臺灣博碩士論文加值系統

目的：眼睛是人體全身唯一的透明窗口，透過這個窗口我們可以直接觀察到網膜血管和視神經；因此眼底的觀察成為評估身體健康情形及視力健康與否的重要情報來源，例如，高血壓、糖尿病、青光眼及某些血液方面的疾病等，常可以從它們引發的眼底病變觀察出來。
除了眼睛之外，身體沒有其他地方可在放大的情形下以非侵害性的方式檢查活的人體組織及神經結構，而數位眼底攝影機正是提供後眼部眼底如視神經盤、視杯、網膜、血管、黃斑等的觀察與拍攝記錄工具。
傳統眼底鏡檢查有些需要散瞳(如間接眼底鏡)，需等藥效作用，費時較長，且檢查結果無法紀錄，治療前後的狀況也無法追蹤比對，患者沒有參與感，無法雙向溝通，自然接受度不高，因此檢查率偏低。
近來由於科技的進步，免散瞳數位眼底攝影機的研發，不需散瞳、不需等待、不限場所；可存檔編輯、可與病人面對面研討病情、可追蹤比對，因此大幅提升其實用性、便利性與普及性。
方法：以k公司為研究平台，全省有162個門市店點設置了免散瞳數位眼底攝影機，平均分佈在北、中、南各區，針對來店顧客實地拍攝眼底圖並透過k公司網路系統回傳總部，過濾篩選後再雲端傳輸至特約眼科醫師眼底圖判讀專家，進一步做判讀，依判讀結果給予建議再回傳各店點，由各店點告知相關顧客，轉達醫生的提醒與關懷。
結果：本研究針對相關目的設計顧客問卷調查表進行資料收集，統計分析了解一般顧客除了醫療院所，能在有視光背景的眼鏡門市施行免散瞳數位眼底攝影的認知與接受度。
結論：從早期的眼底檢查設備，有些需經長期的專業訓練且學習不易，如直接式眼底鏡；有些必需施點散瞳劑，費時且不舒適，器材又昂貴，設置不易，如間接式眼底鏡。導致檢查點無法普及加上患者配合意願低，可能錯失醫療的黃金時間，減低治癒機會並增加醫療成本。
因此能廣為運用此科技產品，增加設置的普遍性、操作的便利性、顧客的認知性，以臻預防重於治療的醫學基本原則，而早期的異常發現 (診斷) ，有利於健康的迅速回復(治療) 。

Objective: eye is the only transparent window of human body, through which we can directly observe retinal vessel and optic nerve. Therefore, observation of fundus oculi provides important information for evaluating physical health and vision health. For example, hypertension, diabetes, glaucoma and some blood diseases can be detected via an observation of fundus lesions caused by these diseases.
Except eyes, no other parts of human body can be subject to non-invasive examination of living tissues and neural structures under amplification. Fundus camera is a tool for observing, photographing and recording posterior ocular fundus such as optic disc, optic cup, retina, vessel and macula lutea.
Conventional ophthalmofundoscopy sometimes requires mydriasis (e.g. indirect ophthalmoscope) and equivalent action and is time-consuming. In addition, examination result cannot be recorded. Pre- and post-treatment conditions cannot be traced or compared. Patients have no sense of participation. Two-way communication is not impossible. Natural acceptance is not high. Therefore, inspection rate is low.
Along with technological advances in recent years, non-mydriatic digital fundus camera that doesn’t need mydriasis and waiting and can be used at any place is developed. Examination results can be documented, edited, tracked and compared. Face-to-face discussion with patient about pathogenetic condition is possible. Consequently, its practicability, convenience and popularity are significantly enhanced.

Methods: with Company k as research platform, non-mydriatic digital fundus cameras are provided at 162 stores in northern, central and southern areas of Taiwan. Customers’ fundus images are taken onsite, sent to the headquarter through network system of Company k, screened and selected, and then transmitted via cloud to specially invited ophthalmologists and fundus image interpretation experts for further interpretation. According to interpretation results, advices are given and then sent back to each store. Finally, these stores inform related customers to communicate doctor’s reminding and caring.

Results: the present study collects data by virtue of questionnaires designed for targeted customers and conducts statistical analysis to find common customers’ recognition and acceptance of performing non-mydriatic digital photography in eyeglasses store with optometrical background besides medical institution.

Conclusions: some early fundus examination devices require long-term professional training and are not easy to learn, such as direct ophthalmoscope. Some early devices need application of mydriatic, and are time-consuming, uncomfortable, expensive and difficult to set, for example, indirect ophthalmoscope. Therefore, it’s impossible to popularize examination stations. Furthermore, patients’ unwillingness to cooperate may lead to missed prime time of treatment, reduced chance of cure and increased medical cost.
Therefore, for wide use of such technological products, it’s necessary to increase universality of setting, convenience of operation and recognition of customers in order for conforming to the basic medical principle that “prevention is better than cure”. Early detection of abnormality (diagnosis) benefits rapid recovery of health (cure).

目錄
中文摘要 ............................................................ii
英文摘要.............................................................iv
誌謝 ................................................................vi
目錄 ...............................................................vii
表目錄 ..............................................................ix
圖目錄 ...............................................................x
第一章 緒論 ........................................................1
第一節 研究背景與動機 ..........................................1
第二節 研究流程.................................................2
第三節 研究目的.................................................2
第二章 文獻回顧 ....................................................4
第一節 眼底鏡(Ophthalmoscope) 簡介與發展........................4
第二節 直接眼底鏡...............................................6
第三節 間接式眼底鏡.............................................9
第四節 人類眼睛的構造..........................................10
第三章 研究方法 ...................................................15
第一節 數位眼底攝影機設置......................................15
第二節 Miis Horus Eye-Fundus Camera vs Canon CX1 Retinal Camera..................................................17
第三節 數位眼底攝影機使用流程..................................18
第四節 眼底檢查程序............................................18
第五節 眼底病徵記錄............................................23
第六節 K眼鏡公司臨床判圖-知識迴旋計劃.........................25
第四章 實証分析....................................................29
第一節 參與研究對象之基本變項...................................29
第二節 眼底攝影機評估眼底之認知問卷調查分析.....................32
第三節 研究對象之基本變項分佈...................................37
第五章 結論與展望 .................................................40
第一節 實証分析結果.............................................40
第二節 K眼鏡公司眼底檢查服務成果 ..............................41
第三節 結論 ....................................................44
第四節 展望 ....................................................44
參考文獻 ............................................................56

表目錄
表3-6-1 表3-6-1眼底圖IRB判讀分析表.................................27
表4-3-1 研究對象之基本變項分佈 .................... .................37
表4-3-1 研究對象之基本變項分佈(續二)................................38
表4-3-1 研究對象之基本變項分佈(續三)................................39
表5-1-1 研研究對象基本變項最大次與最大百分比 .......................40
附件一 參加研究同意書 ................................................45
附件二 眼底攝影機評估眼底之認知研究 問卷調查 .........................46
附件三 同意書.........................................................49

圖目錄
圖 1-3-1 研究流程 .....................................................3
圖 2-1-1 Hermann von Helmholtz赫爾曼•馮•亥姆霍茲（1821-1894年）.......4
圖 2-1-2 最早期的眼底鏡〝eye-mirror〞 .................................5
圖 2-1-3 西元1851年發明的眼底鏡 .......................................5
圖 2-1-4 單眼間接眼底鏡 ...............................................6
圖 2-1-5 19世紀的眼底鏡 ...............................................6
圖 2-2-1 直接式眼底鏡之架構圖 .........................................6
圖 2-2-2 直接式眼底鏡附屬視標..........................................7
圖 2-2-3 直接式眼底鏡的光學原理 .......................................8
圖 2-2-4 直接式眼底鏡檢查法 ...........................................8
圖 2-3-1 間接式眼底鏡 .................................................9
圖 2-3-2 間接式眼底鏡之光學架構圖 .....................................9
圖 2-3-3 間接式眼底鏡檢查法 ..........................................10
圖 2-4-1 眼球的基本構造 ..............................................11
圖 2-4-2 光感受器細胞分布圖 ..........................................13
圖 2-4-3 遮眼板.......................................................13
圖 2-4-4 標記A、B圓圈的紙卡..........................................13
圖3-1-1 數位眼底攝影機分佈圖 ........................................15
圖3-1-2 免散瞳數位眼底攝影機 ........................................16
圖3-1-3 門市數位眼底攝影機設置 ......................................16
圖3-3-1 數位眼底攝影機使用流程 ......................................18
圖3-4-1 眼底圖 ......................................................19
圖3-6-1 臨床判圖-知識迴旋計劃 .......................................25
圖3-6-2 判圖流程................... .................................25
圖3-6-3 判圖雲端系統導入時程 ........................................26
圖3-6-4 IRB判圖系統門市時程 .........................................26
圖3-6-5 眼底圖IRB判圖系統圖..........................................28
圖4-1-1 性別 ........................................................29
圖4-1-2 年齡 ........................................................30
圖4-1-3 教育圓形圖 ..................................................31
圖4-1-4 職業圓形圖 ..................................................32
圖4-2-1 對眼鏡公司視光師的形象認同 ..................................33
圖4-2-2 您是否做過眼底攝影檢查 ......................................34
圖4-2-3 您做眼底攝影檢查的原因 ......................................35
圖4-2-4 眼鏡公司提供眼底檢查服務的感想 ..............................35
圖4-2-5 眼底攝影檢查後是否讓您更了解自己的視力保健 ..................36
圖4-2-6 在此次眼底檢查後您最希望做的事 ..............................36
圖5-2-1 每月送圖數量 ................................................41
圖5-2-2 IRB判圖系統成效分析 ..........................................42
圖5-2-3 醫師眼底判圖 統計分析 .......................................43

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