非错觉图像时，斜视个体倾向于过度调整直线段的长度（p=0.009）；而在垂直-水平错觉测试的中性图像任务中，该群体同样表现出过度调整的倾向（p=0.000）。本研究结果表明，斜视儿童在几何错觉与中性图形的感知中存在功能缺损，尤以庞佐错觉测试表现最为显著。由于对错觉图像的行为学反应可间接反映此类个体的视觉与形态功能改变，我们认为视觉错觉感知的探究可作为斜视患者视觉功能研究领域的新型研究策略。