近視學童使用長效型散瞳劑對於其眼動能力與視覺功能之影響:眼動儀研究

The influences of atropine usage on ocular motility and visual function in myopic children: an eye tracking study

葉育仁(YU-JEN YEH)

指導教授 ： 郭蕙瑛

中山醫學大學/醫學科技學院/視光學系/碩士(2019年)

https://doi.org/10.6834/CSMU201900096

摘要

目的: 調查台灣學童使用長效型散瞳劑後對其雙眼視覺機能與閱讀時眼動表現之影響。
方法: 60位年齡介於7~12歲國小學童參與了本研究，所有受測者依據其是否使用近視控制藥物-阿托品(Atropine)分成兩個組別:點用組與未點用組。第一階段針對受測者的屈光狀態與視覺機能進行檢查，包括自覺式驗光、閱讀發展測驗、視覺機能等測驗。第二階段則為眼動儀測試，使用設備為Eyelink 2000眼動儀，閱讀距離為55公分，每位受測者需完成閱讀四篇文本(水平讀本兩套與垂直讀本各兩套)，在閱讀第一套的水平讀本與垂直讀本時，受測者配戴全矯正屈光度進行閱讀測驗，於第二套的水平讀本與垂直讀本則是配戴近距離加入度(near addition)後進行閱讀。
結果: 在近用的低對比視力值與近用視力值中，點用（阿托品）組與未點用（阿托品）組有顯著的差異(0.32 ± 0.13 vs. 0.17 ± 0.08 logMAR, p < 0.05; 0.10 ± 0.12 vs. 0.04 ± 0.05 logMAR, p < 0.05)，且其瞳孔大小與低對比視力值呈現中度正相關(r = 0.59, p < 0.01)。在視覺機能檢查結果發現，點用組其立體視覺相較於未點用較差(62.67 ± 33.31vs. 51.33 ± 22.09 秒角, p < 0.05)；而在眼動儀測試結果發現點用組不論是水平讀本或是垂直讀本，在閱讀時以近用加入度為變因，點用組會有較長的總躍視時間(水平讀本: 54.13 ± 3.72 vs. 47.07 ± 4.17 ms, p < 0.05；垂直讀本: 51.96 ± 3.58 vs. 37.56 ± 2.60 ms,p < 0.05)，但此現象在無點用組並無出現(水平讀本: 42.45 ± 3.72 vs. 53.03 ± 4.17 ms, p = 0.32；垂直讀本: 40.94 ± 3.58 vs. 40.43 ± 2.60 ms,p = 0.44)。
結論: 學童之視覺機能與閱讀表現皆受到近視控制藥物阿托品影響，包含視力值、眼球肌肉協調與瞳孔大小等因素間交互作用應慎重評估。瞳孔擴大造成過多的入光量造成近距離視力值下降且影響到立體視覺與閱讀時眼動表現，對於點用阿托品之學童在閱讀時因調節狀況不穩定造成閱讀時眼動的總躍視時間較長。本研究觀察到點用阿托品學童平均躍視時間較長之現象在停點阿托品後會有所改變仍是未知。

關鍵字

阿托品 ； 近視控制 ； 眼動能力 ； 眼動追蹤

並列摘要

Purpose: To investigate the effects of atropine use on ocular motility, binocular visual function, and reading performance in Taiwanese schoolchildren.
Methods: 60 children aged 7 to 12 years participated in the study. All the subjects were divided into two groups: the constantly using atropine group and the control group. The refractive status was determined based on the results of subjective refraction and primary reading ability was assessed using the DEM test. A variety of visual functions were measured binocularly for the children who are constantly using atropine to control their myopia progression and for those who don’t use. All the participants were assured that they had normal visual functions and DEM test results prior to the eye-tracking test. Four series of the articles were read (including 2 horizontal and 2 vertical articles. In which, the first series of the horizontal and vertical articles were read with their distant corrections, and the second series were read while wearing near addition lenses. The reading performance was recorded by using the equipment of Eyelink 2000 eye-tracker.
Results: There were significant differences in low contrast (10%) and high contrast near visual acuities between the atropine group and their controls (0.32 ± 0.13 vs. 0.17 ± 0.08 logMAR, p < 0.05; 0.10 ± 0.12 vs. 0.04 ± 0.05 logMAR, p < 0.05). A moderate correlation was found between pupil size and low contrast near visual acuity (r = 0.59, p < 0.01), and stereopsis was also reduced in the children who received atropine medications (the atropine group vs. the control group: 62.67 ± 33.31vs. 51.33 ± 22.09 arc, p < 0.05). For the eye-tracking results, Using near addional lens as an independent variable, the atropine group had a significant longer saccadic duration for both article formats (horizontal: 54.13 ± 3.72 vs. 47.07 ± 4.17 ms, p < 0.05；vertical:51.96 ± 3.58 vs. 37.56 ± 2.60 ms, p < 0.05). However, the significant difference no longer existed in the without atropine group. (horizontal:42.45 ± 3.72 vs. 53.03 ± 4.17 ms, p = 0.32；vertical: 40.94 ± 3.58 vs. 40.43 ± 2.60 ms, p = 0.44)
Conclusion: Visual functions and reading behavior in children would be affected by atropine administration. The interactions of visual clarity, muscle strength and pupil size should be concerned. Pupil dilation caused too much illumination which would influence children’s near visual performance not only on visual acuity but also on stereopsis and eye movement in reading. In the research we found that children with atropine had longer saccadic duration in reading because their accommodative condition wasn’t stable. Whether the prolonged duration remains after stop using atropine is still unknown.

並列關鍵字

atropine ； myopia control ； eye motor function ； eye tracking

參考文獻

1. Lin, L., Prevalence of Myopia in Taiwanese Schoolchildren: 1983 to 2000. 2004.

2. Theophanous, C., et al., Myopia prevalence and risk factors in children. Clin Ophthalmol, 2018. 12: p. 1581-1587.

3. Holden, B., IMPACT OF INCREASING PREVALENCEOF MYOPIA. March 2015.

4. Yip, V.C., et al., The relationship between growth spurts and myopia in Singapore children. Invest Ophthalmol Vis Sci, 2012. 53(13): p. 7961-6.

5. Mutti, D.O., K. Zadnik, and A.J. Adams, Myopia. The nature versus nurture debate goes on. Invest Ophthalmol Vis Sci, 1996. 37(6): p. 952-7.