- 學位論文
評估植入非球面人工水晶體對視覺品質影響
Comparison of visual quality in spherical and aspherical intraocular lenses
摘要
目的：比較白內障術後一眼植入球面人工水晶體而另一眼植入非球面人工水晶體，與雙眼皆植入球面人工水晶體和雙眼皆植入非球面人工水晶體之視覺表現。 方法：本研究將受測者分為三組，三組皆接受白內障摘除術，AA組為兩眼皆植入非球面(aspheric)人工水晶體，SS組為兩眼皆植入球面(spherical)人工水晶體，而AS組則是一眼植入非球面而另一眼植入球面人工水晶體。使用Snellen E視標在2.5公尺處進行遠距離視力檢查，分別量測單、雙眼的未矯正視力以及單、雙眼的最佳矯正視力，以LogMAR為單位進行比較。最佳矯正處方之視力為基準使用鏡片產生離焦狀態(+1.00 D至-4.00 D)模擬不同距離視力並繪製離焦曲線(Defocus curve)。使用ETDRS視標卡分別在66公分以及40公分處進行中、近距離視力的檢查；眩光測驗使用軟體Halo v1.0進行檢測。Pelli-Robson對比敏感度檢測表進行對比敏感度的檢測，立體視覺則使用Butterfly Titmus stereo test立體視力本。對於視覺症狀，使用QOV (Quality Of Vision)問卷對受測者進行調查，眼鏡依賴度則使用PRSIQ (Patient-Reported Spectacle Independence Questionnaire)問卷進行調查。 結果：本研究共收集20名雙眼非球面(AA組)、20名雙眼球面(SS組)以及6名一眼球面一眼非球面(AS組)的受測者數據，平均年齡為68.8 ± 7.62歲，介於43至81歲之間。離焦曲線(-4.00 D至+1.00 D)中，在大部分離焦刺激下，三組間視力無統計上顯著差異；除在離焦刺激-2.50 D中，AA組視力表現比AS組之間達到統計上顯著較佳(AA：0.26 ± 0.10 LogMAR VS SS：0.30 ± 0.08 LogMAR, p = 0.033)。中距離(p = 0.445)以及近距離(p = 0.761)視力檢查結果顯示三組之間未達到顯著差異。眩光測驗(p = 0.219)以及對比敏感度檢查(p = 0.906)三組之間取得相似的結果。使用卡方檢定分析三組之間立體視覺的分布情況，顯示三組之間亦沒有統計上顯著差異(p = 0.181)。視覺品質問卷結果顯示三組獲得的分數相似(p = 0.922)，眼鏡獨立性問卷中三組在是否配戴眼鏡的比例上沒有差異，且都有著相似的眼鏡配戴頻率以及不配戴眼鏡時視物的舒適程度(p > 0.05)。 結論：相較於雙眼置換非球面水晶體的患者，一眼非球面一眼球面的患者雖然也能達到預期日常生活所需的視覺品質，但可能在近距離下的視力有較差的趨勢。
並列摘要
Purpose: To compare the quality of vision and the differences in visual function in patients with bilateral spherical or aspheric intraocular lenses (IOL) and those with an aspheric IOL in one eye and a spherical IOL in the contralateral eye. Methods: Patients who underwent cataract surgery were assigned, based on the implanted IOLs, into three groups: AA, bilateral aspheric IOLs; SS, bilateral spherical IOLs; and AS, an aspheric IOL in one eye and a spherical IOL in the contralateral eye. Three months postoperatively, binocular uncorrected and best-corrected distance, uncorrected-distance and best-distance-corrected near, and best-corrected intermediate visual acuities and the defocus curve were measured in the three study groups. The halo test was performed using Halo v1.0. Contrast sensitivity and stereo acuity were measured using the Pelli–Robson contrast sensitivity chart and Butterfly Titmus stereo test, respectively. The QOV and Patient-Reported Spectacle Independence Questionnaires were used to evaluate the quality of vision and independence of spectacle, respectively. Results: In this cohort (age, mean ± SD [range]: 68.8 ± 7.62 [43–81] years), 20, 20, and 6 participants in the AA, SS, and AS group, respectively, completed the examination. No significant intergroup difference was detected in most of the defocus stimuli from +1.00 to −4.00 D, except that, at −2.50 D, the AA group had significantly better VA than the AS group (LogMAR: 0.26 ± 0.10 vs. 0.30 ± 0.08, p = 0.033). There was no significant intergroup difference in the intermediate and near VA (p = 0.445 and p = 0.761, respectively), the halo test (p = 0.219), contrast sensitivity (p = 0.906), and stereopsis (p = 0.181). All groups has similar QOV scores (p = 0.922). There was no significant intergroup difference in the frequency of wearing spectacles and functioning comfortably without spectacles (p > 0.05). Conclusion: Despite similar visual function and quality of daily activities in patients with aspheric IOL in one eye and spherical IOL in the contralateral eye and those with bilateral IOLs, a trend of decreasing near visual acuity was identified.