臺灣博碩士論文加值系統

隨著人類平均年齡的增加，青光眼的流行率也愈來愈高，在這個逐漸高齡化的社會中，青光眼的早期診斷與治療愈來愈重要。而國內青光眼病人視覺功能及健康相關生活品質之相關研究仍著重在兩者關聯性之探討。若能藉由問卷調查的方法來瞭解青光眼病患自覺視覺功能不良的情形及生活品質，同時評估青光眼病患視覺功能與健康相關生活品質、視覺相關生活品質的關係，研究結果將可以作為臨床治療的重要參考依據。研究採取問卷調查方式，有效問卷數量為290份。並利用群集分析、卡方檢定及區別分析進行研究。研究結果說明；1.青光眼病患流行病學因素以「其他眼科疾病或外傷史」最多，其次「高度近視程度」，第三為「青光眼家族史」，「眼軸較短及眼球較小的遠視」為最少；2.病患基本資料在健康相關生活品質、視覺相關生活品質構面之差異分析部份，計有年齡、教育程度、個人月收入、眼壓、運動等因素是相當顯著；3.年齡、教育程度、居住地區、婚姻狀況、個人月收入、眼壓、BMI、運動、熬夜與青光眼判定等與青光眼致病族群成顯著差異關係；4.健康相關生活品質、視覺相關生活品質等構面是可以有效區別青光眼致病族群。建議事項為採取問卷調查的方式瞭解青光眼病患自覺視覺生活品質及一般生活品質，其調查結果可作為臨床治療的重要參考依據。

With the increase of the average human age, the rate of glaucoma pandemic is getting higher in the gradually aging society. The early diagnosis and treatment of glaucoma is growing more important. Domestic glaucoma patient visual function and health-related quality of life research still focuses on the both correlation. If the method of questionnaire survey can be usd to understand the adverse situation and quality of life of glaucoma patients perceived visual function, to assess the relationship between glaucoma patients with visual function and health-related quality of life, vision-related quality of life, then the related findings also can be used as a clinical treatment an important reference. This study adopts questionnaire method which has 290 valid questionnaires numbers and applies the methods of cluster analysis, Chi-square test and discriminant analysis. The results shows that 1.glaucoma patients epidemiological factors other eye disease or history of trauma ", followed by the degree of high myopia," third for "family history of glaucoma, axial length shorter and smaller eye hyperopia at least; 2.demographic data analysis part, namely, age, educational level, personal monthly income, intraocular pressure, exercise and other factors are significant differences in health-related quality of life, vision-related quality of life dimensions; 3. age, educational level, area of residence, marital status, personal monthly income, intraocular pressure, BMI, and sports, staying up late with glaucoma to determine significant differences in relationship with the glaucoma pathogenic ethnic groups; 4. The structure of health-related quality of life and vision-related quality of life can effectively distinguish glaucoma pathogenic populations. Therefore, this research research suggests taking the questionnaire survey to understand consciously the visual quality of life and general quality of life of glaucoma patients can be used as important reference for clinical treatment.

摘　要 i
ABSTRACT ii
誌 謝 iii
目 錄 iv
表目錄 vi
圖目錄 viii
第一章 緒論 1
1.1 研究背景與動機 1
1.2 研究目的 3
1.3 研究流程與章節架構 3
第二章 文獻探討 5
2.1 眼部疾病的類別 5
2.2 青光眼之盛行率 6
2.3 青光眼之定義 7
2.4 青光眼之種類 9
2.5 青光眼之治療方式 9
2.6 視覺疾病對生活品質的影響 14
2.7 影響眼部疾病的相關因素 15
2.8 生活品質之相關文獻 18
2.8.1 生活品質的概念 18
2.8.2 生活品質的測量 18
2.8.3 視覺相關的生活品質 20
第三章 研究方法 23
3.1 研究架構 23
3.2 問卷調查 24
3.3 研究對象與抽樣計劃 29
3.4 群集分析 29
3.5 統計分析方法 30
第四章 研究分析結果 34
4.1 人口統計因素 34
4.2 流行病學因素資料 36
4.3 差異性分析檢定 39
4.4 K-means集群分析 52
4.5 卡方檢定 57
4.6 區別分析 76
4.7 二元Logistic迴歸分析 81
第五章 研究結論與建議 85
5.1 研究結論 85
5.2 管理意涵 86
5.3 未來研究建議 87
參考文獻 88
研究問卷 95

[1]文良彥、尤之浩，終結白內障消除霧化的視覺，台北市：宏欣文化事業有限公司，2004。
[2]行政院衛生署，96年度全民健康保險醫療統計年報，台北：行政院衛生署，2007。
[3]吳萬益，企業研究方法(四版) ，台北市：華泰文化，2011。
[4]林人傑，青光眼病人視覺功能及健康相關生活品質之相關性探討，碩士論文，國立台灣大學醫療機構管理研究所，台北，2006。
[5]林嘉理，先天與後天性色盲，財團法人尹書田紀念醫院，書田泌尿科眼科診所，2005。(cited 2011 Nov 26) Available from: URL: http://www.shutien.org.tw/0117_011.htm，造訪日期：2012/06/25。
[6]姚開屏，「簡介與評論常用的一般性健康相關生活品質量表兼談對未來研究的建議」，測驗年刊，第四十七卷，第二期，2000，第11-138頁。
[7]姚開屏，「健康相關生活品質概念與測驗原理之簡介」，台灣醫學會雜誌，第六卷，第二期，2002，第183-192頁。
[8]施永豐，「色盲乎? --色覺異常」，健康世界，第一百四十七卷，1998，第10-15頁。
[9]柯玉潔，角膜厚度與弧度對眼壓測量值的影響，碩士論文，國立陽明大學醫學院臨床醫學研究所，台北，2004。
[10]洪伯廷，青光眼的預防與保健，台北市：正中書局，1995。
[11]洪伯廷，淺說青光眼，台北市：宏欣文化，2003。
[12]張朝凱等，看見清楚與美麗：眼科疾病的治療保健與雷射近視手術，台北市：宏欣文化事業有限公司，2005。
[13]陳慕師，「糖尿病友發生視力障礙的原因」，糖尿病家族，第四卷，2002，第4-7頁。
[14]曾旭民、盧瑞芬、蔡益堅，「國人生活品質評量:SF-36台灣版的常模與效度檢測」，台灣公共衛生雜誌，第二十二卷，第六期，2003，第512-518頁。
[15]程景煜等，台灣地區老人視力與眼及現況，台中市：行政院衛生署國民健康局，2003。
[16]楊佳靜，青光眼量性預防醫學與成本效益評估，博士論文，臺灣大學公共衛生學院預防醫學研究所，台北，2008。
[17]褚仁遠等，眼病學，中國北京：人民衛生出版社，2005。
[18]蔡景耀等，「社區老人視力障礙盛行率及其相關因子」，北市醫學雜誌，第1卷，2004，第344-351頁。
[19]邱宗聖, G. J. Johnson, “The Prevalence of Glaucoma in an Urban Chinese Population in Taiwan a Pilot Study,” 中華民國眼科醫學會雜誌, vol. 45, no. 2, 2006, pp. 63-75.
[20]U. Altangerel, G. L. Spaeth & D. J. Rhee, “Visual function, disability, and psychological impact of glaucoma,” Curr Opin Ophthalmol, vol. 14, no. 2, 2003, pp. 100-105.
[21]B. L. Barber, E. R. Strahlman, R. Laibovitz, H. A. Guess, S. A. Reines, “Validation of a questionnaire for comparing the tolerability of ophthalmic medications,” Ophthalmology, vol. 104, 1997, pp. 334-342.
[22]J. Burr, A. Azuara-Blanco, A. Avenell, Medical versus surgical interventions for open angle glaucoma, Cochrane Database of Systematic Reviews, 2005.
[23]J. H. Chen, L. Xu, A. L. Hu, B. C. Sun, J. J. Li, K. Ma, C. R. Xia, T. T. Cui, Y. Y. Zheng, Y. B. Li, R. X. Zhang, H. Yang, X. Y. Sun, Y. Zou, Y. Wang, B. R. Ma, “The prevalence and its effective factors of primary angle-closure glaucoma in defined populations of rural and urban in Beijing,” Zhonghua Yan Ke Za Zhi, vol. 83, 2003, 1413-1418.
[24]E. M. Chia, J. J. Wang, E. Rochtchina, W. Smith, O. R. Cumming, P. Mitchell, “Impact of Bilateral Visual Impairment on Health-Related Quality of Life: the Blue Mountains Eye Study,” Invest Ophthalmol Vis Sci, vol. 45, 2004, pp. 71-76.
[25]P. Desai, A. Reidy, D. C. Minassian, G. Vafidis, J. Bolger, “Gains from cataract surgery: visual function and quality of life,” Br J Ophthalmol, vol. 80, 1996, pp. 868-873.
[26]E. J. Duh, L. P. Aiello, Basic Pathobiology of the eye and its complications. Ellenberg & Rifkin''s Diabetes Mellitus, New York: McGraw-Hill, 2002.
[27]A. W. Foong, S. M. Saw, J. L. Loo, S. Shen, S. C. Loon, M. Rosman, T. Aung, D. T. Tan, E. S. Tai, T. Y. Wong, “Rationale and methodology for a population-based study of eye diseases in Malay people: The Singapore Malay eye study (SiMES),” Ophthalmic Epidemiology, vol. 14, 2007, pp. 25-35.
[28]P. J. Foster, R. Buhrmann, H. A. Quigley, G. J. Johnson, P. J. Foster, R. Buhrmann, H. A. Quigley, G. J. Johnson, “The definition and classification of glaucoma in prevalence surveys,” Br J Ophthalmol, vol. 86, 2002, pp. 238-242.
[29]Z. Gao, “An epidemiologic study of glaucoma in Tongcheng county, Anhui province,” Zhonghua Yan Ke Za Zhi, vol. 31, 1995, pp. 149-151.
[30]C. C. Geringer, N. R. Imami, “Medical management of glaucoma,” Int Ophthalmol Clin, vol. 48, 2008, pp. 115-141.
[31]C. A. Hazel, K. L. Petre, R. A. Armstrong, M. T. Benson, N. A. Frost, “Visual function and subjective quality of life compared in subjects with acquired macular disease,” Invest Ophthalmol Vis Sci, 41, 2000, pp. 1309-15.
[32]M. He, P. J. Foster, J. Ge, W. Huang, Y. Zheng, D. S. Friedman, P. S. Lee, P. T. Khaw, “Prevalence and clinical characteristics of glaucoma in adult Chinese: a population-based study in Liwan District, Guangzhou,” Invest Ophthalmol Vis Sci, vol. 47, 2006, pp. 278-282.
[33]R. Q. Ivers, R. Norton, R. G. Cumming, M. Butler, A. J. Campbell, “Visual impairment and risk of hip fracture,” Am J Epidemiol, vol. 152, 2000, pp. 633-9.
[34]N. K. Janz, P. A. Wren, P. R. Lichter, et al., “Quality of Life in newly diagnosed glaucoma patients: the Collaborative Initial glaucoma treatnment Study,” Ophthalmology, vol. 108, 2001, pp. 887-897.
[35]B. E. Klein, R. Klein, K. E. Lee, K. J. Cruickshanks, “Associations of performancebased and self-reported measures of visual function. The Beaver Dam Eye Study,” Ophthalmic Epidemiol, vol. 6, 1999, pp. 49-60.
[36]B. L. Lee, M. R. Wilson, “Health-related quality of life in patients with cataract and glaucoma,” J Glaucoma, vol. 9, no. 1, 2000, pp. 87-94.
[37]B. L. Lee, P. Gutierrez, M. Gordon, et al., “The Glaucoma Symptom Scale. A brief index of glaucoma – specific symptoms,” Arch Ophthalmol, vol. 116, 1998, pp. 861-866.
[38]J. H. Liu, C. Y. Cheng, S. J. Chen, F. L. Lee, “Visual impairment in a Taiwanese population: prevalence, causes, and socioeconomic factors,” Ophthalmic Epidemiol, vol. 8, 2001, pp. 339-350.
[39]C. Louis, S. B. Michael, A. H. Elizabeth, A. L. David, W. Roy, W. Martin, Glaucoma, “American Academy of Ophthalmology,” Basic and Clinical Science Course Section, 2000, pp. 7-8, pp. 11-13, pp. 104-127.
[40]C. M. Mangione, P. P. Lee, J. Pitts, et al., “Psychometric properties of the National Eye Institute Visual Function Questionnaire (NEI-VFQ). NEI-VFQ Field Test Investigators,” Arch Ophthalmol, vol. 116, no. 11, 1998, pp. 1496-1504.
[41]C. M. Mangione, P. P. Lee, J. Pitts, et al., “National Eye Institute Visual Function Questionnaire Field Test Investigators. Development of the 25-item National Eye Institute visual function questionnaire,” Arch Ophthalmol, vol. 119, 2001, pp. 1050-1058.
[42]C. M. Mangione, R. S. Phillips, J. M. Seddon, et al., “Development of the “Activities of Daily Vision Scale,” A measure of visual function status. Medical Care, vol. 30, 1992, pp. 1111-1126.
[43]P. Nelson, P. Aspinall, C. O’Brien, “Patients’ perception of visual impairment in glaucoma: a pilot study,” Br J Ophthalmol, vol. 83, 1999, pp. 546-552.
[44]W. S. Ng, G. S. Ang, A. Azuara-Blanco, Laser peripheral iridoplasty for angle-closure, Cochrane Database Syst Rev, 2008.
[45]G. V. Padilla and M. M. Grant, “Quality of life as a cancer nursing outcome variable. ANS Adv Nurs Sci,” vol. 8, no. 1, 1985, pp. 45-60.
[46]S. Resnikoff, D. Pascolini, D. Etya''ale, I. Kocur, R. Pararajasegaram, G. P. Pokharel and S. P. Mariotti, “Global data on visual impairment in the year 2002,” Bulletin of the World Health Organization, vol. 82, no. 11, 2004, pp. 844-851.
[47]R. Ritch, C. C. Tham, D. S. Lam, “Argon laser peripheral iridoplasty (ALPI): an update,” Surv Ophthalmol, vol. 52, 2007, pp. 279-288.
[48]C. Rolim de Moura, A. Paranhos, Jr., R. Wormald, Laser trabeculoplasty for open angle glaucoma, Cochrane Database Syst Rev, 2007.
[49]E. Steinberg, J. Tielsch, O. Schein, et al., “The VF-14. An index of functional impairment in patients with cataract,” Arch Ophthalmol, vol. 112, 1994, pp. 630-638.
[50]D. S. Friedman, R. C. Wolfs, B. J. O''Colmain, B. E. Klein, H. R. Taylor, S. West, M. C. Leske, P. Mitchell, N. Congdon, J. Kempen, “Prevalence of open-angle glaucoma among adults in the United States,” Arch Ophthalmol, vol. 122, 2004, pp. 532-553.
[51]C. Y. Tsai, L. C. Woung, P. Chou, C. S. Yang, M. M. Sheu, J. R. Wu, T. L. Chuang, T. H. Tung, “The current status of visual disability in the elderly population of Taiwan,” Jpn J Ophthalmol, vol. 49, 2005, pp. 166-172.
[52]I. L. Tsai, L. C. Woung, C. Y. Tsai, L. L. Kuo, S. W. Liu, S. Lin and I. J. Wang, “Trends in blind and low vision registrations in Taipei City,” Eur J Ophthalmol, vol. 18, no. 1, 2008, pp. 118-124.
[53]C. Vass, C. Hirn, T. Sycha, O. Findl, P. Bauer, L. Schmetterer, Medical interventions for primary open angle glaucoma and ocular hypertension. Cochrane Database Syst Rev, 2007.
[54]M. Vetrugno, F. Cantatore, G. Ruggeri, P. Ferreri, A. Montepara, A. Quinto, C. Sborgia, “Primary open angle glaucoma: an overview on medical therapy,” Prog Brain Res, vol. 173, 2008, pp. 181-193.
[55]J. E. Ware Jr, “Conceptualizing disease impact and treatment outcomes,” Cancer, vol. 53, 1984, pp. 2316-23.
[56]I. B. Wilson, P. D. Cleary, “Linking clinical variables with health-related quality of life. A conceptual model of patient outcomes,” JAMA, vol. 273, 1995, pp. 59-65.
[57]T. Y. Wong, S. C. Loon and S. M. Saw, “The epidemiology of age related eye diseases in Asia,” Br J Ophthalmol, vol. 90, no. 4, 2006, pp. 506-511.
[58]World Health Organization (WHO) (2012). Web Site (世界衛生組織網站), http://www.who.int/mediacentre/factsheets/fs282/en/index.html, 造訪時間:2012/06/25。
[59]L. Xu, L. Zhang, C. R. Xia, J. J. Li, L. N. Hu, K. Ma, Y. J. Chen, G. Z. Fan, W. X. Song, Y. Y. Shi, S. Y. Zhang, B. C. Sun. “The prevalence and its effective factors of primary angle-closure glaucoma in defined populations of rural and urban in Beijing,” Zhonghua Yan Ke Za Zhi, vol. 41, 2005, pp. 8-14.
[60]M. Zainal, S. M. Ismail, A. R. Ropilah, H. Elias, G. Arumugam, D. Alias, J. Fathilah, T. O. Lim, L. M. Ding, P. P. Goh, “Prevalence of blindness and low vision in Malaysian population: results from the National Eye Survey 1996,” Br J Ophthalmoll, vol. 86, 2002, pp. 951-956.
[61]J. Zhao, R. Sui, L. Jia, L. B. Ellwein, “Prevalence of glaucoma and normal intraocular pressure among adults aged 50 years or above in Shunyi county of Beijing,” Zhonghua Yan Ke Za Zhi, vol. 38, 2002, pp. 335-339.