臨床分析漸進鏡片矯正老花的配鏡以及視覺問題

適應以及舒適感一直以來都是漸進鏡片最常抱怨的視覺問題。因此，本研究將以台灣老花患者進行試驗，探討分析漸進鏡片矯正老花的配鏡及其視覺問題，以作為臨床的參考。本研究以54位選配漸進鏡片的老花患者隨機試戴單焦點鏡片 (SF) 以及HOYA summit CD ( CD) 、HOYA summit CD True Form (TF) 和HOYALUX FD (FD) 等三種漸進鏡片，測量鏡片的明視域。另外，本研究亦隨機提供三種不同的漸進鏡片處方觀察研究提供的視力檢查圖表，包括最佳矯正的漸進處方 (FC) 、漸進處方遠用區＋0.25 D (UC1) 和漸進處方遠用區＋0.50D (UC2) ，評估患者的遠、中、近距的視覺表現，確認這三種處方哪一種可以提供患者一個更好的視覺感受。另外，本研究還觀察記錄患者進行注視和左右注視轉移60°時患者的注視行為和頭部姿勢。由於本研究為患者的臨床配鏡試驗，因此，患者適應後患者除了需要填寫有關配戴結果的問卷外，還須接受配鏡後的明視域和整體視覺評估。研究結果發現鏡片的明視域範圍以SF鏡片最寬，其次為FD鏡片，再其次為T F鏡片，CD鏡片的範圍比較窄。相同的鏡片，個體之間的明視域範圍差距很大。三種處方的遠、中距整體視覺比較有顯著差異，患者認為FC處方的遠、中距視覺比較清晰。近距的整體視覺比較三種處方也有顯著差異，患者認為UC2處方的近距視覺更為鮮明。還有，研究發現，加入度數與近距的景深 (deep of field) 遠點有顯著性的負相關，意即加入度數越高，近距的景深遠點與眼球距離越近。屈光度數與景深近點有顯著性的正相關，也就是負的屈光度數越高，近距景深近點與眼球距離越近。另外，不同類型的漸進鏡片與加入度處方，鏡片的周邊視覺患者反映不一。問卷結果發現，遠方視時，患者的頭部移動和視覺影像無顯著關係；近距工作時，患者的頭部移動和視覺影像有顯著關係。需要顧及遠、中及近距視覺患者建議選擇FC處方，以中、近為主要訴求的患者建議給予UC2處方。高度近視患者可能擁有較多的景深幅度，高加入度患者有較少的景深幅度，這些都是給予患者加入度處方時需要審慎考量的變數。另外高加入度的患者在近距工作時可能需要有較多頭部的動作，這也是必須提醒患者的注意事項。因此，以舒適度和較少的頭部移動為考量，建議患者選擇明視域較寬的漸進鏡片。

關鍵字

漸進鏡片； free form ；老花

並列摘要

The practice shows that visual discomfort and difficulty in adapting Progressive Addition Lens (PALs) were the most common visual complaints of PAL wearers. The objective of this study is to analyze the fitting of PALs and visual problems associate with presbyopic correction in Taiwan. The results obtained from this study may enable for eye care practitioners to reference. 54 patients showed a preference of PALs were recruited in this study and randomly given four types of trial lenses including single-focus lens (SF)、HOYA summit CD ( CD)、HOYA summit CD True Form (TF) and HOYALUX FD (FD) to measure the range of the clear vision with these lenses . In addition, three types of PALs with different prescription were randomly offered to the patients, including the best correction with addition (FC) and added +0.25 D in the far region to the prescription (UC1) and added +0.50 D in the far region to the prescription (UC2). Compare their overall visual performance when viewing a picture with optotypes offered by this study placed in the far, middle and near distance. The object of this assessment is to determine which prescription can provide the best overall visual performance for patients. Furthermore, the patient’s head posture and visual behavior were observed and recorded when viewing the picture and gaze shifts to the other pictures placed on the periphery of right and left wall. The angle the gaze shifted was 60°. Owing to this study associated with patient’s dispensing, hence, time after dispensing when the patient has adapted to their PALs, the range of clear vision and overall visual performance of their PALs were measured and assessed and questionnaires has to be filled out. The results show that the range of clear vision of SF lenses were the greatest, FD lenses were the second greatest, TF lenses were the third, and CD lenses were the least wide. The range of clear vision differs greatly with the same type of lenses between individual users. There was a significant difference in the overall visual performance between the three prescriptions at the far and middle distances. The patient reported the FC having better visual performance. There was also a significant difference in the overall visual performance at near. The patient reported the UC2 having the best visual performance at near. In addition, a significant negative correlation between the addition prescription and the far point of depth of field was found, that is, the more addition description, the close the far point of the depth of field to the eye ball. And there was a significant positive correlation between myopia and near point of depth of field, which is, the higher diopters of myopia, the closer the near point of deep of field to the eye ball. In addition, different types of PALs and addition description, the visual performance varied in the peripheral of the PALs when the patient viewing through the lenses. According to the questionnaire, frequent head movement was not associated with the visual image when the patient looking at distance, and frequent head movement was associated with the visual image when the patient working at near distance. Patients who need clear vision at far, middle and near distances are advised to choose the FC. And recommend the FC2 for office field work to achieve better comfort and patients with high myopia may have more depth of field, patients with high addition may have less of field. These are variables practitioners need to consider when prescribing presbyopic addition to the patient. In addition, it is important to remind the patient that high addition needs more head movement when working at near. Therefore, we recommend patients choose a pair of PALs with wide range of clear vision for a less head movement and comfort.