- 學位論文
運用新型近眼顯示系統量測成年人視覺功能
The measurement of visual function in adults using the near eye display system
摘要
研究目的 比較新型近眼顯示系統與臨床常用的視覺功能檢查方式之間的差異與一致性，並且比較兩種系統視標觀看感受度之存在感。 研究方法 本研究招募34位無眼睛相關疾病的健康成年人（年紀範圍：20至25歲）。視覺功能檢查前執行眼睛相關包含立體視、眼睛屈光度數等檢測，而視覺功能檢查皆配戴矯正等價球面度之隱形眼鏡來進行量測。視覺功能檢查包含：眼位、融像能力、調節幅度，視覺功能檢查後進行存在感問卷以評估新型近眼顯示系統與傳統方式所呈現的視標之差異。 研究結果 在水平眼位方面，新型近眼顯示系統在遠距離量測與遮蓋測驗有較高一致性 (ICC = 0.298, -0.051 ~ 0.582)；而在近距離檢測與von Graefe測驗一致性較高 (ICC = 0.009, -0.381 ~ 0.396)。垂直眼位方面，新型近眼顯示系統在遠、近距離量測與改良式稍靈頓測驗有較高一致性（遠距離：ICC = 0.263, -0.089 ~ 0.557；近距離：ICC = 0.421, 0.039 ~ 0.695）。在遠距離負融像能力，新型近眼顯示系統在模糊點及回復點量測與階段式測量法有較高一致性（模糊點：ICC = 0.317, -0.030 ~ 0.596；回復點：ICC = 0.641, 0.381 ~ 0.807）；而破裂點與漸進式測量法一致性較高 (ICC = 0.674, 0.430 ~ 0.826)；在遠距離正融像能力，新型近眼顯示系統在模糊點及回復點量測與漸進式測量法有較高一致性（模糊點：ICC = 0.409, 0.076 ~ 0.660；回復點：ICC = 0.268, -0.110 ~ 0.579），而破裂點與階段式測量法一致性較高 (ICC = 0.332, -0.013 ~ 0.607)。在遠距離垂直融像能力，新型近眼顯示系統在破裂點及回復點量測與階段式測量法有較高一致性（向下破裂點：ICC = 0.501, 0.190 ~ 0.721；向下回復點：ICC = 0.537, 0.237 ~ 0.744；向上破裂點：ICC = 0.171, -0.184 ~ 0.486；向上回復點：ICC = 0.325, -0.021 ~ 0.602）。在近距離負融像能力，新型近眼顯示系統在模糊點、破裂點及回復點量測與漸進式測量法有較高一致性（模糊點：ICC = 0.424, 0.001 ~ 0.718；破裂點：ICC = 0.323, -0.115 ~ 0.656；回復點：ICC = 0.064, -0.432 ~ 0.530）；在近距離正融像能力，新型近眼顯示系統在模糊點及回復點量測與漸進式測量法有較高一致性（模糊點：ICC = 0.068, -0.366 ~ 0.477；回復點：ICC = 0.364, -0.184 ~ 0.740），而破裂點與階段式測量法一致性較高 (ICC = 0.471, 0.060 ~ 0.745)。在近距離向下垂直融像能力，新型近眼顯示系統在破裂點及回復點量測與漸進式測量法有較高一致性（破裂點：ICC = 0.359, -0.076~ 0.679；回復點：ICC = 0.389, -0.041 ~ 0.697）；在近距離向上垂直融像能力，新型近眼顯示系統在破裂點量測與漸進式測量法有較高一致性 (ICC = 0.351, -0.084 ~ 0.674)，而回復點與階段式測量法一致性較高 (ICC = 0.025, -0.402 ~ 0.443)。在調節幅度方面，新型近眼顯示系統量測與兩種測驗一致性差異不大，而存在感問卷平均分數在新型近眼顯示系統與傳統檢測法接近。 結論 本研究為第一個以新型近眼顯示系統量測視覺功能測驗並與的傳統視覺功能檢查比較之研究。根據研究結果可得知各視覺功能檢測上，相比傳統方式不論在平均差異或是可靠程度仍未達到臨床可接受誤差範圍內，未來還有許多地方可以修正及改進。但受測者對於種系統視標觀看感受度間無主觀上的差異，表示本研究設計之視標接近傳統檢測方式。
並列摘要
Purpose: To examine the differences and consistency between new near eye display (NED) system and routine clinical visual function examinations, and to evaluate the presence of the optotypes of the two systems. Methods: 34 young adults without any ocular disease were recruited (age range: 20 ~ 25 y/o). Before the formal visual function tests, stereopsis test and refraction measurement were performed for all the subjects. Soft contact lenses of spherical equivalents power were applied for both eyes during the formal visual function testing for correcting their refractive errors. A series of visual function tests were performed, including phoria status, vergence ranges and amplitude of accommodation by using traditional methods and the NED system. And the difference between the traditional and the NED system was also evaluated by a presence questionnaire. Results: In horizontal phoria, new NED system had a higher agreement with cover test (ICC= 0.298, -0.051 ~ 0.582) at distance, however, it had a higher agreement with von Graefe test at near (ICC= 0.009, -0.381 ~ 0.396). In vertical phoria, new NED system showed higher consistencies with modified Thorington test (at distance: ICC= 0.263, -0.089 ~ 0.557; at near: ICC= 0.421, 0.039 ~ 0.695). At the distance negative fusional vergence, a high agreement was indicated between step vergence method and new NED system in blur and recovery points (blur: ICC= 0.317, -0.030 ~ 0.596; recovery: ICC= 0.641, 0.381 ~ 0.807), whereas break point had higher agreement with smooth vergence method (ICC = 0.674, 0.430 ~ 0.826). Both blur and recovery points of new NED system showed a higher consistency with smooth vergence method in distance positive fusional vergence (blur: ICC= 0.409, 0.076 ~ 0.660; recovery: ICC= 0.268, -0.110 ~ 0.579), In contrast, a high agreement was found between break point and step vergence method (ICC= 0.332, -0.013 ~ 0.607). As for distance vertical fusional vergence, new NED system in break and recovery points showed a good agreement with step vergence method (break point of infra direction: ICC= 0.501, 0.190 ~ 0.721; recovery point of infra direction: ICC= 0.537, 0.237 ~ 0.744; break point of supra direction: ICC= 0.171, -0.184 ~ 0.486; recovery point of supra direction: ICC= 0.325, -0.021 ~ 0.602). In near negative fusional vergence, new NED system in blur, break and recovery points had higher agreements with smooth vergence method (blur: ICC= 0.424, 0.001-0.718; break: ICC= 0.323, -0.115 ~ 0.656; recovery: ICC= 0.064, -0.432 ~ 0.530). Compared to near positive fusional vergence, a high consistency was found between new NED system in blur and recovery points and smooth vergence method (blur: ICC= 0.068, -0.366 ~ 0.477; recovery: ICC= 0.364, -0.184 ~ 0.740). However, break point had higher agreement with step vergence method (ICC= 0.471, 0.060 ~ 0.745). Both break and recovery points in new NED system showed a good agreement with smooth vergence method in near infra fusional vergence (break: ICC= 0.359, -0.076 ~ 0.679; recovery: ICC= 0.389, -0.041 ~ 0.697). In near supra fusional vergence, new NED system in break point had higher agreement with smooth vergence method (ICC= 0.351, -0.084 ~ 0.674), whereas recovery point indicated a higher consistency with step vergence method (ICC= 0.025, -0.402 ~ 0.443). Nevertheless, amplitude of accommodation in new NED system wasn’t different from the agreement between the two traditional measures. In addition, the mean score of presence questionnaire indicated that the optotypes of the two systems were similar. Conclusion: Our study conducted the first experiment of visual function measurement with new near eye display system. However, the results of visual function obtained with the new near eye display system was not precise enough and in an optimal agreement with clinical methods. Therefore, the new near eye display system may provide a new paradigm to visual function assessment after improvement in the future.