不同設計的多焦點隱形眼鏡對於調節下降之成人眼表狀態、視覺品質與視覺功能影響

The Effect on Ocular Surface, Visual Quality and Visual Function of Different Multifocal Contact Lenses Designs in Accommodation Decreased Adults

張鈺雯(Yu-Wen Chang)

指導教授 ： 鄭靜瑩

共同指導教授 ： 蕭清仁(Ching-Jen Hsiao)

中山醫學大學/醫學科技學院/視光學系/碩士(2021年)

https://doi.org/10.6834/csmu202100107

摘要

研究目的
隨著資訊科技發達與隱形眼鏡配戴普及化，針對調節力下降且眼睛易乾澀的族群，鏡片挑選相較於一般人困難許多，故本篇研究欲探討配戴不同設計與不同材質之多焦隱形眼鏡後，附加帶給眼睛表面以及視覺方面的影響。

研究方法
本研究招收年齡為40至55歲之初期老花成年人，將受試者隨機分配至三組配戴不同設計之隱形眼鏡，持續配戴兩週，且一天至少配戴6-8小時，分別於鏡片配戴前與後測量其眼表狀況、視覺品質與視覺功能的影響，包含結膜與輪部發紅程度、角膜螢光染色、接觸式與非接觸式淚膜破裂時間、淚液油脂層分析、眨眼頻率、調製傳遞函數、主觀問卷調查(眼表疾病指數量表、視覺行為表現量表、乾眼問卷調查、隱形眼鏡配戴乾眼問卷)、眼調節力、立體視覺以及對比敏感度檢測，共14項檢測項目，最後透過IBM SPSS Statistic v.22統計軟體分析表較。

研究結果
結果顯示配戴隱形眼鏡前與配戴兩週後，對於結膜發紅程度、眨眼頻率、眼表疾病指數量表、乾眼相關問卷調查以及視覺功能的部份，三組鏡片與不同時間的測量皆無顯著差異。從統計分析中，可以發現鏡片配戴後輪部發紅程度與角膜受損螢光染色的測得值雖皆落於正常範圍內，但仍有上升的趨勢；且配戴鏡片對於角膜前表面與鏡片前表面淚液具有一定的負面影響，兩者於配戴鏡片一週後，非接觸式淚液破裂時間與油脂層厚度的部份，皆有下降的趨勢呈現，尤其為鏡面前表面的淚液變化更為明顯，且以鏡片二下降量最多。
總像差區域範圍之調製傳遞函數的部份，於配戴鏡片後測量皆具有顯著提升的效果，而高階像差區域範圍之調製傳遞函數的部份，配戴鏡片的結果皆比裸時測得的還低。主觀問卷調查結果顯示：視覺行為量表的肢體平衡向度，於鏡片配戴後三組鏡片皆有顯著的改善，且可以從乾眼相關問卷調查中發現，對於眼睛原本較易乾澀、不適的族群，於配戴鏡片後有改善的趨勢。雖然研究的三組隱形眼鏡設計與材質大不相同，但於本次為期兩週的實驗結果呈現，三組之間的影響差異皆不大。

結論與討論
雖然較難避免鏡片配戴對於眼表與淚液的部份具有一定的負面影響，但若能具備良好的配戴方式與鏡片保養觀念，對於眼睛健康及視覺品質方面的影響是有正向改善的效果。未來或許可針對分析不同設計的鏡片較適用於那些族群來做探討，期待可以提供更多有效的鏡片配適參考依據，以減少配戴隱形眼鏡族群的抱怨，也可讓調節力下降之成人矯正眼睛屈光不正多一種選擇方式。

關鍵字

漸進多焦隱形眼鏡 ； 乾眼症 ； 眼表狀況 ； 視覺品質 ； 視覺功能

並列摘要

Purpose
The contact lens has become more popular with the development of information technology. However, it is more difficult for the accommodation reduced and dry eyes people to select contact lenses than the general population. This study explores the effect on the ocular surface and the visual impact by wearing different designs and different materials of multifocal contact lenses.

Methods
The study enrolled presbyopia adults age from 40 to 55 years old. The subjects were randomly assigned to three groups wearing contact lenses of different designs for two weeks and wearing them 6-8 hours per day. The effects on the ocular surface, visual quality, and visual function were measured before and after the lens wearing. There was a total of 14 detection items, including the redness degree of limbus and conjunctiva, corneal staining, tear film break-up time(TBUT), Non-invasive tear break-up time (NI-TBUT), the lipid layer thickness of tear film, blink frequency, modulation transfer function(MTF), the subjective questionnaire of Ocular Surface Disease Index(OSDI), Dry eye Questionnaire-5(DEQ-5), Visual Behavior Performance(CSMU-VBP), Contact Lens Questionnaire-8(CLDEQ-8), the amplitude of accommodation(AA), stereo vision and visual contrast sensitivity. All the measurements were evaluated and compared by using the IBMSPSS Statistics v.22.

Results
The results showed no significant difference between the redness degree of conjunctiva, blink frequency, Ocular Surface Disease Index(OSDI), Dry eye questionnaire, and the Visual Function before and after wearing the contact lenses two weeks. From the statistical analysis, it can be found that, although the measured data of the corneal staining damaged and the limbal redness after the wearing was within normal range, there was an upward trend. Non-invasive tear break-up time and lipid layer thickness of the pre and post lens tear film (the tear film of lens surface and the cornea surface) showed a downward trend after wearing contact lenses for a week, especially the pre-lens tear film, with group 2 lens decreasing the most.
In the modulation transfer function of the total area ratio, there was a significant improvement after wearing the lenses. On the other hand, the modulation transfer function of the high-order aberration area ratio resulted from wearing lenses was lower than that of the naked eye. The results of the subjective questionnaire showed that the Visual Behavior Performance in the body balance dimension, all three groups of lenses, had significantly improved after wearing. And, also it can be found from the dry eye-related questionnaire that the people with dry or discomfort eyes showed a more improved trend after wearing the lenses. Although the design and material of the three groups of contact lenses in the study were quite different, the results of the two-week experiment showed that there were not many different influences in all three groups.

Discussion
Although it is difficult to avoid a specific negative impact on the ocular surface and tear film with contact lens wearing, one can still positively improve eye health and visual quality if one can have a proper lens fitting, wearing modality, and lens care regimens. More studies can be done in the future to explore what types of contact lenses design are suitable for people of various kinds of conditions, provide more references for contact lens fitting, reduce the complaints of contact lens wearing, and give presbyopic adults more choices to correct their refractive errors.

並列關鍵字

Multifocal Contact Lenses ； Ocular Surface ； Visual Quality ； Visual Function

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