方法：前瞻性临床研究。序贯选取近视性散光受试者166例(右眼)，检查各受试者注视不同距离(视远眼前5m、眼前40cm、眼前20cm)的散光性屈光不正度、配戴静态屈光矫正眼镜时的近视力(distance corrected near vision acuity， DCNVA)及散光修正后的近视力(accommodative astigmatism corrected near vision acuity， ACNVA)。视近状态下的散光在视远单眼全矫基础上采用交叉柱镜进行修正，受检眼水平向前注视近视力表中其最佳视力的视标。对三个注视距离下(视远5m、视近40cm、视近20cm)两两之间的散光度及轴位的差异、DCNVA与ACNVA的差异分别采用两两配对检验，若数据服从正态分布采用配对t检验，否则采用配对符号秩和检验。

结果：三个不同注视距离，两两间散光度的差异均具有统计学意义(视近40cm与视远5m：Z=-5.316，P<0.0167； 视近20cm与视远5m：Z=-5.672，P<0.0167； 视近20cm与视近40cm：Z=-2.463，P<0.0167)，且视近20cm散光度(0.83DC±0.52D)>视近40cm散光度(0.78DC±0.43D)>视远5m散光度(0.63DC±0.47D)； 三个不同注视距离，两两间散光轴位的差异均不具有统计学意义； DCNVA与ACNVA的差异具有统计学意义，且散光修正后视力呈提高的趋势(Z=-5.741，P<0.01； Z=-6.848，P<0.01)。

结论：随注视距离移近，散光度呈增大的趋势且散光轴位朝着顺规散光的方向发展，然而这种改变对于个体来讲是随机的、个性化的，在散光改变量最大的距离处发生视疲劳的可能性较大，在该距离下进行屈光矫正可能是治疗该类视疲劳患者的有效方法。

METHODS: In this prospective clinical study, 166 right eyes with myopic astigmatism were selected by sequential processing to measure at distance of 5m, 40cm and 20cm. The distance corrected near vision acuity(NCNVA)and accommodative astigmatism corrected near vision acuity(ACNVA)were measured with distance-corrected glasses and near-corrected glasses, respectively, using near vision chart. The astigmatism at near were measured under monocular condition with cross-cylinder lenses, with the tested eye looking straight ahead at the line of its best corrected vision acuity in near vision chart. The degree and axis of astigmatism between two distance of the three, DCNVA and ACNVA were compared by paired t test respectively if the data are normal distribution, if not, compared by Wilcoxon matched-pairs signed-ranks test.

RESULTS: The degree of astigmatism with accommodation was increased significantly as follow order: fixating at 20cm, 40cm and distance. \〖(40cm-5m): Z=-5.316, P<0.0167;(20cm-5m): Z=-5.672, P<0.0167;(20cm-40cm): Z=-2.463; P<0.0167 respectively\〗; The axis of astigmatism showed no statistical significance among different level of accommodation \〖20cm,(0.83DC±0.52D)>40cm,(0.78DC±0.43D)>5m, 0.63DC±0.47D)\〗; The near vision acuity when fixing at 40cm and 20cm were both increased significantly when accommodative astigmatism corrected(Z=-5.741, P<0.01; Z=-6.848, P<0.01, respectively).

CONCLUSION: The degree of astigmatism has a tendency of increasing when fixating at near, and astigmatism with the rule will be followed by the axis, while this change is random and personalized, asthenopia is more likely to appear at the distance of maxium astigmatism change, so correct the refractive error at near may be a appropriate method to treat asthenopia.