不同材質多焦點隱形眼鏡對老花眼成人淚膜穩定性與視覺品質之影響

The effect of various multifocal contact lens materials on the tear and visual quality in presbyopic patients

林鴻隆(Hung-Lung Lin)

指導教授 ： 蕭清仁

共同指導教授 ： 鄭靜瑩(Ching-Ying Cheng)

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/csmu202100155

摘要

目的
臺灣的社會目前已逐漸進入老齡化的結構，在40歲以後就容易出現老花眼的現象，且生理結構逐漸退化。藉由研究中的兩款多焦點隱形眼鏡對於改善老花眼伴隨的淚水問題與逐漸下降的看近能力，探討配戴時主觀與客觀的研究結果，若能應用於提高老花眼族群的視覺品質，則可以降低整體社會成本，此為本研究的核心目的。
方法
本研究招募20位40歲以上的受試者，年齡介於40~55歲，遠方與近方的單眼個別最佳矯正視力皆在0.8以上。研究鏡片為軟式多焦點隱形眼鏡和大直徑硬式多焦點隱形眼鏡(鞏膜鏡)，主要依變項為淚膜品質與視覺品質之變化。主觀檢查項目為視覺行為表現問卷(CSMU VBP,2020)與眼表疾病指數量表(OSDI)，客觀檢查項目為淚膜破裂時間、眨眼頻率、戴鏡遠近方視力、調製傳遞函數、調節幅度與立體視。研究結果以SPSS V22.0進行統計分析，本研究遵從赫爾辛基宣言規範並通過中山醫學大學附設醫院第二人體實驗委員會審查（許可案號：CS2-20089）。
結果
配戴硬式多焦點隱形眼鏡無論在淚膜破裂時間、眨眼頻率、及OSDI中的表現皆優於基線值與軟式多焦點隱形眼鏡；在視覺品質分析中，配戴軟或硬式多焦點隱形眼鏡的雙眼視力值皆優於單眼視力，調製傳遞函數在高階像差的測量結果高於基線值並達到顯著差異，在立體視的部分則沒有明顯變化。配戴硬式多焦點隱形眼鏡的整體表現優於軟式多焦點隱形眼鏡，尤其在調節幅度方面有明顯的增加。
結論
配戴硬式多焦點隱形眼鏡 ( 鞏膜鏡 ) ，在本研究中證明對於老花眼成人有改善淚水與視覺上的品質的效果，尤其在調節幅度的部分，可以增加老花眼成人在近距離工作時的聚焦平面範圍，並減少長時間配戴後淚水減少所帶來的不舒適感，進而提升隱形眼鏡使用者的生活品質，改善社經活動的不便性。

關鍵字

老花眼 ； 鞏膜鏡 ； 多焦點隱形眼鏡 ； 淚水品質 ； 視覺品質 ； 調節幅度

並列摘要

Purpose
Taiwan's society has slowly entered an aging structure. Presbyopia is prone to appear after the age of 40 and is accompanied by many gradual physiological degradations. This study analyzes the effect of different multifocal contact lens materials on the tear problem and the decline in reading ability associated with presbyopia. If the test result is proven to improve the visual quality effectively, it may help lower the overall social cost by applying to presbyopia patients in general.
Method
This study recruited 20 subjects aged between 40 and 55, with monocular best-corrected visual acuity of both distant and near vision above 0.8. The research lenses were soft multifocal contact lenses and large-diameter hard multifocal contact lenses (scleral lenses). The primary dependent variables were the changes in tear quality and visual quality. The subjective examination items were the Visual Behavior Performance Questionnaire (CSMU VBP, 2020) and the Ocular Surface Disease Index (OSDI). The objective examination items were tear breakup time, blink frequency, near and far vision with glasses, modulation transfer function, the amplitude of accommodation, and stereopsis. SPSS V22.0 statistically analyzed the results of the study. The study complied with the Declaration of Helsinki and passed the review by the Second Human Experiment Committee of the Hospital of Sun Yat-Sen Medical University (license number: CS2-20089)
Result
The results of wearing hard multifocal contact lenses outperformed baseline values and soft multifocal contact lenses in tear breakup time, blinking frequency, and OSDI; in the visual quality analysis, wearing either soft or hard multifocal contact lenses, the binocular acuity was better than monocular acuity, the result of the modulation transfer function at high-order aberrations was significantly higher than the baseline value, and there was no change in stereo vision after wearing. The overall performance of wearing hard multifocal contact lenses was better than soft multifocal contact lenses, especially the amplitude of accommodation.
Conclusion
Wearing hard multifocal contact lenses (scleral lenses) in this study proved that it could improve the tears and visual quality for presbyopia patients, especially the amplitude of accommodation; this can widen the focused field of view for them when working at close distances. It also reduces the discomfort caused by the reduction of tears after wearing for a long time, thereby improving the quality of life of contact lens users, hence social and economic activities.

並列關鍵字

Presbyopia ； Scleral lens ； Multifocal contact lens ； Tear quality ； Visual quality ； Amplitude of accommodation

參考文獻

1. Walline, J.J., et al., Benefits of contact lens wear for children and teens. Eye Contact Lens, 2007. 33(6 Pt 1): p. 317-21.

2. Horwood, J., et al., Common visual defects and peer victimization in children. Invest Ophthalmol Vis Sci, 2005. 46(4): p. 1177-81.

3. Kandel, H., et al., Impact of refractive error on quality of life: a qualitative study. Clin Exp Ophthalmol, 2017. 45(7): p. 677-688.

4. Leske, D.A., et al., Eye-related quality of life and functional vision in children wearing glasses. J aapos, 2020. 24(2): p. 91.e1-91.e6.

5. Rah, M.J., et al., Vision specific quality of life of pediatric contact lens wearers. Optom Vis Sci, 2010. 87(8): p. 560-6.