影響弱視孩童視力進步之因素探討

Vision Improvement in Amblyopic Children-Factors Study and Analysis

陳芷郁(Chih-Yu Chen) ； 林隆光(Luke L. K. Lin) ； 施永豐(Yung-Feng Shih)

《中華民國眼科醫學會雜誌》 43卷3期 (2004/09) Pp. 178-186

https://doi.org/10.30048/ACTASOS.200409.0006

摘要

研究背景與目的：探討影響弱視治療之因素與弱視治療視力進步的關係。
研究方法：這是一個回溯性病歷研究。自1995-2001年間，台大醫院弱視特別門診選出符合弱視條件、在臺大醫院起始治療且完成弱視療程弱視孩童共242位。研究屈光異常程度、初診時年紀、初診最佳矯正視力、配合度好壞、立體感有無等；及最終最佳矯正視力與弱視原因有無相關。
結果：在近視組與斜視組有較差的初診最佳矯正視力，而散光組有較好的初診最佳矯正視力。治療結果以達到視力0.5為標準時：近視組平均需治療15.7個月，較其他組平均約需7-8個月為久。若以達到視力0.9為標準：仍是近視組最差，近四分之三(75%)達不到此標準；斜視組與不等視組約四分之一達不到此標準（分別為：28.3%，22.2%），散光組14.8%及遠視組6.9%達不到視力0.9的標準。初診視力亦可影響治療之預後；初診最佳矯正視力小於或等於視力0.2者，達不到視力0.9者佔三分之一(33.3%)，而初診最佳矯正視力大於視力0.2者，達不到視力0.9佔15.2%。只有在斜視組且視力大於0.2者，其預後與年齡分組有統計差別。年齡小於5.5歲者，100%（14位）治療後視力可達到0.9或以上；而大於5.5歲（斜視組病人皆小於8歲）者，只有61.5%（8位）治療後視力可達到0.9或以上。另外，視力進步速率在依弱視原因分組各組間並無統計上差別。
結論：視力進步的預後，與弱視的原因分組及初診最佳矯正視力有關，而此兩因素彼此也有關連。

並列摘要

Purpose: To study the factors that may affect the amblyopia treatment including initial visual acuity, causes of amblyopia, the age of starting therapy, refractive error and existence of stereopsis.
Methods: This study was a retrospective chart-review study. Two hundreds and forty-two patients were selected from Strabismus-Amblyopic Clinic at National Taiwan University Hospital (NTUH). The study criteria were amblyopic children with strabismus, anisometropia or high refractive error, no organic disease in the eye, no prematurity, and no other developmental problems.
Results: The strabismus group and the high myopic group had poor initial visual acuity and the astigmatic group had better initial visual acuity. Patients with existence of stereopsis had better initial visual acuity. In hyperopic group, the higher of refractive error had lower initial visual acuity. But such corelation was not find in other groups. The myopic group and strabismus group had lower ratio to reach 0.9 snellen visual acuity level. And the amblyopic group with initial visual acuity lower than 0.2, had higher failure rate to reach 0.9 snellen visual acuity level than the group with the initial visual acuity better than 0.2. The group with no stereopsis had higher failure rate to reach the 0.9 snellen visual acuity level. There is no significant difference in visual improvement among groups of different causes of amblyopia. The group of younger than eight years old had faster improvement rate than the group of age older than eight years old. The mean improvement rate was around 1.1 LogMAR lines over three months.
Conclusions: The cause of amblyopia was an important factor in visual improvement of amblyopic children. The myopic group and strabismus group had significant lower proportion to reach better final visual acuity after therapy. However, the hyperopic group had more proportion to achieve better visual acuity after therapy.

並列關鍵字

Amblyopia ； Vision improvement