點用阿托品控制近視之臺灣國小學童配戴漸進多焦點鏡片其視覺功能與度數變化之追蹤調查

A Follow-up Study of Visual Functions Improvement and Refractive Development in Taiwanese Myopic Children with Atropine

粘瑛珊(Ying-Shan Nien)

指導教授 ： 郭蕙瑛

中山醫學大學/醫學院/醫學研究所/碩士(2016年)

摘要

目的：評估點用Atropine之學童配戴近方加入度後其視覺功能改善情形，並結合配戴制式化與客製化漸進多焦點鏡片探討其控制近視的效果為何。
方法：受試者為40位年齡介於8-12歲，等價球面度數介於-0.25~ -5.50D之國小學童且正在點用Atropine控制近視發展。比較40位點用學童其初始狀態、配戴遠用矯正處方及近方加入度後三者間之視覺功能變化差異，並隨機分配配戴制式化或客製化度數之漸進多焦點鏡片進行為期一年的追蹤。
結果：點用Atropine控制近視學童其初始狀態之雙眼遠距離視力值平均為0.41 logMAR，配戴矯正遠用處方後提升至0.07 logMAR，有顯著改善(p<.0001)。初始狀態之雙眼近距離高對比視力值為0.14 logMAR，配戴近方加入度後提升至0.08 logMAR；而初始狀態之雙眼近距離低對比視力值為0.29 logMAR，配戴近方加入度後提升至0.23 logMAR，配戴近方加入度後，其高或低對比視力皆有顯著改善(p<.0001)。在近視控制方面，一年後等價球面屈光度變化配戴制式化近用加入度組增加之近視度數為0.20D(兩眼平均值)，客製化近用加入度組為0.24D，兩組間無顯著差異。相較於控制組(未配鏡且未點藥)增加0.66D，配戴漸進多焦點之點用Atropine學童雙眼平均近視度數僅增加0.21D (p<.0001)。
結論：點用Atropine之學童配戴漸進多焦鏡片其遠近視力值可立即獲得改善，且控制近視之效果顯著優於單純點用Atropine或單純配戴漸進多焦點鏡片之學童，其減緩近視效果可達70% (MC70)。

關鍵字

阿托品 ； 近視控制 ； 漸進多焦點鏡片 ； 視覺功能 ； 近視學童

並列摘要

Purpose: To investigate the improvement of visual functions and the effect of myopia control in Taiwanese myopic schoolchildren with the combination of Atropine usage and progressive addition lenses. The effect of the types of addition prescriptions (Uniform or Customized) on slowing down myopia progression is also studied.
Methods: Subjects were 40 myopic schoolchildren aged between 8~12 years and have spherical equivalents between -0.25 ~ -5.50D. All of the subjects are currently using Atropine to control myopia and they were randomized to wear the uniform or customized progression addition lenses for one-year follow-up. The differences in visual functions and myopia control effect were compared.
Results: The mean binocular distant visual acuity of all the subjects were 0.41 logMAR in the original status, and improved to 0.07logMAR after applying distance correction prescriptions(p<.0001). For near visual acuities, the mean binocular high contrast NVA were 0.14 logMARin the original status, and improved to 0.08 logMAR with addition prescriptions(p<.0001); the low contrast NVA enhanced from 0.29 to 0.23 logMAR(p<.0001).In the aspect of myopia control, there is no significant difference in annual myopia progression between the customized(0.24D) and the uniform(0.20D) groups.However, the mean myopia progression rate in the first year of the subjects with Atropine + PAL increased only 0.21D comparing to the control group(0.66D) (p<.0001).
Conclusion: The myopia control effect is significantly better with the combination of Atropine + PAL (up to 70%), and the visual function is also significantly improved.

並列關鍵字

Atropine ； Myopia control ； progressive addition lenses ； visual functions ； Myopic Children

參考文獻

彭秀英, 林隆光, & 吳仁宇. (2010). 國小及幼稚園教師對學童視力保健知識, 態度, 行爲效能的相關因素研究. 學校衛生(56), 21-38.

柯青秀. (2010). 評估臺中市國小學童使用睫狀肌麻痺劑控制近視其視覺功能與視覺活動之現況調查.

Aller, T. A. (2014). Clinical management of progressive myopia. Eye (Lond), 28(2), 147-153. doi: 10.1038/eye.2013.259

Berntsen, D. A., Barr, C. D., Mutti, D. O., & Zadnik, K. (2013). Peripheral defocus and myopia progression in myopic children randomly assigned to wear single vision and progressive addition lenses. Investigative ophthalmology & visual science, 54(8), 5761.

Berntsen, D. A., Sinnott, L. T., Mutti, D. O., & Zadnik, K. (2012). A randomized trial using progressive addition lenses to evaluate theories of myopia progression in children with a high lag of accommodation. Invest Ophthalmol Vis Sci, 53(2), 640-649. doi: 10.1167/iovs.11-7769