摘要目的：:探讨受检者采用梯度法测量时的调节刺激反应对调节性集合/调节比率（AC/A）的影响，并评估通过优化调节刺激反应来提高AC/A值测量准确度的可能性。方法：:前瞻性研究。随机纳入2023年3月至2024年6月漳州卫生职业学院符合条件且自愿参加本研究的18~21岁在校大学生62例，男24例，女38例。使用综合验光仪近视力表的0.9单行视标，在受检者自觉清晰情况下测得隐斜量；并在此基础上确定BCVA，反复阅读BCVA的单行视标后调整测出隐斜量。随后予以附加+2.00、+1.00、-1.00、-2.00 D镜片，分别测出受检者在自觉清晰和达到全矫时的BCVA的AC/A值，作为VG0.9组和VG-BCVA组。VG0.9组和VG-BCVA组组内不同附加镜片的AC/A值比较采用 H检验，VG0.9组和VG-BCVA组组间相同附加镜片下AC/A值比较采用配对 t检验或配对设计符号的秩和检验。 结果：:VG0.9组附加+2.00、+1.00、-1.00、-2.00 D镜片时测得的AC/A值分别为3.50（2.50，4.00）、4.00（2.00，5.00）、3.00（2.00，4.13）、3.00（2.50，3.50）；VG-BCVA组附加+2.00、+1.00、-1.00、-2.00 D镜片时测得的AC/A值分别为3.50（3.00，4.50）、4.00（3.00，5.00）、4.00（3.00，4.63）、3.50（3.00，4.00）。VG0.9组和VG-BCVA组组内4种附加镜片间测得的AC/A值总体差异均无统计学意义（均 P>0.05）；组间同一附加镜片VG0.9组的AC/A值均低于VG-BCVA组（ Z=-5.55~-3.99，均 P<0.001）。 结论：:受检者的调节刺激反应对梯度法测量AC/A的准确性具有明显影响，通过确保受检者在附加镜片后达到BCVA，可以更准确地评估AC/A，从而优化临床诊断和治疗策略。

abstractsObjective::To explore the effect of accommodation stimulus responses on the accommodative convergence/accommodation (AC/A) ratio when measured using the gradient method and to assess whether optimizing the accommodation stimulus responses can improve AC/A ratio measurement accuracy.Methods::In this prospective study, 62 school students aged 18 to 21 years including 24 males and 38 females, who were eligible and volunteered to participate in this study at Zhangzhou Health Vocational College from March 2023 to June 2024, were randomly recruited. The magnitude of latent strabismus was measured using the 0.9 single-line visual acuity scale of the comprehensive optometry near vision chart under the subjects' self-perceived clarity. The BCVA was determined based on this measurement. The magnitude of latent strabismus was further assessed by adjusting the single-line visual acuity scale at BCVA after repeated assessments, Subsequently, +2.00, +1.00, -1.00, and -2.00 D lenses were attached, and the AC/A values of BCVA were measured when the subjects were consciously clear and when full correction was achieved, respectively, as the VG0.9 group and the VG-BCVA group. Comparisons of AC/A ratios under different additional lenses within the VG0.9 and VG-BCVA groups were performed using the Kruskal-Wallis H test, and comparisons of AC/A ratios under the same additional lens between the VG0.9 and VG-BCVA groups were performed using the paired t-test or the Wilcoxon signed-rank test. Results::The AC/A ratios measured with +2.00 D, +1.00 D, -1.00 D, and -2.00 D lenses in the VG0.9 group were 3.50 (2.50, 4.00), 4.00 (2.00, 5.00), 3.00 (2.00, 4.13), and 3.00 (2.50, 3.50), respectively, while those in the VG-BCVA group were 3.50 (3.00, 4.50), 4.00 (3.00, 5.00), 4.00 (3.00, 4.63), and 3.50 (3.00, 4.00). There was no significant difference in the AC/A ratios among the four additional lenses within either the VG0.9 group or the VG-BCVA group ( P>0.05). However, for each corresponding additional lens, the AC/A ratios in the VG0.9 group were lower than those in the VG-BCVA group ( Z=-5.55 to-3.99, all P<0.001). Conclusions::The subject's accommodation stimulus response has a significant impact on the accuracy of AC/A ratio measurement using the gradient method. By ensuring that subjects achieve the BCVA with additional lenses, the AC/A ratio can be more accurately assessed to optimize clinical diagnosis and treatment strategies.