台灣地區學齡前幼童近視及其相關因素研究

A Study on Myopia of Preschool children and Its Related Factors in Taiwan

彭秀英(Hsiu-ying Peng)

指導教授 ： 陳政友 ； 林隆光

國立臺灣師範大學/教育學院/健康促進與衛生教育學系/博士(2011年)

摘要

本研究目的在於了解影響台灣地區學齡前兒童近視發生及視力近視化之因素，以就讀於台灣地區公私立幼托園所且在2009年及2010年完成相同視力檢查之5-7歲幼童為樣本，運用追蹤回溯法，進行問卷調查，共完成1,108份資料收集，回收率為72.5％。結果歸納如下：
一、以左眼為例，學齡前幼童眼球平均屈光度，前測為＋0.98D、標準差1.00D；後測時為＋0.71D、標準差1.04D，都屬於輕度遠視，在性別上沒有顯著差異；近視罹患率，第一年為6.9%，第二年為 12.5%，女生比男生高；前後間隔一年的眼球屈光度平均增加為-0.27D、標準差0.36D，不同屈光類別在一年間眼球屈光度變化有顯著差異，其中近視的度數變化顯著大於正視及遠視者。任一眼近視發生率為7.64%、近視化比率為30.2%。
二、學齡前幼童在一年內有半數以上曾就醫，原因是幼托園所通知視力複查，且就醫之後，有半數以上能回診。其家長認為就醫的距離還不算遠。
三、學齡前幼童之家長防治幼童近視的行為，在「讀寫環境照明」、「讀寫姿勢不良之糾正」、「眼疾觀察與照顧」實踐程度較好；在「陪幼童到戶外運動」、「不提早讓幼童執筆寫字」、「近距離用眼30-40分鐘就讓他休息10分鐘」、「放學後不要讓幼童看電視」則實踐程度較差。
四、學齡前幼童每日近距離用眼時數平均為213分鐘、戶外活動時數為79.5分鐘、睡眠時數為9.4小時。近距離用眼時數最多的項目是看電視，平均每日76分鐘、其次是讀書寫字，平均每日65分鐘。
五、學齡前幼童近視發生與「年齡」、「父母任一方有近視」、「家庭社經地位」、「近距離用眼時數」有顯著關係；其中「年齡」、「家庭社經地位」、「父母任一方有無近視」、「近距離用眼時數」為主要預測變項，表示年齡越大者、父母任一方有近視者、家庭社經地位越低者、近距離用眼時數越多者，容易發生近視。父母任一方有近視者發生近視約為父母無近視者的4倍。
六、學齡前幼童視力近視化與「年齡」、「家庭社經地位」、「近距離用眼時數」有顯著關係。其基本變項、家長防治幼童近視之行為、個人用眼行為等變項能有效預測視力近視化現象，並解釋視力近視化總變異量之8.5%，其中「家庭社經地位」、「父母任一方有無近視」及「近距離用眼時數」為主要預測變項，顯示學齡前幼童的象家庭社經地位越低者、父母任一方有近視者及近距離用眼時數越多者，其視力近視化情形越為嚴重。
結論與建議：近視一旦發生其度數比非近視者容易惡化，而影響近視發生與近視化之因素與近距離用眼時數關係密切，建議教育與衛生主管單位應加強規劃多元化之課後活動，減少近距離用眼時間，並應進行近視防治縱貫性研究，監測近視發生與惡化之危險因子，對學齡前兒童施行特殊保護措施，預防早發性近視之發生。

關鍵字

學齡前幼童 ； 眼球平均屈光度 ； 近視發生 ； 近視化 ； 近視防治

並列摘要

The purpose of this study is to investigate the incidence of myopi and myopia progression among preschool children in Taiwan. Children aged 5 to 7 years from public and private kindergartens, who completed the same eye examination in 2009 and 2010, were chosen as the study sample. Retrospective and prospective study were applied to the follow-ups and questionnaire survey. Eye examination and questionnaire were administered in this study, with 1108 valid examinations and questionnaires and the response rate of 72.5％.
The major findings were as follows:
1). The mean refraction of children’s left eye was +0.98D (SD,1.00D) in the initial examination and +0.71D (SD,1.04D) in the follow-up examination. Both were slight hyperopia. There was no significant difference in gender. Myopia prevalence was 6.9% in the first year and 12.5% in the second year. There was higher myopia prevalence among girls. Between the two examinations,the mean refraction slight was howard myopia -0.27D (SD, 0.36D). Eyes with different refraction status experienced significantly different change of refraction. Myopic children had more change of refraction than emmetropic and hyperopic kids. Incidence of myopia and myopia progression rate of either eye were 7.64% and 30.2%, respectively.
2). Within a year, over 50% of preschool children visited doctors for eye disorder. The major reason for clinic visit was the notice of the follow-up eye examination given by kindergartens. The majority of preschool children made the follow-up visits after the first time. Parents did not consider the location of clinics.
3). Among parents’ preventative measures against myopia in children, “illuminating the reading and writing environment”, “correcting the improper reading and writing postures”, and “observing and taking care of eye disorder” were better practiced. On the other hand, “doing outdoor sports with children”, “preventing children from writing with pen in early age”, “taking a 10-minute rest after engaging in near work for 30 to 40 minutes”, and “prohibiting kids from watching TV after school” were less observed.
4). In average, preschool children devoted 213 minutes to near work, 79.5 minutes to outdoor activities, and 9.4 hours to sleeping each day. Watching TV (76 minutes per day) accounted for the biggest portion of the time, followed by writing and reading (65 minutes per day).
5). There was a significant relation between the incidence of myopia and “age”, “one myopic parent”, “social-economic status”, and “time for near work”. “Age”, “one myopic parent”, “social-economic status”, and “time for near work” were major predictive variables. In other words, those who with older age, one myopic parent, lower social/economical status, or more time for near work had a higher rate of myopia. Children with one myopic parent were 4 times more likely to develop myopia than children without myopic parents.
6). There was a significant relation between myopia progression and “age”, “social-economic status”, and “time for near work”. The basic variables of the subjects, the parents’ preventative measures against myopia in children, and the ways kids using eyes can effectively predict incidence of myopia and explain 8.5% of the myopia progression. “Age”, “one myopic parent”, “social-economic status”, and “time for near work” were major variables for prediction. Myopia progression was more severe among preschool children who had lower social-economic status, one myopic parent, or more hours of near work.
According to the aforementioned findings, this study provided some suggestions for educational and government insititutes and would be a reference to some researches of preschool children’s myopia prevention in the future.

並列關鍵字

pre-school children ； mean refraction ； incidence of myopia ； myopia progression ； myopia prevention

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