老花眼不同矯正方式之比較

Comparison of different solutions for presbyopia

林怡萱(I-Hsuan Lin)

指導教授 ： 陳賢堂

中山醫學大學/醫學科技學院/視光學系/碩士(2022年)

https://doi.org/10.6834/csmu202100283

摘要

目的
隨著人口結構的改變，未來將面臨一個高齡化的社會，因此老花眼矯正是個不容忽視的問題。本研究之目的為探討兩種隱形眼鏡矯正老花眼之主觀及客觀視覺表現，日常用眼評估、對老花眼認知之評估、對配戴者之選擇及如何提高驗配成功率。

方法
本實驗總共納入44位40歲以上的受測者，隨機分成兩組分別配戴多焦點隱形眼鏡及單眼視隱形眼鏡，在基線、初次配戴及持續配戴兩週後的三次檢查，都測量遠近視力、立體視、及對比敏感度，並以問卷作為實驗後測，統計以IBM SPSS Statistic v.26軟體分析比較客觀視覺功能之變化。

結果
結果顯示兩種矯正老花眼不同方式之隱形眼鏡的遠距視力在三次測量無統計學上的顯著差異。在近距視力，多焦點隱形眼鏡的基線與初次配戴（p = 0.004）、基線與配戴兩週後（p = 0.002）皆有顯著差異，顯示配戴多焦點隱形眼鏡使近距視力下降，且經適應兩週後沒有提升 ; 單眼視組的基線與初次配戴得到顯著差異（p = 0.004），配戴兩週後與初次配戴也有顯著差異（p = 0.046），顯示配戴單視法隱形眼鏡初期近距視力下降，但經兩週適應期後提升至接近基線。兩種隱形眼鏡在立體視檢測上，下降皆具統計學上顯著差異（皆為p = 0.000），並且在適應兩週後沒有提升。在對比敏感度，多焦點隱形眼鏡組於高頻對比度（18cpd）初次配戴顯著下降（p = 0.018），但在兩週適應期後回升 ; 單眼視組則在配戴兩週後在低頻對比度（3cpd）顯著優於初次配戴（p = 0.045），而中頻對比度（6cpd）顯著優於基線與初次配戴（p = 0.026）。另外，在主觀視覺感受得分上，線性迴歸顯示兩種矯正方式的主觀感受得分與年齡及加入度無關。但在多焦點隱形眼鏡組中，主觀感受得分與近距視力及高頻對比度（18cpd）呈現正相關，與遠距視力呈現負相關，在單眼視覺組中沒有發現主觀視覺感受與客觀視覺檢測的相關。在本研究中，兩種矯正老花眼方式的成功率皆為86%，並且主要工作距離、近距用眼時間及戶外活動時間不影響偏好。

結論
患者的主觀感受是決定配戴成功與否的主要關鍵，因此在驗配老花隱形眼鏡時，溝通與依據患者需求試戴調整度數是必要的。另外，不要受限於對較高年齡或加入度可能效果不佳的既定刻板印象，只要眼生理健康，有配戴需求，經過詳細的驗光檢查與試戴調整，高齡者也可以是老花眼隱形眼鏡的合適人選。

關鍵字

老花眼矯正 ； 多焦點隱形眼鏡 ； 單眼視覺法 ； 視覺功能表現 ； 主觀視覺感受

並列摘要

Purpose
With the changing demographic structure, the world will face an aging society in the future and therefore presbyopia correction is a problem that should not be ignored. The purpose of this study was to investigate the subjective and objective visual performance of two types of contact lenses for presbyopia , assessment of personal lifestyle and knowledge of presbyopia , and how to select the wearers and to improve the success rate of fitting.

Methods
A total of 44 subjects aged 40 years or older were randomly divided into two groups to wear multifocal contact lenses and monovision contact lenses., and their distance and near vision, stereopsis, and contrast sensitivity were measured three times at baseline, initial wear, and after two weeks of continuous wear. Questionnaires were taken as posttest. Statistics were analyzed by IBM SPSS Statistic v.26 software to compare the changes in objective visual function.

Results
The results showed no statistically significant differences in distance visual acuity between the two contact lens modalities for presbyopia correction by the three measurements. For near vision, there were significant differences between baseline and initial wear (p = 0.004) and between baseline and two-week wear (p = 0.002) for multifocal contact lenses, indicating that near vision decreases with multifocal contact lenses and does not improve after two weeks of adaptation; for the monovision group, there were significant differences between baseline and initial wear (p = 0.004) and between two-week wear and initial wear (p = 0.046), indicating that near vision decreased initially with monovision contact lenses, but improved to near baseline after a two-week of wearing. Both contact lenses showed a statistically significant decrease in stereo vision testing (p = 0.000 for both) and did not improve after two weeks of adaptation. In terms of contrast sensitivity, the multifocal contact lens group showed a significant decrease in high-frequency contrast (18 cpd) at initial wear (p = 0.018), but rebounded after the two-week adaptation period; the monovision group showed a significant improvement in low-frequency contrast (3 cpd) after two weeks of wear (p = 0.045), and medium-frequency contrast (6 cpd) showed signification improvement compared to baseline and initial wear (p = 0.026). In addition, the linear regression showed that the subjective perception scores of both correction methods were independent of age and add-lens level. However, in the multifocal contact lens group, subjective perception scores were positively correlated with near visual acuity and high-frequency contrast (18cpd) and negatively correlated with distance visual acuity, but no correlation between subjective visual perception and objective visual testing was found in the monocular vision group. In this study, the success rate of both presbyopia fitting options were 86%, and the primary working distance, working hours and outdoor activity time did not affect the preference.

Conclusion
The patient's subjective perception is the main key to successful fitting. Therefore, when fitting presbyopic contact lenses, communication and trial adjustments according to the patient's needs are necessary. In addition, do not be limited by the stereotypes that higher age or add power prescriptions may not be effective, as long as the eye physiological is healthy and there is a need to wear them, elderly can be suitable candidates for presbyopic contact lenses after detailed optometric examinations and trial adjustments.

並列關鍵字

presbyopia correction ； multifocal contact lens ； monocular vision method ； visual function performance ； subjective visual perception

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