弱視兒童在一般視力訓練與密集訓練之成效

The effectiveness of regular visual training and intensive training for amblyopic children.

章綠思(Lyu-Shi Chang)

指導教授 ： 陳賢堂

中山醫學大學/醫學科技學院/生物醫學科學學系碩士班/碩士(2016年)

摘要

目的：主要探討弱視兒童現今眼科弱視訓練是否足夠，透過密集訓練是否能夠縮短弱視的治療時程，及防阻弱視的回退。
　　方法：研究對象由彰化縣鹿港鎮豐安診所招募15位弱視兒童(8男7女，平均年齡5.79 ± 0.67)，皆為屈光型弱視，無任何眼睛相關疾病，平均分為兩組，一般訓練組(CAM)，使用CAM訓練每週一次，每次90分鐘。密集訓練組(AM) 除了每週一次CAM訓練外，每天再密集訓練90分鐘，直達到總時數20小時為止，針對受試者的視力值變化、Hart Chart秒數變化、反轉鏡(Accommodative facility)秒數變化、立體視(Titmus stereo acuity)變化，進一步進行分析，本研究使用的統計方法為描述性統計、無母數分析。
　　結果：一般訓練組WO到W3平均視力值改善，弱眼LogMAR 0.1637，強眼LogMAR 0.135，沒有人達到最佳視力值1.0，W3到W5弱眼LogMAR 0.0063，強眼LogMAR 0.0087，沒有人達到最佳視力值1.0。密集訓練組WO到W3平均改善弱眼LogMAR 0.1886，強眼LogMAR 0.1242，有1位兒童達到最佳視力值1.0，W3到W5弱眼增加LogMAR 0.0357，強眼回退LogMAR 0.0171，共2位兒童達到最佳視力值1.0。Hart Chart W0到W3平均秒數，弱眼減少87秒，強眼減少76秒，W3到W5弱眼減少2秒，強眼減少3秒。Accommodative facility W0到W3平均秒數，弱眼減少30秒，強眼減少28秒，W3到W5弱眼多1秒，強眼不變。立體視皆有維持並無退步，立體視第一週，未測量到立體視者1位、400秒角1位、200秒角１位、160秒角1位、100秒角1位、63秒角2位，第五週200秒角1位、63秒角１位、40秒角1位、20秒角4位。
　　結論：我們發現一般訓練三週的時間，對於弱視兒童是不夠的，透過密集訓練能讓弱視縮短治療時程，培養視知覺能力和立體雙眼視覺，能避免弱視回退，停止密集訓練後，在後測的表現能夠維持或是更好。

關鍵字

弱視 ； 一般視力訓練 ； 密集視力訓練 ； 雙眼視 ； 弱視回退

並列摘要

Purpose: We mainly investigate if present training for child amblyopia in ophthalmic clinic is sufficient. If with intensive training, we can decrease the time of amblyopia treatment, and prevent amblyopic regression.
Method: There are fifteen amblyopic children (8 boys and 7 girls, the average of age is 5.79 ± 0.67) who are recruited from Fengan clinic in Lukang town, Zhanghua county. The subjects are all refractive amblyopia, and without any eyes diseases. They are divided into two groups, one for regular training (CAM), and the other for intensive training (AM). The regular group use CAM trainer 90 minutes once a week. Besides CAM training, the intensive group train 90 minutes every day until the child reaches 20 hours of total training time. We focus on visual acuity , hart chart , accommodative facility , and Titmus stereo acuity performance and analyze their performance further. The statistic methods are descriptive statistics and nonparametric statistics.
Result: For regular group, the weak eyes and the strong eyes improved LogMAR 0.1637 and LogMAR 0.135 in average respectively from W0 to W3. From W3 to W5, the weak eyes and the strong eyes improved LogMAR 0.0063 and LogMAR 0.0087 in average respectively, None reached the best visual acuity 20/20. For intensive group, the weak eyes and the strong eyes improved LogMAR 0.1886 and LogMAR 0.1242 in average respectively from W0 to W3, and there is one child reached the best visual acuity 20/20. From W3 to W5, the weak eyes improved LogMAR 0.0357, but the strong eyes reduced LogMAR 0.0171. There were two children reached the best visual acuity 20/20. In Hart chart performance, the weak eyes and the strong eyes decrease 87 seconds and 76 seconds in average respectively from W0 to W3. From W3 to W5, the weak eyes and the strong eyes decrease 2 seconds, and 3 seconds in average respectively. In accommodative facility performance, the weak eyes and the strong eye decreased 30 seconds and 28 seconds in average respectively from W0 to W3. From W3 to W5, the weak eyes increased one second, and the strong eyes did not change. On the first week, in Titmus stereopsis, there were one child without global stereopsis, one of 400 arc sec., one of 200 arc sec., one of 160 arc sec., one of 100 arc sec., and two of 63 arc sec.. On the fifth week, there were one child of 200 arc sec., one of 63 arc sec., one of 40 arc sec., and four of 20 arc sec..
Conclusion: We found that three weeks of regular training are not enough for amblyopic children. With intensive training, it may decrease the period of treatment, and cultivate visual perception ability and improve stereopsis. Binocularity helps to prevent amblyopic regression.

並列關鍵字

amblyopia ； regular visual training ； intensive visual training ； binocularity ； regression

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